House of Commons
(2 years, 10 months ago)
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Prayers
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Speaker’s Statement
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Mr Speaker
Before we come to questions, I wish to make a short statement. I am exercising the discretion given to the Chair in respect of the resolution on sub judice matters to allow full reference to the challenge to the Northern Ireland protocol and to allow limited reference to active legal proceedings and open inquests in relation to historical troubles-related deaths. As before, reference to those cases should be limited to the context and to the events that led to the cases, but Members should not refer to the detail of cases, nor the names of those involved.
Oral Answers to Questions
(2 years, 10 months ago)
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Johnny Mercer (Plymouth, Moor View) (Con)
Stuart Anderson (Wolverhampton South West) (Con)
The Secretary of State for Northern Ireland (Brandon Lewis)
Before we begin, I would like to make some brief remarks regarding the upcoming anniversary of Bloody Sunday. This Sunday marks the 50th anniversary of Bloody Sunday. The killing of 14 people on that day began what was the most brutal and tragic year of the troubles in terms of lives lost. I echo the words of the then Prime Minister David Cameron, who, following the publication of the Saville report in 2010, stood at this Dispatch Box and apologised on behalf of the British Government, describing the events of Bloody Sunday, rightly, as “unjustified and unjustifiable.” It is important that we do not repeat the mistakes of the past, but remember these difficult moments in our history, and come together to help build a better shared future for all the people of Northern Ireland. My thoughts this weekend will be with all those affected.
The Government collectively believe that any system for addressing the legacy of Northern Ireland’s past must focus on delivering for those most impacted by the troubles, including victims, survivors and veterans. We were very clear when publishing the Command Paper that we would engage intensively and widely with stakeholders, including the Northern Ireland parties, before introducing legislation, and that is what we have done and what we are doing. We are reflecting carefully on what we have heard, and we remain committed to addressing the issue through legislation.
Johnny Mercer
Does the Secretary of State agree that if he reflects carefully on the responses to his Command Paper and if he engages with the professionals who have worked on legacy over many years, there is a landing zone for victims and for veterans that will address the grievance industry that has been built up in Northern Ireland off the back of people’s horrendous experiences and will deliver a lasting legacy agreement so that Northern Ireland can move forward?
Brandon Lewis
My hon. Friend is absolutely right, and I agree with what he says. It is important that we find a way forward that works for the people of Northern Ireland and, as I say, delivers for victims, survivors and veterans; has a lasting ability to move things forward; and ensures that those who still do not know the truth and do not have information about what happened to loved ones will have a chance to get to that truth in a reasonable timeframe.
Stuart Anderson
As a veteran who served in Op Banner, I welcome any legislation that comes forward on this issue. While we wait for that legislation, will the Secretary of State work with the Office for Veterans’ Affairs to ensure that any Op Banner veterans have the support they need?
Brandon Lewis
Yes. Again, my hon. Friend is absolutely right. The Government are unequivocal in our commitment to deliver for all those most impacted by the troubles, including those who served so bravely to protect life and country for people in Northern Ireland. As part of that process, I assure my hon. Friend that we will work closely—and we are working closely—with the Office for Veterans’ Affairs and my hon. Friend the Minister for Defence People and Veterans; in fact, we will be meeting this afternoon.
Colum Eastwood (Foyle) (SDLP)
Can I welcome the Secretary of State’s words at the outset? Fifty years ago this week, the Parachute Regiment were sent to my city to murder 14 people—people who were unarmed, marching for civil rights—[Interruption.] And I would condemn that as well, as well the right hon. Member for East Antrim (Sammy Wilson) knows. Last weekend, Parachute Regiment flags were flown on the outskirts of Derry. The Parachute Regiment rightly condemned the flying of those flags as a grossly offensive act against the victims of Bloody Sunday, but they have yet to apologise for and condemn the actions of their soldiers on Bloody Sunday in Derry in 1972. Does the Secretary of State think they should?
Brandon Lewis
As I have outlined, as the Prime Minister said at the time and as I have said in responding to public inquiries recently, we as the Government must accept responsibility for what has happened in the past. When things are wrong, we need to be clear about that, as we have been. It is right that we have apologised for that, and I have added my own personal apology to that of the Government. We also need to ensure that we all work together to find a way forward to ensure that people are clear that violence is not an answer to anything in Northern Ireland or elsewhere.
Tony Lloyd (Rochdale) (Lab)
The Secretary of State rightly made his comments about Bloody Sunday at the beginning of his remarks, but he will recognise that it took nearly 40 years for the Saville inquiry to clear the innocent victims who were murdered that day and those who were injured. Will he confirm that under the proposals that he will bring to the House a judicial inquiry will still be possible? If not, we condemn victims and their families to the accusation of guilt when an inquiry would prove their innocence.
Brandon Lewis
The hon. Gentleman gives a powerful example. Ballymurphy, which I spoke about at the Dispatch Box not that long ago, is another powerful example of it taking far too long in these situations for families to get answers and to get to the truth. I can be very clear with the House, as I have been before, that I am determined that the legislation we bring forward will allow families to get to the truth and understand what happened quicker than we have seen before. People should not be waiting decades for information.
Sir Mike Penning (Hemel Hempstead) (Con)
British soldiers like myself were sent to Northern Ireland to keep the peace, and to put their lives on the line for the peace of everybody in Northern Ireland. I say to the Secretary of State that, while I welcome the Command Paper, we must not have any delay in the functions of Government getting to a conclusion on this, so that veterans—many of them have passed away already—can live their lives in peace, rather than in fear of being dragged before the courts.
Brandon Lewis
My right hon. Friend makes an important point, from the point of view of veterans. He is absolutely right: most people who went out there served their country to protect life, in quite a contrast to the terrorists in Northern Ireland who went out every day to do harm. It is important that we deal with the issue, so that we do not leave it to another generation, and that we do so before we lose a generation who not only have information but deserve to live their final years in peace.
Sir Jeffrey M. Donaldson (Lagan Valley) (DUP)
Every life lost in Northern Ireland matters, and we remember the two very courageous Royal Ulster Constabulary officers murdered in Londonderry 50 years ago tomorrow. As a proud former member of the Ulster Defence Regiment, I want to ensure that whatever proposals the Government bring forward do not create a moral equivalence between the brave men and women who served in our armed forces and the police service and those who took the law into their own hands, engaged in acts of terrorism and sought to bring Northern Ireland to its knees. Will the Secretary of State be clear that there will be no moral equivalence between our armed forces and police and the terrorists of the IRA and other paramilitary groups?
Brandon Lewis
The right hon. Gentleman makes an important point. I can be very clear, and as a Government we are clear, that we will never accept any moral equivalence between those who upheld the law in Northern Ireland—those who, as I say, went out every day to protect life and to do their service—and those who, from any point of view, went out every morning to destroy life and to destroy Northern Ireland. They must never be allowed to win, and there can be no moral equivalence.
Sir Jeffrey M. Donaldson
In bringing forward proposals on dealing with the legacy of our past, can the Secretary of State advise what discussions he has had with the representatives of innocent victims in Northern Ireland, and will he heed the very clear view, right across the community in Northern Ireland, from those innocent victims and their families that what they want out of the process is access to truth and justice? Justice must not be dispensed with.
Brandon Lewis
The right hon. Gentleman is absolutely right. As we have said from the beginning, it is important that we engage with a wide range of stakeholders. I have done that myself, as have my Ministers. Indeed, in the last week I have been meeting with the very groups that he refers to—victims groups as well as veterans. It is clear that people have waited far too long for information. We also have to be honest with people about what is achievable and the reality of what we can do, bearing in mind the Northern Ireland (Sentences) Act 1998 that followed the Good Friday agreement, decommissioning and other things that have happened since then. We must deliver a process and a structure of investigations and information recovery that helps people to get to the truth, while being clear that, as I have said before, there are so many people who did so much to keep Northern Ireland safe.
Julian Smith (Skipton and Ripon) (Con)
Gavin Robinson (Belfast East) (DUP)
Brandon Lewis
A stable Northern Ireland needs sustainable devolved institutions. We have progressed the Northern Ireland (Ministers, Elections and Petitions of Concern) Bill to that end. Prosperity is another foundation stone of stability. We have been working with the Executive to deliver the city and growth deals, which my hon. Friend the Minister of State, the right hon. Member for Bournemouth West (Conor Burns), is taking forward, and to invest in priority areas such as skills through the new deal for Northern Ireland. We will continue to support stability and co-operation in Northern Ireland throughout this important election year.
Julian Smith
We are absolutely right to recall David Cameron’s apology in 2010, and I send my best wishes to the families and the people of Derry/Londonderry. Will the Secretary of State confirm that the measures in New Decade, New Approach to protect sustainability and to keep Stormont running will be put on the statute book at the earliest opportunity?
Brandon Lewis
Yes, absolutely. That is our focus, and we have been taking this through the House. As my hon. Friend the Minister of State said a short while ago, and no doubt he will be back here talking about it soon, taking this through is important for Northern Ireland and its people, who want a functioning Northern Ireland Executive.
Gavin Robinson
The right hon. Member for Skipton and Ripon (Julian Smith) brought forward New Decade, New Approach with commitments within it that would guarantee and protect the stability of our institutions. The Secretary of State knows that the commitment to protect the UK’s internal market has not been delivered. He knows that some of the balanced commitments in that document are now being tinkered with, be they on legacy or on language. What steps will he take in the very short term to sincerely protect the institutions?
Brandon Lewis
On the cultural package, what we agreed to take forward is exactly what was agreed between the parties in New Decade, New Approach itself, and we will continue to look at that. It is important that we deliver on all of New Decade, New Approach. We have the United Kingdom Internal Market Act 2020, which is doing that work and has ensured that trade between GB and NI from the NI side is working in an unfettered way. We said we would bring forward further work to develop and deliver that, which we will do, but it is also important—this is why the work on the Northern Ireland protocol is so important—to ensure the same sort of effect in GB to NI as in NI to GB and that it is working for everyone in Northern Ireland.
Simon Hoare (North Dorset) (Con)
My right hon. Friend knows that the thuggery and criminality of the self-styled paramilitaries add nothing to stability anywhere in Northern Ireland. What further steps can his Department take to disrupt their activity, in particular through unexplained wealth orders?
Brandon Lewis
We have been making progress in this area. We work in partnership with and support the Northern Ireland Department of Justice in the devolved areas, as well as with the Police Service of Northern Ireland and other partners, who are doing phenomenal work. We have seen real success this year, and in the crackdown over the past 12 to 18 months on criminal gangs. My hon. Friend the Chair of the Select Committee is right: these groups are criminal gangs and should be treated as such. They are nothing more than thugs who threaten people and try to destroy life in Northern Ireland. I support the PSNI and partners in their work to disrupt their activity and bring the people involved to justice.
Peter Kyle (Hove) (Lab)
I associate myself with the Secretary of State’s important words regarding Bloody Sunday. I also pay tribute to the right hon. Member for Skipton and Ripon (Julian Smith) for skilfully negotiating the New Decade, New Approach in the first place. Part of that was legislation on identity, language and culture. When will that package of legislation be introduced?
Brandon Lewis
We are committed to bringing that forward within the mandate of the period for Stormont, as we said at the time, and that remains our commitment.
Peter Kyle
The statement to the House last June was that we would have it by October last year. There is a theme: we did not get that by October last year; legacy was promised by autumn, then by Christmas, and it is still nowhere to be seen; and then the Secretary of State introduced double-jobbing to Parliament and, within the same week, withdrew it. A question constantly put to me by people in Northern Ireland is, “What’s the point of Brandon Lewis?” Perhaps he can tell us.
Brandon Lewis
I appreciate that the hon. Gentleman has been over to Northern Ireland once and so is basing his comments on some odd conversation. I find what he just said a bit rich, bearing in mind that he is part of a Labour Front-Bench team who over the past six to nine months have called for us to bring forward dual mandates, then argued against them when we did what we said we would do. They called for us to engage widely on legacy and to take into account what people say; then they complain when we do exactly that. Labour argues that it is a party of the Union, but does not get involved in Northern Ireland and then cannot get its Front Benchers to confirm that it supports the Union for Northern Ireland on live TV. Until Labour decides that it is a party for the Union in Northern Ireland, I will not take any lessons.
Mr Speaker
Come on, we have to get through these questions. I call Theresa Villiers.
Theresa Villiers (Chipping Barnet) (Con)
The Northern Ireland protocol is clearly causing political instability. Will the Secretary of State agree that it needs replacing, not just a few amendments?
Brandon Lewis
My right hon. Friend makes an important point. The protocol is not working—that is clear. The feedback we get from businesses across Northern Ireland is that it is not sustainable in its current format. It needs to be dealt with. It needs to be fixed. That is what the Foreign Secretary and I are working on together to ensure we can do that and do well for the people of Northern Ireland.
Owen Thompson (Midlothian) (SNP)
Joanna Cherry (Edinburgh South West) (SNP)
The Secretary of State for Northern Ireland (Brandon Lewis)
We are committed to boosting trade in Northern Ireland with both the rest of the United Kingdom and the rest of the world. The Northern Ireland protocol has, as I just said, impacted businesses. It is creating barriers to trade and causing disruption. It is the Government’s priority to deal with those issues and make the protocol work better for business. That is essential to ensuring Northern Ireland continues to prosper as part of the Union.
Owen Thompson
Exports from Great Britain to the Republic of Ireland have crashed by more than 20% since Brexit, costing the GB economy more than £3 billion. Meanwhile, Northern Irish exports to the Republic, which are benefiting from still being in the EU market, have soared by 64% in 2021 alone. Does the Secretary of State recognise the overwhelming benefits of being in a market seven times the size of the UK market?
Brandon Lewis
We are seeing 200-plus businesses in Northern Ireland stopping delivering to customers in Northern Ireland, medicines and drugs having issues and challenges getting to Northern Ireland, consumers having reduced choice on the shelves, and garden centres unable to get the plants and seeds they want from the rest of the UK. That is a farcical situation. It is not sustainable. It is not fair or right for the people of Northern Ireland and it is right that we focus on correcting that.
Joanna Cherry
I wonder if I could invite the Secretary of State to actually answer the point made by my hon. Friend the Member for Midlothian (Owen Thompson). The most recent quarterly economic survey by the Northern Ireland chamber of commerce shows that 70% of Northern Ireland businesses believe that their unique trading position of being both within the UK and the EU single markets and the customs union presents opportunities for Northern Ireland. Does he agree with the vast majority of businesses in Northern Ireland? If so, why did his Government not fight for remain-voting Scotland to have the same benefits of dual access as Northern Ireland?
Brandon Lewis
I meet businesses across Northern Ireland representing all sectors of Northern Ireland on a regular basis, as does the Minister of State, Northern Ireland Office, my right hon. Friend the Member for Bournemouth West (Conor Burns). They are very clear: the protocol in its current format is not working. It is not sustainable. The EU offer is not good enough. They are very clear about that. That is something we are determined to fix. The hon. and learned Lady is absolutely right that if the protocol works in the way it was envisaged, it does create opportunities for Northern Ireland. The problem is that the EU’s requirements for implementation are failing Northern Ireland and we need to see that fixed.
Mr Peter Bone (Wellingborough) (Con)
The Secretary of State says the Northern Ireland protocol is not working and he is right. Why don’t we scrap it?
Brandon Lewis
The Foreign Secretary, the Prime Minister and I are absolutely determined to ensure that we resolve the issues for Northern Ireland. We would obviously like to do that in a sustainable and agreed way with the EU. That is the best way to get legal certainty. That is our focus, but we do not rule out anything from the table to deliver for Northern Ireland.
Gareth Bacon (Orpington) (Con)
Does my right hon. Friend agree that reducing barriers to trade between Northern Ireland and Great Britain is not just desirable, but vital to protecting the integrity of the United Kingdom?
Brandon Lewis
Yes. My hon. Friend is absolutely right. We need to ensure that consumers and businesses in any part of the UK can access products as they would anywhere else in the UK. That is what we are determined to deliver, and that is where our focus and work is.
Richard Thomson (Gordon) (SNP)
I take this opportunity to associate my party with the Secretary of State’s remarks about the anniversary of Bloody Sunday. Our thoughts are very much with those who continue to grieve and who continue to be affected to this day.
When it comes to trade, the Government have not so much been ambushed by cake as by reality. While the Northern Ireland economy is thriving as part of the single market, the economy of the UK is labouring. Should the UK Government not, with the opportunities presented by the possibility of a change in Prime Minister, realign Great Britain with Northern Ireland in the single market and allow businesses across these islands to flourish?
Brandon Lewis
I encourage the hon. Gentleman to do a little more research. It is very good news that the Northern Ireland economy is moving forward, as is the whole UK economy. Of course, in Northern Ireland there are more factors, not least the scale of the public sector compared with anywhere else in the UK. However, it is also true that the UK is moving forward as one of the fastest-growing economies in the G7, if not the fastest, with employment going up from where it was even before covid. That is because the Government are focused on delivering for people across the United Kingdom. I am sure he understands why, as a Unionist, I support that. He should too.
Andrew Lewer (Northampton South) (Con)
Antony Higginbotham (Burnley) (Con)
Mike Wood (Dudley South) (Con)
Andrew Rosindell (Romford) (Con)
The Minister of State, Northern Ireland Office (Conor Burns)
May I briefly associate myself with the comments of the Secretary of State on the dreadful events in the city of the hon. Member for Foyle (Colum Eastwood) in 1972, the year of my birth in Belfast?
Officials in the Northern Ireland Office are working closely with officials in the Department for Digital, Culture, Media and Sport, the lead Government Department on the jubilee. My right hon. Friend the Secretary of State and my noble Friend Lord Caine are working on a series of events in Northern Ireland to mark Her Majesty’s jubilee, her immense contribution to life in Northern Ireland and to peace and reconciliation on the island of Ireland.
Andrew Lewer
Will the Minister describe how he will encourage all parts of the NHS across Northern Ireland to celebrate the platinum jubilee as one great, unifying feature of the Union towards another?
Conor Burns
My hon. Friend makes an important point. Everyone in every part of our United Kingdom is deeply proud of the national health service. People across Northern Ireland, whatever their allegiance, recognise the immense contribution of frontline NHS staff, whom I hope will be recognised in this jubilee year.
Antony Higginbotham
Her Majesty’s platinum jubilee is a fantastic opportunity to celebrate our Union far and wide, with people around the Commonwealth and the world joining us in marking the occasion. Will the Secretary of State set out the Government’s plans on using the jubilee to showcase the best of Northern Ireland?
Conor Burns
Whatever tradition or belief they come from in Northern Ireland, everyone recognises the immense contribution Her Majesty the Queen has made to this United Kingdom. As I alluded to, Her Majesty’s contribution to reconciliation and mutual understanding on the island of Ireland has been beyond compare. This will be a fantastic opportunity to celebrate her amazing life and achievements.
Mike Wood
This summer, Her Majesty will award jubilee medals to members of the armed forces and emergency services and to prison officers. As things stand, frontline paramedics working for ambulance services will rightly be recognised, but those working in hospital A&E departments and private ambulances might not be. Will my right hon. Friend work with ministerial colleagues to ensure that all frontline paramedics get the recognition their work so richly deserves?
Conor Burns
My hon. Friend makes his point powerfully, as ever. I am sure it will be heard. If it is not, I will make sure that it is by making it on his behalf to relevant Ministers.
Andrew Rosindell
As we begin the 70th year of Her Majesty’s reign, the Northern Ireland protocol still seems to threaten the free movement of goods between Great Britain and Northern Ireland. Will the Minister take urgent action to stand up to the bureaucratic posturing of the European Union and ensure that oak tree saplings can be traded freely between Northern Ireland and the rest of the United Kingdom for the platinum jubilee?
Conor Burns
I am immensely grateful to my hon. Friend. He makes that point incredibly powerfully. Members from across the House will look forward to planting oak saplings in their constituencies to mark this amazing achievement of Her Majesty’s platinum jubilee. The Foreign Secretary is on the Front Bench. I know her well; I served with her in International Trade. She is on the case. There is absolutely no reason why oak tree saplings should not be planted in Northern Ireland as they are in every other part of the United Kingdom.
Ian Paisley (North Antrim) (DUP)
The Queen’s Green Canopy is a wonderful way to both celebrate the jubilee and promote the environment. Tomorrow, in Dervock, Bushmills, Ballymoney and Ballymena, a number of primary schools will plant trees to mark Her Majesty’s jubilee. I encourage the Secretary of State, the Minister and, indeed, the Foreign Secretary, who will be in Northern Ireland tomorrow, to take the opportunity to visit one of those schools and encourage young people as they promote the environment, honour Her Majesty the Queen and encourage our country to look positively to its future.
Conor Burns
I entirely agree that all Members across the House will look forward to planting trees on the amazing anniversary of Her Majesty’s reign. I was in the hon. Gentleman’s constituency just before Christmas, at my grandfather’s former primary school in Armoy. The event is cross-community and cross-tradition, and we are all looking forward to celebrating it. I will happily accept an invitation, as I am sure my right hon. Friend the Secretary of State would, to join the hon. Gentleman in his constituency and plant a tree.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
As hon. Members on the Benches behind me know, my wife hails from County Armagh. There is a tremendous link between Scotland and Northern Ireland through music; recently, the Kiltearn Fiddlers from my constituency have played in Northern Ireland as the guests of Ulster University. Would it not be splendid if we could celebrate Her Majesty’s jubilee by having musical events the length and breadth of our United Kingdom?
Conor Burns
I totally agree, and what a wonderful, harmonious note on which to end Northern Ireland questions.
Ruth Jones (Newport West) (Lab)
People in Newport West and across Northern Ireland know that Her Majesty has always led by example and demonstrated the highest standards in public life, so can the Minister confirm that this Government will be following her example as they mark her platinum jubilee?
Conor Burns
The hon. Lady is absolutely right that Her Majesty is an example to us all. The House should unite in thanking her for her decades of dedicated service to our country and the Commonwealth.
Stephen Farry (North Down) (Alliance)
The Secretary of State for Northern Ireland (Brandon Lewis)
My engagement with the Northern Ireland business community is extensive. Just this week I have been in Northern Ireland engaging directly with businesses, as I do every week, to discuss the impacts of the protocol as well as any wider concerns or issues.
Stephen Farry
The Government published their Command Paper last July, the European Union published four papers last October, and I understand that the Government have tabled a revised legal text in the negotiations. Does the Secretary of State recognise that there is a desire among businesses in Northern Ireland for much greater transparency around the UK Government’s negotiating objectives?
Brandon Lewis
We have been very transparent and clear with businesses. The Minister for Europe and I, and indeed the Foreign Secretary, have met and engaged with businesses, as we will be doing tomorrow, and outlined exactly what our objectives are: to deliver what businesses in Northern Ireland want, which is to rectify the problems that are hampering businesses in Northern Ireland. We need to correct the protocol, and the EU needs to show some flexibility to make that work.
Tonia Antoniazzi (Gower) (Lab)
When it comes to negotiations with the European Union, this Government told us that we could have our cake and eat it, but we face a harsh reality: a Prime Minister ambushed by cake while businesses in Northern Ireland are crying out for certainty. When will the Government finally bake off and deliver a veterinary agreement?
Brandon Lewis
I will ignore the cakeism directed from the Opposition Front Bench and just say that it is good to see the hon. Lady finally supporting the UK Government, which Labour has failed to do while we are focused on delivering for Northern Ireland, rectifying the protocol and fixing the problem. Get on board!
Mr Speaker
Before we come to Prime Minister’s questions, I would like to point out that the British Sign Language interpretation of proceedings is available to watch on parliamentlive.tv.
Kate Osamor (Edmonton) (Lab/Co-op)
The Prime Minister (Boris Johnson)
As my right hon. Friend the Secretary of State for Northern Ireland remarked to the House earlier this morning, this Sunday marks a tragic day in our history, one of the darkest days of the troubles: the 50th anniversary of Bloody Sunday. I echo his call to learn from the past, to reconcile and to build a shared, peaceful and prosperous future.
This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.
Kate Osamor
I associate myself with the Prime Minister’s remarks on Bloody Sunday.
Did the Prime Minister agree to the Chancellor of the Exchequer writing off £4.3 billion of fraud? That is £154 from every household in the country that went directly into the pockets of fraudsters.
The Prime Minister
No, of course not. We do not support fraudsters or those who steal from the public purse, but what I can tell the hon. Lady is that everybody in this country should be very proud of the huge effort that was made by Lord Agnew and others to secure ventilators and personal protective equipment. At the time, Captain Hindsight and others were calling for us to go faster.
Craig Tracey (North Warwickshire) (Con)
The Prime Minister
Yes, of course. I thank my hon. Friend, and I am pleased that so many of the volunteers and staff at George Eliot Hospital have been recognised in the Queen’s new year honours list. I have seen the medal that the hospital is proposing, and I think it is lovely. As I have told the House before, we are establishing a UK commission on covid commemoration to consider how we can commemorate everything that we have all been through, and the commission will also consider how we can recognise the courage of frontline workers.
Mr Speaker
We now come to the Leader of the Opposition, Keir Starmer.
Keir Starmer (Holborn and St Pancras) (Lab)
I join the Prime Minister in his comments in relation to Bloody Sunday.
The ministerial code says that:
“Ministers who knowingly mislead Parliament will be expected to offer their resignation”.
Does the Prime Minister believe that applies to him?
The Prime Minister
Of course, but let me tell the House that I think the right hon. and learned Gentleman is inviting a question about an investigation on which, as you know, Mr Speaker, I cannot comment, and on which he, as a lawyer, will know that I cannot comment. What I am focused on is delivering the fastest recovery from covid of any European economy, the fastest booster roll-out, and 400,000 more people on the payrolls now than there were before the pandemic began. We are launching a policy tomorrow. The right hon. and learned Gentleman talks about people being out of work—in my case, I understand why he wants it. We are launching a plan tomorrow to get half a million people off welfare and into work. It is a fantastic idea, and I hope he supports it.
Keir Starmer
I think the Prime Minister said yes, he agrees that the code does apply to him. Therefore, if he misled Parliament, he must resign.
On 1 December, the Prime Minister told this House from the Dispatch Box, in relation to parties during lockdown, that
“all guidance was followed completely in No. 10.”—[Official Report, 1 December 2021; Vol. 704, c. 909.]
He looks quizzical, but he said it. On 8 December, the Prime Minister told this House that
“I have been repeatedly assured since these allegations emerged that there was no party”.—[Official Report, 8 December 2021; Vol. 705, c. 372.]
Since he acknowledges that the ministerial code applies to him, will he now resign?
The Prime Minister
No. But since the right hon. and learned Gentleman asks about covid restrictions, let me just remind the House and, indeed, the country that he has been relentlessly opportunistic throughout. He has flip-flopped from one side to the other. He would have kept us in lockdown in the summer. He would have taken us back into lockdown at Christmas. It is precisely because we did not listen to Captain Hindsight that we have the fastest-growing economy in the G7, and we have got all the big calls right.
Keir Starmer
This is the guy who said that, in hindsight, he now appreciates it was a party. We have discovered the real Captain Hindsight, have we not? Let me spell out the—[Interruption.] They shout now, but they are going to have to go out and defend some of this nonsense. Let me spell out the significance of yesterday’s developments. Sue Gray reported the matter to the police, having found evidence of behaviour that is potentially a criminal offence. Prime Minister, if you do not understand the significance of what happened yesterday, I really do despair. The police, having got that material from Sue Gray, subjected it to a test to decide whether to investigate. That test was whether it was the “most serious and flagrant” type of breach in the rules. The police spelled out what they meant by that: that those involved knew, or ought to have known, that what they were doing was an offence and that there was “little ambiguity” about the
“absence of any reasonable defence”.
Does the Prime Minister—[Interruption.]
Mr Speaker
Order. This question will continue, and I will hear the question. Members might not believe this, but our constituents are very interested in the questions and the answers. If some Members do not wish to hear it, please leave quietly.
Keir Starmer
Having got the material from Sue Gray, the police had to take a decision as to whether what they had before them were the “most serious and flagrant” types of breaches of the rules—[Interruption.] If Members want to laugh at that, they can laugh. The police spelled out what they meant. They decided, from the material that they already had, that those involved knew, or ought to have known, that what they were doing was an offence, and that there was “little ambiguity” around the
“absence of any reasonable defence”.
Does the Prime Minister really not understand the damage his behaviour is doing to our country?
The Prime Minister
I hope the right hon. and learned Gentleman understands that, although the issue he raises is important, there is simply no way—as he knows, as a lawyer—that I can comment on the investigation that is currently taking place. He talks about the most serious issue before the public and the world today. It is almost as though he was in ignorance of the fact that we have a crisis on the borders of Ukraine. I can tell him that in the Cabinet Room of this country, the UK Government are bringing the west together. Led by this Government and this Prime Minister and our Foreign Secretary and Defence Secretary, we are bringing the west together to have the toughest possible package of sanctions to deter President Putin from what I think would be a reckless and catastrophic invasion. That is what this Government are doing. We are getting on with the job, and I think he needs to raise his game, frankly.
Mr Speaker
Order. I say to both sides that our constituents are watching this. Tensions are running high, but we need to allow the people out there who are bothered about their futures to hear what is said on both sides. Please, let us give our constituents the respect they deserve.
Keir Starmer
This was the Prime Minister who went into hiding for five days because of these allegations. He should not talk to me about being around for the allegations—[Interruption.]
Mr Speaker
Order. I do not want to do this, but I am determined to make sure our constituents can hear. The next person that stops me hearing will not continue in this debate.
Keir Starmer
The Prime Minister’s continual defence is, “Wait for the Sue Gray report.” On 8 December, he told this House:
“I will place a copy of the…report in the Library of the House of Commons.”—[Official Report, 8 December 2021; Vol. 705, c. 374.]
His spokesperson has repeatedly stated that that means the full report—not parts of the report, not a summary of the report and not an edited copy—so can the Prime Minister confirm that he will publish the full Sue Gray report as he receives it?
The Prime Minister
What I can tell the right hon. and learned Gentleman is that we have to leave the report to the independent investigator, as he knows. When I receive it, of course I will do exactly what I said. In the meantime, the people of this country want to hear what we are doing to tackle the issues that matter to all of us: fixing the cost of living; helping people across the country by lifting the living wage; helping people with their fuel costs, as this Government are doing; and cutting the tax of people on universal credit by £1,000. The party opposite is committed to abolishing universal credit. That is their policy.
Keir Starmer
Cutting the tax? [Laughter.]
The police say the evidence meets the test. Frankly, the public have made up their minds. They know the Prime Minister is not fit for the job. That is what really matters here. Throughout this scandal, the Tories have done immense damage to public trust. When the leader of the Scottish Conservatives said that the Prime Minister should resign, the Leader of the House called him “a lightweight”—English Conservatives publicly undermining the Union by treating Scotland with utter disdain. How much damage are the Prime Minister and his Cabinet prepared to do to save his skin?
The Prime Minister
Well, I think the right hon. and learned Gentleman was offering yet more general criticism of what has been going on in Downing Street, so let me just remind the House of what has been going on in Downing Street. We have been prioritising the covid backlogs, investing massively in 9 million more scans, so that people get the treatment that they need and that they have been waiting for, and making sure that we have 44,000 more people in our—[Interruption.] They say it is rubbish, but they did not vote for it; they do not support it. We have 44,000 more people in our NHS now than in 2020, and we are fixing social care, which Governments have neglected for decades, with Labour doing absolutely nothing. They have no plan at all to fix the NHS or to fix social care. Vote Labour, wait longer.
Keir Starmer
The reality is that we now have the shameful spectacle of a Prime Minister of the United Kingdom being subject to a police investigation, unable to lead the country and incapable of doing the right thing. Every day his Cabinet fail to speak out, they become more and more complicit. What is utterly damning, despite the huff and puff, is that this is all happening when petrol prices, the weekly shop and energy bills are going through the roof. Three months ago, Labour suggested cutting VAT from energy bills. Still the Government have failed to act. Instead of getting on with their jobs, they are wheeled out to save his. Whatever he says in his statement later today or tomorrow will not change the facts. Is this not a Prime Minister and a Government who have shown nothing but contempt for the decency, honesty and respect that define this country?
The Prime Minister
No, we love this country and we are doing everything in our power to help this country. Of course he wants me out of the way. He does, and—I will not deny it—for all sorts of reasons many people may want me out of the way, but the reason he wants me out of the way is that he knows that this Government can be trusted to deliver, and we did. We delivered on Brexit. He voted 48 times to take this country back into the European Union. We delivered the fastest vaccine roll-out in Europe, and we will deliver on our plan to unite and level up across the whole of the UK.
Crime down 10%, job vacancies at a record high, colossal investment—we are delivering, and Labour has no plan. Tech investment in this country is three times that in France, and twice as much as Germany. We have a vision for this country as the most prosperous and successful economy in Europe, because we are going to unite and level up. The problem with the Labour party today is that the right hon. and learned Gentleman is lawyer, not a leader. That is the truth—
Mr Speaker
Order. I cannot hear what the Prime Minister has to say. He is the Prime Minister from the Government side, so I am surprised that that side does not want to listen to him, because I do.
The Prime Minister
Mr Speaker, I only wanted to add the point that we have taken the tough decisions, we have got the big calls right and we are, and in particular I am, getting on with the job.
Simon Baynes (Clwyd South) (Con)
The Prime Minister
I thank my hon. Friend very much, and what pleasure it gives me to address the Member for Clwyd South, where I tried unsuccessfully so many years ago. I am delighted that a Conservative Government are now investing so massively in levelling up in Clwyd South and across the whole of Wales.
Mr Speaker
We now come to the leader of the Scottish National party, Ian Blackford.
Ian Blackford (Ross, Skye and Lochaber) (SNP)
Thank you, Mr Speaker. May I associate myself with the remarks of the Prime Minister about Bloody Sunday?
I am sure that you and the entire House will want to commemorate tomorrow Holocaust Memorial Day, when we remember the 6 million Jews who lost their lives at the hands of the regime of Hitler, and of course, we remember other genocides, not least more recently in Bosnia—we all pray for continued peace in that country.
At the heart of this matter, we have a Prime Minister who is being investigated by the police for breaking his own laws—it is absolutely unprecedented. This is a man who demeans the office of Prime Minister. This is the latest in a rap sheet that is already a mile long: illegally proroguing Parliament; misleading the House; decorating with dodgy cash; and partying while the public suffered. Every moment he stays, he is dragging out the agony for families who remind him of the sacrifices they made and dragging his party further through the dirt. The public know it, the House knows it, even his own MPs know it—when will the Prime Minister cop on and go?
The Prime Minister
I want to join the right hon. Gentleman and echo his sentiments about Holocaust Memorial Day, where I think he is completely right.
I must say that the right hon. Gentleman made the same point last week, and he was wrong then and he is wrong now. It is precisely because I enjoy co-operating with him so much, and with all his Scottish colleagues, that I have absolutely no intention of doing what he suggests.
Ian Blackford
Every moment that the Prime Minister lingers, every nick in this death by a thousand cuts, is sucking attention from the real issues facing the public; Tory cuts, Brexit and the soaring cost of living have pushed millions of families into poverty. The impending national insurance tax hike hangs like a guillotine, while they eat cake. This is nothing short of a crisis, and the only route out—the only route to restore public trust—is for the Prime Minister to go. How much longer will Tory MPs let this go on for? How much more damage are they willing to do? It is time to get this over with—show the Prime Minister the door!
The Prime Minister
I do not know who has been eating more cake. [Interruption.] People do not get this, but behind the scenes the right hon. Gentleman and I co-operate well, and I want to continue to do so.
Jesse Norman (Hereford and South Herefordshire) (Con)
The Prime Minister
I once had a memorable swim in the Wye—I think at about 5 o’clock in the morning—and it tasted like nectar. I understand the problems that my right hon. Friend raises: it is important that our beautiful rivers should be clean. My right hon. Friend the Environment Minister will visit the Wye area shortly, with or without his swimming trunks, and we are urging the Welsh Government to take the matter as seriously as this Government are.
Sir Jeffrey M. Donaldson (Lagan Valley) (DUP)
The Prime Minister will know that many families throughout the United Kingdom are struggling with the increased cost of living and rising energy costs, but in Northern Ireland that is compounded by the protocol. The cost of bringing goods from Great Britain to Northern Ireland has increased by 27%—when we can get access to those goods. It is costing business £2.5 million every day, which is almost £1 billion a year. That is the cost of the protocol. The Prime Minister talks about uniting this nation and levelling up; he could do that by removing the Irish sea border and fully restoring Northern Ireland’s place in the UK internal market.
The Prime Minister
I support passionately the right hon. Gentleman’s indignation. Yes, I never thought, when we negotiated, that it would mean 200 businesses would stop supplying Northern Ireland, foods being blocked and Christmas cards being surcharged. Frankly, the EU is implementing the protocol in an insane and pettifogging way. We need to sort it out and I completely support what the right hon. Gentleman says.
Philip Dunne (Ludlow) (Con)
The Prime Minister
Yes, my right hon. Friend is completely right, and I welcome the report by his Committee. This Government are going further and faster than any other Government hitherto to protect and improve the health of our rivers and seas.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
Mr Speaker
Order. You can say in passing what your constituents say, but you cannot continue to labour that one point.
Lloyd Russell-Moyle
So, I would prefer to be led by a lawyer than by a liar. Will the Prime Minister now resign?
Mr Speaker
Order. The hon. Gentleman will be withdrawing that last comment.
Lloyd Russell-Moyle
I withdraw it. That is what my constituents think, not my view.
The Prime Minister
I am afraid the hon. Gentleman, in everything he said just now, plainly does not know what he is talking about. What I can tell him and his constituents is that, irrespective of what they want to focus on—and I understand why they do—this Government are going to get on with the job and deliver for the people of this country.
Mrs Sheryll Murray (South East Cornwall) (Con)
The Prime Minister
I really cannot improve on that brilliant question. The people of South East Cornwall are lucky to have my hon. Friend as their representative, and she is right in what she says.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
The Prime Minister
I thank the hon. Member for drawing this appalling case to the attention of the House. I can certainly assure him that he will be getting the meeting that he needs at the earliest opportunity.
Sir Mike Penning (Hemel Hempstead) (Con)
The Prime Minister
I am delighted that my right hon. Friend has the meeting he wanted. We have already changed the law to allow doctors to prescribe cannabis products where clinically appropriate, but we are very keen to support this, provided that the Medicines and Healthcare products Regulatory Agency is happy as well.
Rushanara Ali (Bethnal Green and Bow) (Lab)
The Prime Minister
The hon. Lady talks about racism and Islamophobia. She should look at this Government; look at the modern Conservative party. We are the party of hope and opportunity for people across this country, irrespective of race or religion. We do not care what religion people affirm. All we care about is whether they are interested in ideas of aspiration and opportunity; that is what we are about.
Andrew Selous (South West Bedfordshire) (Con)
The Prime Minister
My right hon. Friend the policing Minister has assured me that we will be introducing a new funding formula before the end of the Parliament, but I am pleased that Bedfordshire police have already recruited 100 additional officers as part of our uplift programme. That is part of the 11,000 more officers that this Government have put on the streets.
John Mc Nally (Falkirk) (SNP)
The Prime Minister
There has never in the history of this country been such a bonanza for buses. I am personally a bus fanatic. We are putting £5 billion into buses and cycling during this Parliament, and there is £355 million of new funding for zero-emission buses—and yes of course we want to see the benefits of that funding spread right across the whole of the United Kingdom.
Mr Louie French (Old Bexley and Sidcup) (Con)
The Prime Minister
What a joy it is to welcome my hon. Friend to his place; the joy seems a bit confined on the Opposition Benches. I thank him for his work and support for everybody at Queen Mary’s Hospital, which he and I campaigned for, for many years. Last year Queen Mary’s received £800,000 of funding and I hope that it will benefit further from the £1 million funding awarded to Oxleas NHS Foundation Trust to improve technology services across its estate.
Richard Burgon (Leeds East) (Lab)
The Prime Minister
I do not think there was a question there. There was an invitation for me to do what of course the Labour party wants me to do, but I am not going to do it. We are going to carry on with our agenda of uniting and levelling up across the country, and they fundamentally know that they have no answer to that. We have a plan and a vision for this country; they have absolutely nothing to say, and that is the difference between our side and their side.
Rob Butler (Aylesbury) (Con)
The Prime Minister
I thank my hon. Friend. The Chinese military flights that have taken place near Taiwan in recent days are not conducive to peace and stability in the region. What we need is a peaceful and constructive dialogue by people on both sides of the Taiwan Strait. I know that that is what my right hon. Friend the Foreign Secretary and all colleagues are working for.
Economic Crime: Planned Government Bill
(2 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Kevin Hollinrake (Thirsk and Malton) (Con)
(Urgent Question): To ask the Secretary of State for Business, Energy and Industrial Strategy to make a statement on the Government’s plans to bring forward an economic crime Bill.
The Parliamentary Under-Secretary of State for Business, Energy and Industrial Strategy (Paul Scully)
I thank my hon. Friend for his question, but, as I am sure he will appreciate, I am not going to speculate about the content of any future Queen’s Speech, which is the correct moment for the Government to be setting out their legislative agenda for the next parliamentary Session.
However, I can confirm that the Government remain committed to tackling economic crime, which is why my colleagues in the Home Office and the Treasury take the lead on this. In recent years we have taken a number of actions, including creating the new National Economic Crime Centre to co-ordinate the law enforcement response to economic crime and establishing the Office for Professional Body Anti-Money Laundering Supervision to improve oversight of anti-money laundering compliance in the legal and accountancy sectors. We delivered the Criminal Finances Act 2017, which introduced new powers including unexplained wealth orders and account freezing orders. We are determined to go further to crack down on dirty money to protect our security and our prosperity. With the publication of the fraud strategy and second economic crime plan this year, we will further level up the response to crack down on crimes of this type.
My Department is playing its part. The Department for Business, Energy and Industrial Strategy announced plans to reform Companies House in September 2020. In 2021 we consulted on more detailed aspects of the reforms, and we will respond to the consultation soon. Investment in new capabilities at Companies House is already under way, with £20 million being invested in this financial year and a further £63 million announced in the spending review. The draft Registration of Overseas Entities Bill has undergone pre-legislative scrutiny. We are amending the Bill in line with the Committee’s recommendations, and in line with comments that the Prime Minister made to the House just yesterday. We will introduce the Bill and the broader reforms of Companies House when parliamentary time allows.
Kevin Hollinrake
I am grateful to the Minister for his response. As he knows, economic crime costs the people of this country £100 billion per annum, according to the National Crime Agency. The Government have committed themselves repeatedly to legislation to give our agencies the tools that they need to tackle this problem, and it was therefore concerning to hear from my noble Friend Lord Agnew—who recently resigned from his role as Minister responsible for countering fraud—that a decision had been made to drop the economic crime Bill from the legislation that is due in the next parliamentary Session.
This is not a notional white-collar offence; it affects real people in very tangible ways. Terrorists and drug dealers depend on it to launder and legitimise their money through UK banks, companies and properties. Up to 50% of moneys flowing through Russian laundromats, often used for tax avoidance, for stolen public funds and to launder moneys derived from organised crime, flow through UK shell companies. UK corporate structures were involved in arms deals which breached sanctions in Sudan. HSBC and NatWest have been fined hundreds of millions of pounds for allowing criminals and Mexican drug cartels to launder their money through accounts held at their banks. An estimated £5 billion or so of taxpayers’ money, in the form of bounce back loans, has been taken fraudulently because some banks have not applied the most basic of checks. Criminals, despots and terrorists involved in people trafficking, illegal immigration, drug dealing, extortion, kleptocracy, the impoverishment of nations, and fraud—including what is taken directly from the public purse, to the tune of £30 billion per annum—are all facilitated by some of the lax rules that we have in this country.
The Government have promised to tackle this issue—as my hon. Friend the Minister has said—by means of Companies House reform; to fund regulation by applying a small surcharge to the current cost of establishing a company in the UK so that we can close down those shell companies and trusts; and to introduce a register of overseas entities to reveal the real beneficial owners of UK property, and a corporate offence of failing to prevent economic crime so that, for example, banks can be properly held to account for granting those fraudulent bounce back loans.
All this, plus more resources for our agencies and new whistleblower protections, will boost this country’s reputation, tackle crime, and help to reduce our tax burden. Every Minister I have spoken to wants us to do this. The Treasury Committee wants us to do it, all our crime agencies want us to do it, and campaigners want us to do it. I urge the Government to introduce the legislation as soon as possible.
Paul Scully
Let me first acknowledge my hon. Friend’s work on Companies House reform, on whistleblowing, and on general economic crime. He really has a handle on this issue, and his thoughts are always well received.
My hon. Friend is right to say that economic crimes are a significant cost to the economy. It should also be borne in mind that there are victims at the end of these crimes, and that they experience significant distress. We also recognise the national security implications of allowing dirty money from overseas into our financial system. We acknowledge the need for action on economic crime, and the Government have acted. My colleagues in the Home Office and the Treasury have begun reforms to the suspicious activity reporting regime, created the National Economic Crime Centre to co-ordinate the law enforcement response, and reviewed our money laundering regulations and supervisory regime. That review will produce a report by June 2022. We are legislating for the economic crime levy in the current Finance (No. 2) Bill. We are committed to building a framework that will deter such crimes from happening and to providing a framework that will ensure that those who commit such crimes can be held to account.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I thank the hon. Member for Thirsk and Malton (Kevin Hollinrake) for his urgent question today.
At the beginning of the pandemic, there was widespread recognition of the urgent need to get money out to support businesses as soon as possible, but what made Lord Agnew’s resignation statement this week so alarming was his criticism of how the Government are handling cases of fraud now we know about them, and the news that the Government may no longer be intending to bring forward an economic crime Bill.
Lord Agnew described the performance of the Department for Business, Energy and Industrial Strategy as “nothing less than woeful”, and added that it has
“been assisted by the Treasury, which appears to have no knowledge of, or little interest in, the consequences of fraud to our economy or society.”—[Official Report, House of Lords, 24 January 2022; Vol. 818, c. 20.]
To be honest, it is one of the few times in this Parliament that the two Departments have been consistent with each other. These are very serious allegations for a serving Minister to make, and I am worried by what the Minister has just had to say about the economic crime Bill, so let me ask him however about the Government’s intentions in his area and whether its commitments still apply.
First, is it still Government policy to legislate for a register of beneficial ownership of property in the UK, so that we can find out who really owns property in this country? Secondly, will the Government still legislate to prevent abuses of Scottish limited partnerships? Thirdly, will the Government still legislate to prevent the shortcomings in the unexplained wealth order regime highlighted by the recent case in the High Court of NCA v. Baker and others? Fourthly, will the Government still reform Companies House? If the register of British companies was more rigorously checked and policed, there would not have been as many fraudulent companies as there were to engage in fraud when the crisis began. Finally, can the Minister confirm that his Department’s latest estimate of the value of fraudulent bounce back loans is £4.9 billion, and that it is the Department’s intention to write off £4.3 billion of that?
This sorry episode reveals a Government far too casual with wasting taxpayers’ money, but there is also an aspect to economic crime that relates to the probity and integrity of our financial and political systems. I hope the Minister can provide me, and the House, with some much needed reassurance today.
Paul Scully
I thank the hon. Gentleman for his comments. Our appetite for tackling economic crime remains undiminished, as it does with Companies House reform, which has been well trailed and well considered. We will continue to work in this area, but I cannot pre-empt what Her Majesty will say in the Queen’s Speech.
In terms of the bounce back loans, the Economic Secretary to the Treasury, my hon. Friend the Member for Salisbury (John Glen), made it clear in the House that HMRC did not produce the figure of £4.3 billion, and the money has not been written off. The figure was an inference by journalists, who subtracted £1.5 billion—the estimate of the amount to be recovered by taxpayer protection—from the £5.8 billion that was estimated as error and fraud in 2020-21. It was publicised before Christmas. Our Department continues to work with our fraud measures with partners in Government, the British Business Bank and all the partner banks who issued this money in the first place.
John Penrose (Weston-super-Mare) (Con)
I appreciate that the Minister cannot be tempted to comment on what might or might not be in the Queen’s Speech, but based on what Lord Agnew said, if it were to be true, I please urge the Minister to consider that it will be about as popular as a cup of cold sick with anyone out there who is concerned about the fight against corruption or the fight for transparency. The well of excuses after three or four years of promising this piece of legislation or its related pieces has now run dry. This legislation is essential for the credibility of this country and this Government, particularly when we have a crisis in Ukraine and all sorts of Russian oligarchs waiting to move money into this country if they can, and when there are fundamental questions, as we heard in Prime Minister’s questions, about Westminster today. It is essential that we do not back away from this central piece of legislation, which is a touchstone issue for many stakeholders out there.
Paul Scully
I appreciate my hon. Friend’s work in tackling corruption and encouraging further transparency, which we have had several conversations about. We remain undiminished in our approach to tackling economic crime, for the reasons that he has given, and to Companies House reform, too. We will work with the Home Office and the Treasury to make sure we can get these measures in place as soon as possible.
Alison Thewliss (Glasgow Central) (SNP)
“Lamentable”, “woeful”, “arrogance, indolence and ignorance” were just some of the words that Lord Agnew used to describe the Government’s action on economic crime. In resigning at the Dispatch Box in the Lords, he has shown a lot more courage than anybody on the Front Bench in this place.
Some £4.3 billion was lost in the covid schemes and as-yet-unknown sums were lost in Government-backed loan schemes to crooks and fraudsters, while some in this country got no support. For example, it was deemed too difficult to redress support for parents in the self-employment income support scheme. Lord Agnew also said that it was a foolish decision to kill off the economic crime Bill, and given the evidence that I have heard at the Treasury Committee during our inquiry on it, I wholeheartedly agree.
Many cases of economic crime could be halted if the Government tightened up Companies House, because reform is well overdue. They have huge volumes of evidence on that. There is no verification, it costs only a tiny sum to set up a company and the information on the Companies House register is—politely—utter guff. If the Minister looks at Graham Barrow’s account on Twitter, he will see some of the absolute nonsense that is entered on to the Companies House register and somehow accepted. All that has led to an open door through which crooks and fraudsters have been allowed to waltz off with public money and Government-backed loans. UK corporate structures, such as Scottish limited partnerships, allow that to happen—and have done for years.
When, on what date, will we see an economic crime Bill? When, on what date, will we see the registration of overseas entities Bill, for which I sat on the Joint Committee years ago and on which the Government have failed to act? Why are the Government so unconcerned that the UK is deemed Londongrad and notorious for the laundering of dirty money? Who benefits from that—is it Tory donors and their pals?
Paul Scully
I think the last comment is beneath the debate. The hon. Lady talks about Companies House reform. Clearly, a lot of work is already happening in Companies House and it supports law enforcement on hundreds of cases each month. We want to get the balance right to ensure that new entrepreneurs can set up businesses through Companies House easily and affordably. There is much more reform to be done, however, which is why our appetite remains undiminished. She talked about Lord Agnew, who I thank for his work on this area. I worked closely with him to put measures in place to tackle fraud in bounce back loans and other areas of Government. He was a great servant of the Government and I regret the fact that he has gone.
Mr Andrew Mitchell (Sutton Coldfield) (Con)
May I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on raising the matter? I point out to the Minister that, over the last 10 years, the Government have made a lot of progress on this area but many hon. Members have put a lot of time and effort into working across the House to try to advance what is an important British agenda, not least at the G8 under David Cameron’s leadership. Companies House remains a good library, but it does not have investigatory powers, and it is there that we want progress to be made. Will he agree to meet me, my hon. Friend the Member for Thirsk and Malton and others who are concerned about progress in that area, together with those who run Companies House, to see whether we can make some progress?
Paul Scully
My right hon. Friend raises some interesting and important points. I will ask the relevant Minister, likely Lord Callanan from the other place, to meet him, but I am happy to meet him either way.
Chris Bryant (Rhondda) (Lab)
I am sorry—the Minister is a nice chap—but we have been calling for this Bill for ages and ages. Time after time, Ministers come back to the House to say, “Yes, there’s going to be a public register of beneficial ownership,” but it still has not happened. They say they will do it in the overseas territories, but it still has not happened. They say that they will stop giving out golden visas to Russians with dodgy money coming into the UK, but it still has not happened. We in this country are a soft touch. If we want to send a strong message to Russia, particularly at the moment, we have to move swiftly and not say, “Oh, I can’t possibly comment on what legislation we might be thinking of in the future.”
Paul Scully
I thank the hon. Gentleman for that—it was a shame he did not stop at his first sentence, but it was very kind of him. I appreciate all of those measures that he wants to put in place and, as I say, we remain undiminished on that. In the meantime, we have sanctions to tackle corruption from other countries. We already have very robust procedures in place, but we know we need to go further. That is why these measures will come, but I cannot pre-empt Her Majesty.
Sir Robert Buckland (South Swindon) (Con)
I associate myself with the remarks of praise for my noble Friend Lord Agnew, an outstanding Minister who asked searching questions of government at all times. It was a pleasure to work with him. May I press my hon. Friend about the work the Law Commission is undertaking on corporate criminal liability. It is due to present options early this year and I urge him, first, to use all expedition to get on with the job of legislating on economic crime and, secondly, to incorporate what I hope will be sensible recommendations from the Law Commission so that we can get corporate criminal liability in this country right? At the moment, the law is just not working and action is needed.
Paul Scully
I thank my right hon. and learned Friend for his work in this area as well. Because there has been no consensus, it is important that the Law Commission looks at this matter, because we are dealing with a very technical crime and if we are going to get the answers to it right, we have to get this right first time. We will, absolutely, consider that report in its fullest when it comes to us.
Layla Moran (Oxford West and Abingdon) (LD)
First, I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing this urgent question and thank him for backing my Bill, which would have brought in that register of beneficial interests. When I mentioned this to the Prime Minister just this week, he pointed to the Leader of the House and said it would be introduced as soon as possible, but now look what has happened: the vehicle we would have used to do that is gone. So I ask the Minister: how can he say that he is taking this seriously, given that this Government say one thing and do the complete opposite, do they not?
Paul Scully
I am afraid the hon. Lady is pre-empting the Queen’s Speech—Her Majesty will present this. There has been nothing pulled at all; Her Majesty will set out the Government’s programme in due course.
Mary Robinson (Cheadle) (Con)
I congratulate my hon. Friend the Member for Thirsk and Malton on securing this important urgent question. The National Crime Agency, using figures supplied by the national fraud indicator, estimates that up to £190 billion is lost to fraud, with £140 billion of that coming in the private sector and £40 billion coming in the public sector. That is a huge amount, which could be best invested in our economies. Does the Minister agree that we need to reward and protect whistleblowers who are at the forefront of this? We are talking about the informed insiders who bring these issues to light; more than 40% of this crime is uncovered by whistleblowers. Does he agree that the current legislation, the Public Interest Disclosure Act 1998, is not fit for purpose and needs to be looked at again, and that we need an office of the whistleblower, which would bring together all of these areas?
Paul Scully
I congratulate my hon. Friend and thank her for the work she does in this area. We have had a number of conversations and we will always look to see what more we can do to strengthen the whistleblowing framework in legislation. We do not necessarily agree on the end result, but, again, it is a complicated area that we do want to get right, for the reasons she set out. I will continue to work with her and with my hon. Friend the Member for Thirsk and Malton.
Dame Angela Eagle (Wallasey) (Lab)
While the Minister wrings his hands, London has become the jurisdiction of choice for dirty money. The levels of fraud are soaring upwards in the wrong direction. We have waited years and years for the open register of beneficial ownership of companies and it has not appeared, and we have waited years and years for corporate liability reform. How much longer do we have to wait? How much worse are this Government going to let fraud and money laundering get before they get off their collective backside and do something?
Paul Scully
What I am not going to do is pre-empt Her Majesty.
Matt Hancock (West Suffolk) (Con)
May I associate myself with the remarks praising Lord Agnew, who has done great service in government? Will the Minister ensure that, at the same time as he develops this policy, we ensure that the UK is also home to new innovations such as fintech and the extraordinary growth of cryptocurrencies? Those innovations have the potential to disrupt finance just as social media has disrupted communications and online shopping has changed retail. Post Brexit, the UK has the chance to be the home of fintech, which not only can be an economic driver, but can help to cut fraud and financial crime because of the transparency it brings. Will he make sure that we get this right and that new legislation is fit for the future, so that Britain can be the home of this revolution?
Paul Scully
My right hon. Friend is absolutely right. We have to get the legislation right, not only because we want to tackle economic crime, but because we do not want to stifle innovation and the investment in this country that makes us the highest receiver of foreign direct investment in Europe and one of the highest across the world. This is a great place to do business, to set up, grow and scale up.
Sammy Wilson (East Antrim) (DUP)
The whole House would love to believe the Minister’s words, as would Northern Ireland, where paramilitary money has been turned into a vast empire, especially along the border, and economic crime is rife. The evidence is not great, though, given the casual writing off of £4.3 billion-worth of bounce back loans; the fact that Companies House is in such chaos that people can avoid paying debts by going bankrupt one day and starting a company the next; the fact that in the middle of the Ukraine crisis we have threatened sanctions on Russia yet we are not taking action on the dirty money from Russia, which flows into London and props up the Putin regime; and the fact that the former fraud Minister said this week that the Treasury has little interest in or little knowledge of fraud. The evidence is not great for the assurances that the Government are serious about tackling fraud.
Paul Scully
As I said, the £4.3 billion figure cited is an inference by journalists; that money has not been written off by this Government. We are working with partners to ensure that we tackle the fraud that is clearly in the system, having given the money out at a crucial stage in the pandemic to enable businesses to survive. On the phoenix companies that the right hon. Gentleman talked about, that is exactly why we introduced the Rating (Coronavirus) and Directors Disqualification (Dissolved Companies) Act 2021, which tackles such directors, but there is clearly more that we need to do, and we will do it when parliamentary time allows.
Aaron Bell (Newcastle-under-Lyme) (Con)
I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and endorse everything he asked for. I know the Minister cannot anticipate the Queen’s Speech, but may I ask him to read the debate the House had on lawfare last Thursday, to which the Under-Secretary of State for Justice, our hon. Friend the Member for South Suffolk (James Cartlidge), responded? Right now in our courts, in cases that are being investigated, litigants are outgunning the Serious Fraud Office. Oligarchs are basically waging lawfare in judicial review against our regulators and preventing these cases from being prosecuted properly. Will the Minister speak to our hon. Friend the Under-Secretary of State for Justice and make sure that any future legislation takes into account the threat of lawfare?
Paul Scully
I agree that the lawfare debate was incredibly interesting and enlightening. We will make sure that we work together across Government to take all those matters into consideration when drawing up future legislation.
Rushanara Ali (Bethnal Green and Bow) (Lab)
The former Minister Lord Agnew said that fraud in government is rampant—it is estimated to be approximately £30 billion a year—with a complete lack of focus on the cost to society or indeed the taxpayer, yet what we have heard so far from the Minister today is complacency. We need action now, because criminal fraud and money laundering are financing organised crime, drug trafficking, prostitution and much of society’s ills. The Minister needs to step up and get on with the job, legislate and go after the fraudsters who have stolen taxpayers’ money.
Paul Scully
The hon. Lady is right about tackling fraudsters. That is why our determination to introduce legislation in this area is undiminished. At the other end of the scale but still adding up to a lot of money, universal credit, as well as being more responsive to claimants, was itself an anti-fraud measure. One of Lord Agnew’s great qualities was his attention to detail—to the small acts that had big implications but were often missed. We will bring that learning to bear across government.
Chris Evans (Islwyn) (Lab/Co-op)
The Department uses the National Investigation Service for frauds worth more than £100,000. The National Audit Office has reported that the service received 2,100 intelligence reports last year, but only 50 were investigated. The NAO has identified that as a lack of capacity, so rather than waiting for the Queen’s Speech, why does the Minister not speak to the Chancellor and ask for some extra funding for the service to pursue those frauds?
Paul Scully
We have invested in a number of schemes, including an investment in the National Investigation Service to boost its capacity to investigate cases of serious fraud, especially within the bounce back loan scheme. It received £5 million in the 2020 spending review and made recoveries worth £3.1 million in 2021-22, exceeding its targets. It has investigations into bounce back loan frauds and other areas, and we will continue to work with it.
Mark Pawsey (Rugby) (Con)
I know that the Minister will agree that my constituents have the right to expect that victims of economic crime will get the same redress as for other crimes, including where the victims are taxpayers. He will also welcome the many comments that I have had from businesses in my constituency about the speed of the support that was made available to prevent failures. In respect of Government-backed loans during the pandemic, does he think it would be helpful for the British Business Bank to be required to release performance data on the lenders to provide transparency on banks’ activities at the time?
Paul Scully
I thank my hon. Friend for all his work throughout the pandemic. In his position as a member of the Business, Energy and Industrial Strategy Committee, he has been asking probing questions. With the British Business Bank, we have tried to get the balance right between the transparency required to tackle the issue and the speed at which we can act, so that we are not consuming too much of its resources. It is early days in terms of fraud and recovery, but yes, data will become available.
Mr Ben Bradshaw (Exeter) (Lab)
How can the Minister reassure us when one of the reasons for the Government’s reluctance to act was highlighted in the Intelligence and Security Committee’s report on Russian interference in our democracy as the large amounts of Russian and other dirty money that flow into Conservative party coffers?
Paul Scully
I come back to this point: there is no reluctance to act. What I cannot do is pre-empt Her Majesty. Our appetite, as I say, remains undiminished. It is just a shame that the right hon. Gentleman hides behind Intelligence and Security Committee papers to throw political accusations when what we are trying to do is make sure that the taxpayers of this country get value for money and are not losing money, that the number of victims of economic crime is reduced and that they get their recoveries. Let us not make it a party political issue.
Damian Collins (Folkestone and Hythe) (Con)
Does my hon. Friend agree with the recommendation of the Joint Committee on the Draft Online Safety Bill that online platforms such as Facebook should not be allowed to profit from the advertising of known frauds and scams? As part of the online safety regime, they should be required to proactively block and withdraw advertising that promotes known frauds and scams.
Paul Scully
We are really aware of the issues and we appreciate the comments in that report. As that Bill progresses, we will consider them with all due process.
Stephen Timms (East Ham) (Lab)
The introduction of universal credit has led to a big increase in fraud. The current growth of economic crime and corruption poses an existential threat to financial services—one of our biggest and most successful business sectors—and therefore to the UK economy as a whole. Does the Minister accept that effectively tackling this scourge urgently requires an economic crime Bill?
Paul Scully
I dispute the right hon. Gentleman’s comments about universal credit, but yes, tackling economic crime requires legislation. That is why we remain undiminished in our appetite to push this forward.
Richard Fuller (North East Bedfordshire) (Con)
My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) has very eloquently described the reason for and priority of bringing forward new legislation, but that opens the door to questions about the effectiveness of, and the force with which, existing legislation will be brought to bear on the key issue that Lord Agnew raised: fraud within the BBLS and CBILS during covid. We know from Lord Agnew that there were issues with fraudsters because of processes in the British Business Bank that were not up to scratch. We know from Lord Agnew that there were some banks—maybe two out of seven—where fraud was a priority.
The Minister has a choice to make. Will he come down on the fraudsters with a slap on the wrist or with a mighty hammer? I know which I would choose. What is he going to do?
Paul Scully
I suspect that we have the same choice, frankly, with that mighty hammer. But what we have to do first is make sure that we have those processes in place. The British Business Bank obviously had to scale up very quickly in the pandemic, but we are working with it and the banks, which are our first port of call in this, as it is a delegated scheme. We want to make sure that the worst-performing banks scale up to the best-performing banks in tackling this, and we will continue to work on that endeavour.
Andy Slaughter (Hammersmith) (Lab)
The lawfare debate, which the Minister described as “interesting”, identified how money launderers use UK courts to cover up unlawful activity, so the term that he has used is a slight underestimate. The Minister responding to that debate said:
“the Government are poised to act.”—[Official Report, 20 January 2022; Vol. 707, c. 603.]
Given that they have abandoned their economic crime Bill, given that the Attorney General is investigating malpractice at the Serious Fraud Office, which she is supposed to supervise, and given that too much oligarch money flows into the Tory party, how poised are they?
Nigel Mills (Amber Valley) (Con)
May I ask the Minister just how bad the level of economic crime has to be before the Government bring the Bill forward? Can he also set out to the House how well worked our legislation is? Many of the proposals have been promised for years and years. I think he will find that there is quite a lot of support across the House to bring those measures forward piecemeal. We still have three months of this Session, so why wait for the Queen? Let us bring some forward and get on with them.
Paul Scully
I agree with my hon. Friend that we want to get this right. It is a technical and complex issue, and we will continue to work with people who are experts and knowledgeable in this field to make sure that we can get that legislation totally in place so that we can push it through in good time.
Peter Grant (Glenrothes) (SNP)
The Minister will be aware, and certainly his Treasury colleagues are aware, of the activities of Patrick McCreesh and Philip Nunn, of Blackmore Bond notoriety. Nearly five years after their dodgy and probably illegal sales tactics were first brought to the attention of regulators, those two are still allowed to continue in operation at the helm of a veritable spider’s web of companies, collecting scores of yellow cards, and some red cards, for breaches of statutory obligations. They are subject to no personal sanction, other than the occasional closure of one of the companies that they wanted to close down anyway. How much longer are we supposed to be satisfied with a regulator that, in one case, accepted the registration of a 10-year-old as a company officer? When are we going to have a regulator with teeth to drag dodgy directors out from hiding behind company nameplates in order for them to be held personally responsible, in a way that correctly reflects the fortunes that they have made and the financial misery they have inflicted on their victims?
Paul Scully
I know the hon. Gentleman has used that example on a number of occasions. It is a particularly pertinent example but, as I say, Companies House reform is foremost among our priorities and it will come as soon as parliamentary time allows.
Simon Fell (Barrow and Furness) (Con)
I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing the urgent question.
From migrant boats to county lines, the golden thread that runs between them is illicit money flows. Although the national cyber-security strategy and the economic crime plan, and the measures in them, are welcome, what we really need is a Bill to bring this forward. May I urge my hon. Friend to use his good offices to make that case, in order to deal with not only some of the big issues but the low-level frauds that are affecting so many of our constituents? Let us not forget that it is the No. 1 crime in this country at the moment.
Paul Scully
I thank my hon. Friend for his work in this area and those comments. He is absolutely right: the theme in this is economic crime—county lines and those kinds of things. That is why the Business Department, the Treasury and the Home Office are working together to get this right and to tackle all of that in the round.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
Fraud is a traumatic experience, which makes reports that victims are having their details collated and sold on the dark web as part of a so-called “suckers list” extremely worrying. What can be done to protect victims from being targeted a second time, and will the Minister ensure that this is a particular focus of the Government’s work moving forward?
Paul Scully
First, we need to do lots of work on awareness of scams and those kinds of areas, which fall into my direct remit. Action Fraud is taking more and more of a position here to support victims and—the hon. Gentleman rightly referred to this—to tackle the immediacy after the event and to make sure that it cannot happen again.
Mike Wood (Dudley South) (Con)
Cyber-criminals prey on vulnerable people in all our communities. Yesterday’s launch of the very first cyber security strategy was an important step forward, but will my hon. Friend the Minister continue to work with Ministers on further measures that will strengthen the UK’s resistance to cyber-fraud?
Paul Scully
I thank my hon. Friend for welcoming the Government’s cyber strategy. He is absolutely right to highlight the importance of this area, which the Government are tackling. We will continue to do more as time allows and as we get more and more information. The legislation needs to be right for the 21st century. It needs to keep up with the areas—cyber, the dark web and so on—that criminals are using.
Jim Shannon (Strangford) (DUP)
I thank the Minister for his answers so far, but after the recent resignation of Lord Agnew following a lack of consideration for an economic crime Bill, there have been many calls for that decision to be reconsidered or reviewed. The Bill was set to protect and better manage the UK’s economic prosperity. May I gently remind the Minister of the £26 million robbery of the Northern Bank in Northern Ireland by the IRA? Experts state that moneys have been laundered through legitimate businesses. Alongside that, there is the £396 million of fuel duty that has been lost to the Chancellor. Through an economic crime Bill, we can address the issues relating to the IRA’s illegal and murderous activities. Will the Minister confirm to the House that every action will be taken to ensure the Bill is introduced as soon as possible to take on those who live off the backs of others?
Paul Scully
I thank the hon. Member, as ever. He raises the really good point that not all economic crime is international. There is a lot of home-grown economic crime and he cites just one of a number of crimes happening in Northern Ireland and across the UK. Yes, we will ensure that we bring forward measures to this place to be scrutinised and pushed through as soon as possible.
Philip Dunne (Ludlow) (Con)
Fraudsters, criminals and bad people take advantage of measures introduced in response to crises, whether financial or otherwise. This is an incredibly complex area. Every Member will have had constituents who have lost out one way or another through fraud over the years, so I hope the Minister will take the sentiments from across the House—I think every party in the House has spoken today—expressing concern about this issue and the delay that has come about. May I urge him to take two things into account? He says he is learning lessons. Will he learn the lessons from the response to the financial crisis, when our banks introduced measures that led to the virtual confiscation of, for example, more than 16,000 customers from the Global Restructuring Group within RBS? And can he please learn lessons to try to ensure proper corporate behaviour by lenders? Secondly, he mentions Action Fraud. The threshold for Action Fraud to investigate, or urge the police to investigate in various forces, is incredibly high. As a consequence, while we all urge our constituents to make contact with Action Fraud, invariably nothing follows.
Paul Scully
My right hon. Friend is absolutely right. We recognise those constraints, which is why we are looking at replacing Action Fraud with a new organisation based with City of London police to try to tackle the areas he raises. We will also learn the lessons. He is absolutely right. We want to get the balance right, so that we are confiscating the right amount of money from the right people—the criminals.
Points of Order
(2 years, 10 months ago)
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Johnny Mercer (Plymouth, Moor View) (Con)
On a point of order, Mr Speaker. During Northern Ireland Office questions, the hon. Member for Foyle (Colum Eastwood) made the extremely incendiary allegation that British troops went to his constituency in the ’70s with the express purpose of murdering the people who lived in Derry. We all have a responsibility in this place for the language we use. Legacy is extremely difficult to deal with. What guidance can you give me, Mr Speaker, so that when a Member repeatedly makes such claims—to generate whatever online presence he may have—that are clearly incendiary to people across the House and across the country, we can put a stop to that behaviour and behave in this place with the dignity that our offices demand?
Mr Speaker
First, I thank the hon. Gentleman for giving me notice of his point of order. These are very sensitive issues and, as I set out in my opening remarks ahead of Northern Ireland questions, Members should exercise caution in referring to historical troubles-related deaths. In this case, the details of the case and the names of those involved have not been referred to and nothing disorderly has occurred, but Members’ views are now on the record. May I take this opportunity to remind the House that good temper and moderation are the characteristics of parliamentary language? Perhaps we can learn from this point of order.
Chris Bryant (Rhondda) (Lab)
On a point of order, Mr Speaker. As you will know, during the evacuation from Afghanistan many hon. Members were concerned about constituents who had loved ones stuck in Afghanistan. One issue that arose was how it came to be that Pen Farthing and Nowzad were allowed to evacuate animals while there were still people stuck in Afghanistan.
The Prime Minister said on 26 August that he had “no influence” on that particular case and nor would it be right. On 7 December, he was asked “Did you intervene to get Pen Farthing’s animals out?” He said, “No, that is complete nonsense.” And the Downing Street spokesperson said, “Neither the Prime Minister nor Mrs Johnson was involved.“ Yet today, as I think you are aware, Mr Speaker, the Foreign Affairs Committee has published a letter from Lord Goldsmith’s office saying,
“the PM has just authorised their staff and animals to be evacuated”.
How can I get to the bottom of who is telling the truth?
Layla Moran (Oxford West and Abingdon) (LD)
Further to that point of order, Mr Speaker. Members will know how much correspondence we had on this. In the light of what is happening at the moment, people are very interested in the discrepancies between what the Prime Minister says to journalists versus what is revealed in this House. I seek your advice on how we can ensure that such discrepancies are clarified to Members of Parliament.
Mr Speaker
I thank both hon. Members for giving me notice of this point of order. Ministers themselves are responsible for their answers at the Dispatch Box. However, they are encouraged to correct, as quickly as possible, inadvertently incorrect statements made to the House, if such a mistake has occurred. We know the Treasury Bench will have heard this and, if what has been stated is correct, I would expect them to come to the House to put it right.
I know that for both Members this will not be the end, and quite rightly they will use their best endeavours and the different resources available within the House to ensure this is looked into. I presume the Foreign Affairs Committee may wish to do so, too.
Mr Peter Bone (Wellingborough) (Con)
On a point of order, Mr Speaker. I know that you and the House have been concerned about major Government announcements being leaked to the press. With the Sue Gray report, we think, about to be given to the Prime Minister, have you had assurances that the first that people will know about the report will be when this House has a statement? If the report is delivered on Thursday evening, will you ensure that there is a statement on Friday? The House is sitting on Friday to consider private Members’ Bills, and a statement might encourage more people to turn up.
Mr Speaker
I thank the hon. Gentleman for giving notice of his point of order. I have not been given notice of the date or time of any statement. However, the Treasury Bench will have heard his point of order. As I have said repeatedly, I expect all statements to be made first to this House to allow Members to question Ministers properly. As we know, the Prime Minister has promised to make a statement.
I would expect that Members will be able to see the report, and I would hope time will be given for them to digest it. I have not had any indication of when it will be coming, but I will work with the House to ensure that Members are aware of that statement. Hopefully, good notice will be given, but I am more than happy to suspend the sitting and leave it until later tonight if the report arrives. I am happy to work with the Leader of the House to ensure that the House is treated correctly, fairly and in the right manner. I reassure the hon. Gentleman that conversations between my office, the Leader of the House’s office and Downing Street are taking place in order to do the right thing by this House.
Jim Shannon (Strangford) (DUP)
On a point of order, Mr Speaker. Thank you for your direction in relation to the point of order from the hon. Member for Plymouth, Moor View (Johnny Mercer). Like him and others in this House, the DUP is deeply concerned by allegations made by the hon. Member for Foyle (Colum Eastwood), alleging that paratroopers left here to go and murder. However, he totally ignores the issue that at the same time 50 years ago two police officers were murdered by the IRA, which set out to do that. How can I make sure that there is balance in the comments in this House?
Mr Speaker
I think you just did and, as balance goes, you far outweigh any other Member in all your contributions. However, you did name the constituency and the Member, so I presume that you gave notice to that Member.
Mr Speaker
When Members name a particular person or mention a constituency, please ensure that they are given notice. It is unfair if they do not know that they will be mentioned. You have been here long enough, and I am sure that you would like to speak to the relevant Member privately.
Spiking (Offence)
Wednesday 26th January 2022
(2 years, 10 months ago)
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Richard Graham (Gloucester) (Con)
I beg to move,
That leave be given to bring in a Bill to create an offence of administering or attempting to administer drugs or alcohol to a person without their consent; and for connected purposes.
The subject of my Bill today, spiking, is both an old and a new issue, and one that causes considerable anxiety among the young, particularly teenagers, and their parents. Although drinks have been spiked for a long time, and chemicals were first used to poison and kill a soviet dissident in this country almost 50 years ago, the term “spiking” is relatively new, and spiking drinks happens much more frequently than it did. The phenomenon of spiking by injection at social events is both new and still mysterious.
Let me start with the context, go on to what is known, highlight what is less well known, and then lay out what the Government, Parliament, local police forces and local authorities are already doing and might do. Lastly, I will suggest what more could be done by Government. Our aim in this House is, as always, to protect our young and reassure the public. We can also send a clear message to those who think that spiking is fun. It is not. Spiking has a deeply unpleasant impact on many lives, and it is a crime that should be punishable in its own right.
For the context, I am grateful to many people: my constituent Rosie Farmer and her daughter Maisy; my own young office; colleagues, especially the former Lord Chancellor, my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland), and others here today with their own experiences and constituent cases; organisations in Gloucestershire; the Chair of the Home Affairs Committee, the right hon. Member for Kingston upon Hull North (Dame Diana Johnson), who is in her place, and her Committee and team; and Dawn Dines of “Stamp Out Spiking”, who has been on this case for a decade.
Spiking is not a far-away country of which we know little. It is happening all around us, and even to us. My hon. Friend the Member for Mid Sussex (Mims Davies) was spiked not long ago, as have been several other Members over time. Of course, many of us have children who have also been spiked. One colleague’s daughter was spiked twice in a nightclub. On both occasions, she collapsed and was carried outside by a bouncer and dumped unceremoniously on the pavement. We can all agree that that is not good enough, as would licensed victuallers associations around the country. There is much good practice to recommend, as I will go on to mention, but such incidents highlight both the grisly experience for a young woman and the frustrated feelings of her mother.
We can all relate to that, too, because where neither colleagues nor anyone in our or their immediate families have been spiked, our mailboxes tell us that our constituents have been. One colleague said:
“I know from my inbox that people of all ages and areas will be very pleased that this is being highlighted as it’s awful, can be embarrassing and is often very grim”.
She speaks for us all, as does another colleague, who wrote that
“speaking to police they find that most cases are young women with an unexpected response to drinks…I really worry about the fear that our young live under, and wonder whether this is another type of control of women.”
This not just about young women, although what data we have does suggest that in the vast majority of cases those affected are females. The worst spiking offender of all so far is Reynhard Sinaga—I am sorry to say, an Indonesian national—who was sentenced to a minimum of 30 years for using spiked drinks to sexually assault at least 48 males, many of whom did not know they had been assaulted until Mr Sinaga’s videos were discovered by the police. That confirms that there are male victims, and that there may be many more serious incidents, both on men and women, that we do not know about.
Colleagues from five parties are supporting my Bill today, and I hope the whole House will share my view that this is not a party political but an all-party and all-country issue on which reaching broad consensus inside and outside Parliament is the key to future success. We know already that there have been about 2,600 reported cases over the last five years and we suspect that that is the visible part of the iceberg, which means there is work to be done.
The last case in Manchester shows that there are laws that can be used to prosecute, and they have been used successfully in some cases. The two most relevant laws are the Offences against the Person Act 1861, which covers the use of noxious substances, and the Sexual Offences Act 2003, which covers spiking for sexual gratification. They are, as it were, the two bookends of the issue, but much in between is not covered, especially where it is not clear or cannot be proved what the purpose of spiking was or where the drug used cannot be identified, including because its effects have already worn off.
Most importantly, because spiking itself is not a specific crime, no one can be arrested simply for the act of spiking itself, nor is there enough data on spiking for adequate analysis and response, and at the moment it is not mandatory for hospitals automatically to report suspected spiking incidents to the police, as the National Police Chiefs’ Council lead on drugs confirmed to the Home Affairs Committee this morning. He and I, and I suspect all of us, would like that to change.
That is the context, those are the experiences and that is the gap in the law, which I think will surprise many of our constituents, and that is the main reason for making spiking a crime and therefore for proposing the Bill. As the Chair of the Home Affairs Committee recently said:
“There is not a specific criminal offence. If a drink is spiked or if an injection takes place, it is rolled into a different criminal offence.”
We need something more.
There is a conundrum about spiking to highlight. Spiking by injection is a relatively new phenomenon, but anecdotally, it is growing. Gloucestershire constabulary estimates that its usual historical number of reported spiking incidents of 10 to 12 cases a month rose to 48 in October, of which 10 were spiking by injection. That month coincided with the full reopening of universities, and I believe that is not a coincidence.
My constituent Maisy Farmer—I hope I will not do long-term damage to her reputation by describing her as a very sensible university student of criminology and policing—was behaving manically and completely out of character when recently returning home with friends from a nightclub in Worcester, and the next morning she found a needle mark on her arm that she suspected was evidence of having been spiked. Her mother, Rosie, contacted both her surgery and the Gloucester Royal Hospital A&E, but was told it was too late for tests. Maisy was signposted to sexual health services, which took some tests, and she received preventive inoculation against hepatitis B and HIV. The police, in turn, were very supportive, but without evidence of any substance in Maisy’s body or any known secondary offence, they could not do more. The point is that all these services reacted as they could and should, but if, as seems likely, spiking by needle had taken place, that is wrong and something must be done. The emotional stress alone is considerable. The question is what should be done.
If there is no evidence of a needle or substance and nothing on CCTV to follow up, it is difficult to know exactly what is happening. I understand why my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said this morning that he is still confused by the prevalence of needle spiking without evidence; so, I believe, is the Policing Minister, who is in his place. However, that does not mean that nothing can be done—in fact, the opposite. Some of this is best done at a local level. The Gloucestershire police and crime commissioner’s recent successful safer streets fund award has partly been used to provide testing kits in nightclubs, which can be used by victims and others.
Then there is the question of immediate medical help. Gloucester City Council’s innovation of funding street medics means that immediate paramedic help is available. The local police’s Operation Nightingale, including an increased police presence, may be responsible for a sharp drop in incidents in December. Pooling the best local practice of such examples will be part of what the new national gold command incorporates in its recommendations to Ministers. I should mention that a drug often used in drink spiking, GHB, has been reclassified by the Government as a class B drug, meaning possession can result in a maximum five-year sentence. Last, but by no means least, is the work I referred to from the Home Affairs Committee. I hope that, should our constituents have more evidence to share, the Committee will welcome it, because we need all the possible light that we can shine, especially on spiking by needles.
Spiking is already a considerable issue and is getting worse. Spiking by injection needs more research and investigation. We could send a clear message today in support of the work of all local authorities and answer student groups from St Andrews to Truro, MPs from across the country, “Love Island” contestants and parents everywhere that we want to enlist in a more open partnership with communities by saying that we care and that we will do more. I hope the Bill will have the support of the nation.
Question put and agreed to.
Ordered,
That Richard Graham, Sir Robert Buckland, Siobhan Baillie, Wendy Chamberlain, Wera Hobhouse, Dr Rupa Huq, Cherilyn Mackrory, Mrs Maria Miller, Robbie Moore, Liz Saville Roberts, Jim Shannon and Valerie Vaz present the Bill.
Richard Graham accordingly presented the Bill.
Bill read the first time; to be read a second time on Friday 18 March, and to be printed (Bill 238).
Product Security and Telecommunications Infrastructure Bill
(2 years, 10 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
I inform the House that Mr Speaker has not selected the reasoned amendment.
The Secretary of State for Digital, Culture, Media and Sport (Ms Nadine Dorries)
I beg to move, That the Bill be now read a Second time,
We are living in the digital age. It is not only our computers and smartphones; Brits young and old have an average of nine connected devices in their house, from smart speakers and TVs to baby monitors and doorbells. We are more connected than ever, and we need to make sure that those connections are fast and secure. The Bill will achieve both those aims. It will take our roll-out of gigabit broadband and 5G to the next level while boosting the protection of citizens across the UK.
If there is one thing we have learned from this pandemic, it is how central technology is to our everyday existence. We need technology to work remotely; we need it to reach our children and to drive scientific breakthroughs and business innovations; we need tech to be interoperable—I struggled to say that—because we are living in a world where our baby monitors, kettles and doorbells will all be able to talk to one another; and we need tech that is secure.
Underneath all that, we need the digital infrastructure to support all those connections—the ones that we make minute by minute, hour by hour and day after day. Such networks are vital for the UK’s future prosperity. We cannot stay at the heart of the global economy if our connections are not world class, which is why the Government have made huge investments in digital infrastructure.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
Unfortunately, my constituency has one of the slowest broadband speeds in the UK. In one area in particular, Cilycwm, a WeFibre gigabit scheme has been sitting on the Department’s table for eight or nine months. Will the Department come to a determination quickly so that we can move forward with that scheme?
Ms Dorries
I certainly will. As I am sure the hon. Gentleman is aware, we are moving forward at an absolutely rocketing pace, but I will have a look at the situation in his constituency. I assure him that nothing sits on the Department’s table—it has all gone out to the providers and those going through the procurement process—but I will check on where things are up to in his constituency. If he could contact me with some details after the debate, that would be helpful.
Because the Government have made huge investments, at least 97% of premises now have access to superfast broadband, which is fast enough for a family to stream five different Netflix films in five different rooms in the same house at the same time.
Rachel Hopkins (Luton South) (Lab)
The Secretary of State has just talked about the ability to activate fast broadband in five different rooms, but constituents in my Luton South constituency do not have five devices on which to watch five different Netflix films. Should the Government not be doing more on that basis?
Ms Dorries
We are. The roll out of superfast broadband and gigabit broadband, in respect of which we have covered 65% of the country in just a few years, is levelling up in practice. It is about making sure that anybody who wants access can have it. We are working with Ofcom and the providers to look at left-behind areas in terms of levelling up and how we can increase access to laptops and—this happened particularly during the pandemic, in the first lockdown—how children in particular can access the internet so that they have the same equal access and opportunity as everyone else.
As we have upgraded our networks, we have invested more than £4 billion in our cyber defences since 2016, including by setting up the National Cyber Security Centre. As we all know, the nature of tech is incredibly fast-paced and constantly changing and growing. Monthly broadband usage has doubled since 2018 and continues to rise year on year. But the more we log on, the more open we are to cyber-threats, particularly as new technology—including cutting-edge consumer products such as smart baby monitors—is not always secure by design. To stay ahead of the game we need to keep investing in tomorrow’s networks and to secure ourselves against future threats, which is why we have introduced the Bill.
Let me explain the Bill’s impact in our telecoms networks before I turn to its measures on product security. In 2019, the Prime Minister promised voters a “broadband revolution” and vowed to deliver fast, secure and reliable broadband to everyone in the country. That was an important promise in 2019 but it is even more vital today as we build back from a devastating global pandemic.
We are delivering on our promise. Under this Government, nationwide gigabit coverage has jumped from just 11% at the end of 2019 to 65% today. We have set ambitious targets for the rest of the roll-out and aim to reach a minimum of 85% of homes by 2025 and to get as close to 100% as we can as soon as possible. We are constantly looking for ways to go further and faster with that roll-out. For example, we have already legislated to address the problem of absent or unresponsive landowners, who can hold up the deployment of gigabit broadband in blocks of flats, and we are currently consulting on proposals to amend the building regulations to ensure that all new homes have gigabit from the outset.
At the same time, we are working hard to improve our mobile phone networks, so that people can enjoy world-class connectivity not just when they are at home or work, but when they are out and about. We have agreed a £1 billion deal with the industry to roll out the shared rural network, which is already delivering improved 4G coverage across the UK. Both the operators and the industry remain confident that they will reach 95% of the country by the end of 2025, and we are aiming for the majority of the population to have the next level of cutting-edge 5G mobile coverage by 2027.
James Murray (Ealing North) (Lab/Co-op)
Many of my constituents in Northolt are not able to access faster broadband through a fibre connection. I have repeatedly pressed Openreach on this, and it admitted that one of its cabinets had not been upgraded as it did not meet the commercial criteria. Just last week, I also pressed Virgin Media, which said that it had installed broadband in on Islip Manor Road but not on Islip Manor estate, next door. Will the Secretary of State confirm when, under the Government’s plans, all my constituents in Northolt will be able to access a decent broadband connection?
Ms Dorries
The hon. Member’s question is quite detailed, right down to street names, so I will take it away and we will speak to Openreach. The Department will see what we can do and come back to him, although that is not a promise that we will suddenly be able to connect Northolt. I am interested to hear about individual constituencies, because it is useful to us to know that information. We have not said that everybody is going to have superfast or gigabit broadband tomorrow; we have set dates by which to reach our targets. We will do our very best for the hon. Member, if he lets me know the details of the case he mentioned.
Things like 5G and gigabit have the potential to be truly transformational for people and businesses. They are vital for innovation, and can unlock huge economic and social benefits across every single corner of the country—not just driving our recovery from covid, but boosting our generational mission to level up the UK. We therefore need to ensure that the legal framework underpinning our digital infrastructure encourages and enables the deployment of the latest networks. In 2017, we made changes to that legal framework, implementing reforms to the electronic communications code that regulate installation agreements between landowners and telecoms operators.
Antony Higginbotham (Burnley) (Con)
My right hon. Friend is making an important point about ensuring that we have the infrastructure that we need for the 21st century, not the 20th century. But one of my constituents’ concerns—I know that the constituents of my hon. Friend the Member for Hyndburn (Sara Britcliffe) have a similar concern—is that when private sector providers come in and install new equipment such as telegraph poles, dishes and things like that, if they do not properly engage with residents and the local community, that can blight some of our streets and add unnecessary infrastructure. Does my right hon. Friend agree that when we encourage providers to install such equipment, they should engage with communities and residents, so that we carry people with us?
Ms Dorries
Community engagement and engagement with individual households is vital. People need to know that the connectivity is there. I will look into my hon. Friend’s point and take it further.
Ben Lake (Ceredigion) (PC)
In a similar vein to the hon. Member for Burnley (Antony Higginbotham), I have received a number of concerns from site providers in my rural constituency that have hosted telecommunications infrastructure, in some cases for a decade or more. When the code was last before the House, we were led to believe that the rent reductions would be minimal. However, it has transpired that in some instances, rent offers have been reduced by about 90%. I am interested to know whether the Secretary of State has any comments on that point, and whether there is a way of rebalancing things. We want to ensure that this infrastructure is there to benefit the community, but we do not want site providers to have to sacrifice what is, in many cases, very valuable agricultural land.
Ms Dorries
I am coming to the first point raised by the hon. Member. On his second point, which was about rebalancing, I am afraid that he is probably going to be disappointed.
John Redwood (Wokingham) (Con)
I strongly welcome massive private-led investment in proper broadband, which is what we all need. Could the Secretary of State give guidance to the companies doing it that it is not helpful if they bury cables under main roads, requiring the roads to be dug up again every time they want to improve or mend a cable? Could we not do better, either in ducts or by the side of the road?
Ms Dorries
An interesting point. I will certainly take that back to BDUK, Openreach and others. We need to ensure that the legal framework underpinning our digital infrastructure encourages and enables the deployment of the latest networks. In 2017, we made changes to that legal framework. Implementing reforms to the electronic communications code—this goes to the point made by the hon. Member for Ceredigion (Ben Lake)—requires installation agreements between landowners and telecom operators. The aim was to make it easier for digital networks to be installed, maintained and upgraded, and now we will go even further. The Bill will update the electronic communications code to deliver on the Government’s ambitions for digital connectivity and levelling up. Specifically, it will do three things: make the most of existing infrastructure; encourage stronger and more collaborative relationships between telecom operators and site providers; and build on previous measures to tackle the issue of non-responsive landowners.
Daisy Cooper (St Albans) (LD)
In my constituency of St Albans there is the Highfield Park Trust, run by a group of volunteers. Since the 2017 reforms, it has lost 98% of its income from hosting a mast because of the telecoms company using its new powers to renegotiate the lease. Does the Secretary of State agree that that poses a real risk to the roll-out of 5G, because in some instances small site owners might decide that it is not worth their while anymore and just evict the telecoms companies? Is she willing to look at the issue again, and at the power imbalance that has arisen from the 2017 reforms?
Ms Dorries
In 2017, the prices were too high and they affected the overall roll-out. The new pricing regime is more closely aligned to those of utilities such as water, electricity and gas, which are fair. In order for us to roll out 5G to future-proof our digital economy and our telecoms, and to reach the targets of ensuring that we have 4G/5G coverage and 100% gigabit roll-out as soon as possible, we need to ensure that telecom providers can access land to establish both masts and the facilities that we need to make it happen. It has to be fair. We are not revisiting the code of 2017; the Bill does not do that. It will stay as it was, and there will not be a revision to the pricing regime. It is important that I make that clear straightaway.
Sir Desmond Swayne (New Forest West) (Con)
The Secretary of State highlighted that the prices were once too high. Now we have had multiple complaints that the prices are too low. Clearly, the question of valuation is at the heart of the matter, so why did the Government explicitly exclude valuation from the scope of the consultation that preceded the Bill?
Ms Dorries
We have listened to landowners. We have not introduced the legislation without involving them in its development. We have included measures in the Bill that make it easier for landowners and operators to use a dispute resolution if landowners feel that they are not getting a fair price. That means greater collaboration, and it makes preposterously low offers less likely. Hopefully, a fair and reasonable price would be agreed. If landowners were not happy with it, it would go to independent arbitration. If they were then unhappy with that, they would have recourse to the courts, which we know would look very dimly on a situation where the telecom providers had been neither reasonable nor fair to landowners. We think that that is a fair and reasonable process.
Making the most of existing infrastructure can play a key role in upgrading services and increasing competition. Under the Bill, operators will have the automatic right to upgrade or share apparatus installed before the 2017 reforms. That will be subject to specific conditions to ensure that the work does not negatively impact landowners. The measures have been considered carefully to deliver significant benefits, while ensuring that there will be little impact on landowners. The Bill also rationalises the way that certain older code agreements are renewed so that they reflect the code as reformed in 2017. This means that there will be greater consistency in how agreements are renewed across the UK. On that basis, the 2017 coding agreements will not be revisited.
All those things will make much better use of existing infrastructure, reducing the need for new installations. That means less disruption with fewer street works and fewer mast installations in both rural and urban settings—something that, I am sure, will welcomed in all parts of the House. We will take away that community disruption. In response to my right hon. Friend the Member for Wokingham (John Redwood), I will take away his point about cables being laid under roads. In the area where I live, it is done under the pavement right outside my house. I would imagine that there is a good reason why that has to happen in some areas, but I will get back to him with what it is.
Secondly, we want to build stronger, more constructive relationships between network operators and potential site providers. We are introducing measures to make it easier for those two parties, when negotiating agreements to install telecoms apparatus, to use an alternative form of dispute resolution if a disagreement arises such as I have set out. This will encourage constructive dialogue between networks, operators and potential site providers. It will help new agreements be reached more quickly and address situations where landowners may feel compelled to accept terms offered by operators.
Finally, we are creating a new court process to address situations where landowners are not responsive. This process will provide a quick and inexpensive route for operators to gain access to certain types of land. Again, these measures have been developed to strike the balance between protecting landowners and ensuring that everyone across the UK has access to reliable and quick digital infrastructure.
We need this infrastructure because of the sheer demand on our networks. Just think of all the devices that are in use at this very moment. Millions of people will be switching on their smart TVs to stream a film or a series box-set, unlocking their phones or tablets to call a friend or a relative, or asking their smart speakers to play music or give information. Around this Chamber, right now, many wrists are sporting smartwatches that keep us up to date with the latest news or alert us to the fact that we have a new message from those infamous WhatsApp groups. [Laughter.] Sorry—I just couldn’t resist.
But with every connectable product that enters our lives, the risk of cyber-attack grows. In the first half of 2021 alone, we saw 1.5 billion attacks on connectable products—double the figure for the same period in 2020. Most of us assume that if a product is for sale in the UK it is safe and secure, but thousands of people in the UK have been victims of cyber-attacks. Many of them have lost significant amounts of money or have had their private data hacked and shared, and they have lost trust in the idea that they can connect with one another and go about their daily lives with confidence. This is not just damaging on a personal level; it also has serious implications for our national security. Cyber-criminals now have the ability to use compromised connectable products to attack large infrastructure. We saw this with the 2016 Mirai attack, which targeted anything from baby monitors to medical devices to home appliances to disable internet access across much of the US east coast.
In the past few years, this Government have made significant progress to strengthen the UK’s cyber-security. In 2018, we published a code for manufacturers to improve the security of their own consumer devices. We led the world on this, and that code has since been used by countries such as Australia and India to inform their own product security principles. However, the cyber landscape is constantly evolving and our approach needs to evolve with it if we want to stay safe.
We have reached the point at which legislation is required to protect citizens and networks from the harm posed by cyber-criminafls. Packaged together, the telecoms and product safety measures in the Bill will work in tandem to do just that, creating a reliable, fast broadband while supporting the growth of more secure consumer connectable products.
The Bill will enable the Government to specify a number of mandatory security requirements for smart devices. They will be set out in regulations, but manufacturers are already on notice regarding what the initial three requirements will be. The first is a ban on universal default passwords. Too often, consumer connectable products come with easy-to-guess passwords as their default setting, such as “password”, “admin” or four zeros. That makes them vulnerable to hacking, and risks compromising a user’s privacy and security right from the get-go. Under this new security requirement, all passwords that come with a new device will need to be unique and not easily guessable.
The second mandatory requirement is for manufactured consumer connectable products to provide a public point of contact so that security researchers and others can easily report when they discover security vulnerabilities, flaws and bugs in their devices. Manufacturers can then quickly identify and address any shortcomings in their products. At present, nearly 80% of firms have no such system in place.
Finally, manufacturers will be required to be completely transparent about how often, and for how long, their products will receive security updates and patches. According to the current guidance that is being commonly issued, if we update our computers regularly when asked to do so and use two-step verification, 90% of cyber-attacks can be avoided. The requirement for manufacturers to be transparent about how often their product will receive security updates is intended to help consumers to know at which point they will need to do that.
Businesses will have to give customers that information at the point of sale, and keep them updated throughout. If a product will not be covered by security updates, that must be disclosed. That will enable consumers to have all the facts that they need to make an informed decision about their purchase, to understand when the product they buy could become vulnerable, and to base their decision on whether or not to buy on that information. When the security requirements have not been complied with, businesses will not be allowed to make these products available in the UK. We will be able to monitor, investigate and take enforcement action against non-compliant businesses.
We have been setting consumer standards of this kind for decades. Every product on our shelves has met all sorts of minimum requirements, whether to ensure that it is fire-resistant or to ensure that it is not a choking or suffocation hazard. It should be no different in the digital age. The Bill allows us to protect people across the UK even as the world around us changes. It allows us to keep pace with technology as it transforms our everyday lives. Combined with the measures on the telecoms infrastructure, it will do a huge amount in the coming years to benefit our constituents and society at large.
I hope that Members will show their support for the Bill, and that the benefits can be realised as quickly as possible. I commend the Bill to the House.
Mr Deputy Speaker (Mr Nigel Evans)
I do not think there could be a better birthday present than being in the Chamber today and listening to this Second Reading debate. Happy birthday, Jeff Smith!
Lucy Powell (Manchester Central) (Lab/Co-op)
May I extend those congratulations to my hon. Friend the Member for Manchester, Withington (Jeff Smith)? I think he is 21 again.
Once again, I congratulate the Secretary of State on her continuing blind loyalty to the Prime Minister. Last week she threw Big Dog a bone with her vendetta against the BBC to distract from the Prime Minister’s partying antics. How is that going? This week she has continued her role as dog-walker-in-chief, trying to tidy up Big Dog’s mess after the latest revelations about his lockdown-breaking birthday party antics. She might have picked it up and put it in a plastic bag but, as the saying goes, even she cannot polish this one! [Laughter.] We are lightening the load today, because this is a very technical Bill and we all need lifting.
Mr Deputy Speaker (Mr Nigel Evans)
It is just as well I am in a generous mood today, is it not?
Lucy Powell
It is just as well you are in the Chair, Mr Deputy Speaker!
We have here another infrastructure Bill. As with every big infrastructure project this Government oversee, from the northern rail betrayal to the disastrous green homes schemes, the broadband and 5G roll-out has been beset with piecemeal, short-term thinking. The Government try to get British infrastructure built on the cheap, relying on the private sector, which more often than not means foreign state-run companies. On the broadband roll-out, the Government have wasted a decade and squandered the world-leading position left by the last Labour Government. This Government’s legacy over 10 years has seen huge delays in the superfast broadband roll-out, and a widening in the digital divide. Why were we not, 10 years ago, investing in a public-private partnership, so that home-grown British businesses could develop our own 5G network? Instead of looking towards the future, and building up British capacity and resilience, the Government have left us reliant on Huawei and other foreign state-backed companies for our 5G, with all the security complications that that entails.
This Bill deals with a couple of specific aspects of the broadband and 5G roll-out: part 1 places security requirements on manufacturers of smart devices and part 2 amends the electronic communications code, which governs the rules on how rent is set for community groups and others to host phone masts on their land.
Sir Desmond Swayne
The hon. Lady is no Stalinist. Given that the underlying principle of part 2 of the Bill is the Stalinist principle that property is theft, will she be opposing it on Second Reading?
Lucy Powell
I must object to that suggestion that I am a Stalinist. I am, however, someone who believes that there should be a fair —
Lucy Powell
Oh, no Stalinist. I am someone who believes that there should be a fair valuation, and a fair and balanced approach taken to those who put masts on their land in good faith, expecting that income to come in the future. I will say more on that shortly.
We support the measures in part 1. Smart devices have increasingly become targets for fraud, surveillance and other forms of cyber-attack. We have some concerns that these measures have not come sooner and do not go further. In 2016, the Government promised that
“the majority of online products and services coming into use”
would be
“’secure by default’ by 2021”.
Why are the Government only just bringing this legislation in, given that previous commitment? These requirements should and could have been mandatory from the start, as opposed to our spending four years with a voluntary code. I have real concerns that we are always behind the technology curve. These devices are already being used in ways beyond the scope of this Bill—for example, by stalkers and abusive partners in tracking those they are abusing, as well as in fraud and criminal activity. There is nothing in this Bill about that, let alone measures to address new waves of technology that are already making their way into people’s homes and lives, such as virtual reality.
Moving to part 2, our main concern with this Bill is that it is likely to slow down, rather than speed up, the broadband and 5G roll-out.
John Redwood
I was very interested in the hon. Lady’s comment about virtual reality. Does she think we need to change the legislation now to deal with the metaverse, which is meant to be a great opportunity of bringing together various technologies in something new?
Lucy Powell
I do. I share the right hon. Gentleman’s concern about the metaverse; we are constantly considerably behind the curve on legislating for the regulation of some of these issues, and of course that will not even be covered by the forthcoming Online Safety Bill either. The pandemic has demonstrated more than ever the importance of broadband to our prosperity, but the Government’s failure to deliver the roll-out is hampering creative industries, businesses and those attempting to work from home.
The Government have consistently rolled back on their commitments. The Secretary of State mentioned that the Prime Minister originally promised full-fibre broadband to every household by 2025. He then downgraded that pledge to universal gigabit-capable broadband to every home. The commitment is now that at least 85% of UK premises will have access to gigabit broadband by 2025. That is downgrade after downgrade, which sells our capacity short.
The National Audit Office expressed serious reservations that even the watered-down target would be met. The main barrier is the Government-funded roll-out to harder-to-reach areas. The unequal roll-out of next generation gigabit broadband will mean that the same households that do not have superfast or, in many cases, as we have already heard, any functioning broadband at all, will continue to fall behind—for years, if not decades, to come. As the Public Accounts Committee said last week, the Government have no detailed plan in place for reaching communities where it is not commercially viable to do so, and there is little in the Bill to address that key issue.
The Bill does make further changes to the electronic communications code, which governs the agreements between telecoms companies and the landowners who host their masts. The code was last updated as recently as 2017, but those changes have not had the desired effect of speeding up roll-out.
Despite promises that rent would not reduce by more than 40%, many community sports grounds, churches and local authorities that host phone masts have had their rents cut by up to 90% or even 95% in some of the cases that we have already heard about today. That will be further exacerbated by the Bill, which hands more power to the telecoms companies in court and disincentivises people from coming forward to have phone masts put on their land in the first place. [Interruption.] The right hon. Member for New Forest West (Sir Desmond Swayne) looks like he is itching to come in on that point.
Sir Desmond Swayne
The hon. Member for St Albans (Daisy Cooper) intimated that people would want to take their land back as a consequence of the changes. I hope that she has identified that that is not possible. People will not get their land back unless they are going to develop it, and even then, they would have to go to court to get it.
Lucy Powell
The right hon. Gentleman is absolutely right that the Bill and the previous code mean that those cricket grounds, sport clubs and churches in all hon. Members’ constituencies that had phone masts put on their property in good faith to give them income that they would not otherwise have, which in many cases keeps them going, have been offered dramatically reduced rents but are forbidden by law from taking the masts down. They are between a rock and a hard place. It will put many of those community groups, and the roll-out, at risk.
There is a real risk that the Bill will hamper, rather than support, faster broadband and 5G roll-out, so what assessment has the Secretary of State made of the effect of the 2017 changes on rent levels and on the speed of roll-out? Given that previous reforms to the code have resulted in no demonstrable improvement, what makes her think that strengthening the hand of telecoms firms will speed up the roll-out, rather than simply allowing them to increase their profits further? I think that is the thinking behind the now not-selected reasoned amendment tabled by the right hon. Member for New Forest West, with which I have a great deal of sympathy.
The Opposition support the broad approach of the Bill, but the security measures are too little, too late and are behind the technology curve rather than in front of it.
Ruth Edwards (Rushcliffe) (Con)
I am listening to the hon. Lady with interest and I think that security is an issue on which we can work across the House. What specific measures from the 2018 “Secure by Design” guidance does she think should be included in the Bill but are not at the moment?
Lucy Powell
I am coming to the end of my speech, but there are a number of issues that could have been included in the Bill, some of which I have outlined. There are security issues, and there are new waves of technologies that are not in the Bill’s scope; as the Secretary of State rightly pointed out, they are coming on us really quickly. Bills like this one tend to come three or four years behind the technology, rather than ahead of it. That is what I would like us to work together to address.
In conclusion, we fear that these telecommunications infrastructure measures could further hamper the Government’s pretty woeful record on broadband and 5G infrastructure.
Sir Desmond Swayne (New Forest West) (Con)
I have been asked to vote for some pretty awful stuff over the past couple of years, but this has to be the most profoundly un-Conservative measure. It will compound the damage that was done to rights of property in 2017, and the proposal to amend the Landlord and Tenant Act 1954 will extend that damage to other walks of our national life, fundamentally undermining our position as a stable and predictable place in which to invest.
The digital roll-out has been stymied by changes that have brought about the very reverse of what was originally intended with the changes to the code in 2017. As a consequence, our constituents have been intimidated and bullied.
I have a constituent who refused a survey—she did not want a mast, because it would compromise her existing enterprise—but caved in when she was threatened with court action. Then, when she refused the terms of the mast, she was presented with statutory orders requiring access for both a temporary and a permanent mast. Of course, getting legal advice comes at an enormous cost. Happily, New Forest national park authority has thrown out the applications for both masts, but the battle, the uncertainty and the cost continue.
I have a group of constituents in a block who have let their collective roof for an antenna over the past few years and received an income, but have now received a demand with menace for a dramatic reduction in the income. They are having to deal with a demand for a 30-year lease of their entire roof. It is really quite extraordinary how the terms of trade have been rigged against landowners.
The Secretary of State presented the matter as if the problem were the landowners—as if we have to find ways of getting landowners to become more reasonable. When I had a meeting with the Minister for Media, Data and Digital Infrastructure, she reassured me with the alternative dispute resolution process, which we have heard about from the Secretary of State today. The problem with that procedure is that it is not mandatory. The telecom companies know that they do not need to engage with it, because they can afford to go to court and their victims cannot. That is the difficulty—that is the outrage that we have created.
It is no wonder that the whole roll-out has stalled and that no one wants to give access for a mast, because the income is not worth it and the consequences are frankly deplorable. Small farms, churches and small sports clubs used to have an income, but it has now crashed and they have all the uncertainty and inconvenience of continuing to host a mast. As I pointed out in an intervention on the hon. Member for Manchester Central (Lucy Powell), there is no prospect of getting their land back without court action and development.
Simon Hoare (North Dorset) (Con)
Sports clubs, parish halls, village halls and the like have seen a real depreciation in their income because of non-use as a result of covid, so does my right hon. Friend agree that this is precisely the worst possible time for an enforced reduction in their income? Many of them will have hard-baked an expectation into their future financial forecasts.
Sir Desmond Swayne
Of course, and these are the very people—the hearts of our community—who are now identified as the villains whom the Bill creates more power to bring to heel. It is the most monstrous piece of legislation that has been brought before us, and we should deal with it accordingly. We had a functioning market in 2016, and in 2017 we brought in measures. Whitehall has destroyed that market, egged on by rapacious telecom companies, and this Bill will make it even worse.
John Nicolson (Ochil and South Perthshire) (SNP)
In 2016, the need for regulation on product security became undeniable when huge swathes of the internet went down. This included websites such as Netflix, Amazon, Twitter, Reddit and Airbnb. The attack was conducted by a botnet, an interconnected series of programmes running on a huge number of hacked devices, which overloaded the web providers with requests for access. However, unlike previous or more conventional attacks, this one did not emerge through laptops and computers. This attack came through domestic appliances. I am sure that this will sound completely ridiculous to the many people gripped by this debate: the revenge of the malevolent toaster.
The internet of things is a term given to physical objects that either have processing power or are connected to the internet, such as home security measures or even lighting. When we think of cyber-security, it is natural to think of the precautions we take when using our phones and computers, especially around personal data and online transactions. What is less well known is the risk that poor product security can have. Attacks on internet-of-things devices rose 100% in the first half of last year, and it is a worldwide problem. In the UK since the beginning of the pandemic, 49% of people have purchased an individual smart device and 57% have increased their use of internet-connected devices, yet worryingly, only one in five internet-of-things manufacturers is believed to have embedded strong security into their devices. I want to praise Which? for the excellent work it has done for consumers in investigating this sector.
As we have seen in our inquiries into tech in relation to the Online Safety Bill, it is necessary for Government to intervene, as companies will often do the bare minimum to protect users. As with online safety, one of the core solutions to product security is the principle of secure by design. It is good to see the UK Government acting to embed this principle in law, following on from the Scottish Government’s cyber resilience strategy’s aim to enshrine security by design as a foundation principle of Scotland’s cyber landscape. On the SNP Benches, we are glad that the UK Government have finally taken action on this, but there are some areas where the Bill falls short, and there is the potential to make some aspects of product security less effective.
One area of concern is that the Bill will require manufacturers to declare security flaws in their products publicly, without having a mechanism in place for automatic fixes or requiring that a fix be in place when the flaw is announced. This could make users less, not more, secure. The requirement could in effect alert hackers and malicious users to flaws without giving users the tools to fix the weaknesses, thereby ringing a bell for hackers to target those products. It has been highlighted that a majority of users will likely not have the skills to implement patching, so the benefit of the disclosure mandate, without automatic patching in place, would be without value. The Minister should look to implement requirements for automatic patching or for manufacturers to put solutions in place before the time of a public flaw disclosure.
Another oversight in the Bill is the exclusion of certain types of products, leaving millions out of scope. Internet-connected ovens, which have been targeted by malware, shutting down entire businesses, medical devices, routers and second-hand products, are all excluded from the scope of the Bill. The Bill should clarify which products are in or out of scope. Additionally, the Bill does not cover laptops or desktops, due to the existence of a developed antivirus and security software market. However, a mere 58% of people in the UK use antivirus software. Martin Tyley, head of cyber-security at KPMG UK, has called for the inclusion of laptops and desktops in the scope of the Bill, to protect the increasing number of home workers who have been targeted since the pandemic began. Even with its current flaws, which I hope the Government will be able to iron out, the Bill attempts to tackle an important aspect of cyber-security. However, this should be part of an holistic IT security approach that is taken to defend the UK’s cyber-security landscape.
I would like to mention the enforcement mechanism in the Bill. Section 26(5) makes it clear that the Secretary of State will not be able to bring proceedings in Scotland, but the Bill will still establish enforcement mechanisms and a body to carry out enforcement actions under it. As the Scottish courts and legal system will have to manage enforcement action brought in Scotland, and oversight of the Scottish legal system is devolved, it is only right that the Scottish Government have a role in developing the enforcement mechanism. Therefore, I ask the Minister to consider amending the Bill to include a duty to consult the relevant Scottish Ministers when developing the enforcement mechanism and the security requirements that are to be enforced, so as to account for the requirements of the Scottish legal system.
I also seek clarity from the UK Government on what impact the passage of the Bill will have on the powers of the Scottish Government to regulate products in Scotland. We welcome, in principle, reform of the code. We are working with civil society partners to identify ways in which the Bill can be improved in its passage.
I would like to raise one further issue. BT has highlighted Openreach’s commercial plan to upgrade 6 million properties, all of which will need agreement in order to upgrade them from the copper network. Without more ambitious reform, Openreach risks not being able to access up to 1.5 million flats, even in cases where residents want full fibre. According to BT, the Bill as it stands will not support improved connectivity to flats or rural areas, where most of the network is built above ground.
The need for a fast roll-out must be balanced with the rights of landowners, such as farmers. As we have heard, some campaigners have raised concerns about the rapid drop in rents faced by businesses hosting masts—some by as much as 90%. On this and other issues raised, I look forward to the Minister’s answers.
Selaine Saxby (North Devon) (Con)
It is a pleasure to speak in another debate on improving the nation’s connectivity. My hon. Friend the Minister is well aware of connectivity issues in places such as Ilfracombe in my constituency, as has been so well documented recently, so I very much welcome the steps that the Bill is taking to begin to address some of the issues that have slowed down infrastructure deployment.
I am chair of the all-party parliamentary group on broadband and digital communications. We produced our own inquiry into the electronic communications code in November last year, and we are so pleased to see some of our recommendations materialising in part 2 of the Bill, focusing on telecommunications infrastructure. It is on part 2 that I will focus my comments.
The Government set a manifesto commitment to improve the UK’s broadband connectivity—a manifesto that I was proud to stand on, having heard on far too many doorsteps back in 2019 about my constituents’ connectivity concerns. The telecoms sector has experienced lengthy delays in securing access agreements since the electronic communications code was reformed back in 2017, and the Bill clearly intends to help speed up the deployment of this vital infrastructure. It is therefore warmly welcomed, in the main, by me, industry and the APPG alike.
One of the asks from our inquiry was to have a clear distinction between fibre and mobile infrastructure. It is important that the code works for both, and mobile operators welcome the Bill, which will accelerate the deployment of 4G and 5G. The new code had led to significant delays in reaching agreements with landlords, particularly where operators need to renegotiate leases as they expire, or where additional equipment needs to be added in order to upgrade or share sites to improve the service. The Bill before us seeks compromise between industry and landlords, while noting concerns in rural Britain among organisations such as the NFU, so well articulated by my right hon. Friend the Member for New Forest West (Sir Desmond Swayne).
Sir Desmond Swayne
Does my hon. Friend support making the alternative dispute resolution procedure mandatory?
Selaine Saxby
My right hon. Friend makes a noble point, to which I will allow our hon. Friend the Minister to respond.
I recognise the need to balance competing interests carefully. The single greatest barrier the fixed infrastructure sector faces in the code is obtaining wayleaves and protracted negotiations with unresponsive landlords. To deliver in rural constituencies such as mine, large numbers of wayleaves to cross private land will be needed, which is seen as a risk to Project Gigabit’s success in rural Britain. Landlord negotiations to gain access to multi-dwelling units have also been problematic. The industry warmly welcomes the provisions of the Bill that would fast track wayleave negotiations via the alternative dispute resolution scheme, which will help to level up islands of poor digital connectivity, which too often centre on social housing stock.
Sharing historical wayleave agreements and the underground duct network is also warmly welcomed, although concerns remain about whether the Bill is intended to address the problem of accessing poles situated above ground on private land, which is a particular concern in rural communities, where much of the network is built overhead on poles. I hope that clarity on that point will be given as the Bill proceeds. There is also concern that the Bill does not address automatic upgrade and sharing rights of existing infrastructure, either inside blocks or flats, or overground on poles.
The pandemic has clearly showed how vital connectivity is to all our communities, as those without good broadband have struggled with so much during the pandemic. Too many schoolchildren have explained to me the problems of the circle of doom, so I thank Openreach again for coming to the aid of some of my more rural primary schools and expediting their broadband connection; but I remain concerned that this piecemeal approach to connectivity and the focus on competition in urban conurbations is reducing fibre access altogether in rural Britain. If we are truly to level up our rural communities, speeding up our digital roll-out to them is vital.
Given that my constituency resides at position 607 out of 650, I am sure the Minister is not surprised to find me here again, asking for more to be done across the north, and indeed the whole, of Devon. In this day and age, fibre broadband is a utility, and there should be universal provision. Rural constituencies such as mine should not be left behind to facilitate market competition in our towns and cities. The Bill is a great step forward, and I hope that some of the industry’s concerns will be addressed as it proceeds. The Secretary of State has clearly noted my campaigning, as has the Minister, so I very much hope it will be rewarded with faster rural roll-out than is currently planned in North Devon, before any other visitors to my lovely constituency find themselves in an all-too-readily-available North Devon notspot.
Ruth Edwards (Rushcliffe) (Con)
I start by declaring my interests. Much of my previous career was spent in the cyber-security industry, and in the four years before being elected to Parliament, I led commercial strategy and public policy for BT’s cyber-security team. BT was one of the companies that helped to design the Secure by Design code of practice, some of which we are putting into law through the Bill. Also, I have recently undertaken cyber-security work for MHR, which is set out in my entry in the Register of Members’ Financial Interests, although the company does not produce consumer devices, connected or otherwise.
In some ways, cyber-security was good preparation for politics—for example, waking up to nightmare headlines such as,
“Attack of the refrigerators! The cyber-threats lurking in your home”
and
“Is your smart TV too wise? The FBI warns your screen is watching you”
and
“HACKED IN THE HOME: Your entire home could be HACKED with these simple mistakes, cyber-experts warn”.
Perhaps the most disturbing one I have seen is:
“Hacker who stole nude self-portraits of George W. Bush jailed for four years”.
I am all for being tough on crime, but surely in that case the perpetrator had already suffered enough.
Alarmist headlines aside, the Bill is very much needed to protect our constituents. The average UK household has nine connected devices, and the security on most of them will be poor. Information about how secure the devices are, or how long they will receive security updates for, is unlikely to have been provided when they were sold. What are the risks? There is a huge impact on our constituents’ privacy. Your TV really could be watching you. Two years ago, footage stolen by hackers from home security cameras in Hong Kong was sold to pornographic websites—a huge invasion of people’s intimate private moments. There are numerous reports of baby monitors being hacked by paedophiles.
There is also the danger of hackers using a fairly innocuous connected device as a gateway to jump to other devices and steal valuable information. An infamous example from the business world is the attack in 2013 on Target, one of the top five retailers in the US. Criminals gained access to its network through a supplier connected to an external vendor portal. They then stole the details of 40 million customer credit and debit cards. The supplier just provided air-conditioning. The total cost of the cyber-attack was more than $200 million. That is one hell of an expensive air-conditioning bill. There was also an attack on a casino, where hackers gained entry to the network through the thermometer of a fish tank.
Once they have a foothold in the home, hackers can access other devices that are not properly secured. There is a real danger that sensitive information relating to a constituent’s health or their financial information could be compromised, but how common is that really? Is it just a case of a few alarmist headlines? The consumer watchdog Which? ran an interesting experiment last year. It set up a smart home with a range of consumer devices, from kettles to thermostats, televisions and security devices, all connected to the internet. It experienced 12,000 hacking or scanning attempts in a week. At one stage, it experienced up to 14 hacking attempts an hour. We have a problem, therefore, but not a problem of which many people are aware. A recent report that surveyed 2,000 UK consumers found that people were largely unaware of the risks. Some 48% of respondents were not aware that hackers could hijack their connected devices.
Unsecured consumer devices are also a real risk to our digital infrastructure. Hackers who control connected devices can harness their collective power into a botnet—a network of devices that can be used to launch denial of service attacks on our digital infrastructure. The Secretary of State referred earlier to the Mirai botnet. What is interesting is that it is thought to be the first botnet to harness the power of insecure consumer devices or the internet of things. At its peak, it had about 600,000 devices—baby monitors, radios, cameras—at its beck and call. You and I would not necessarily have noticed it, Mr Deputy Speaker, until the day it launched an attack on the domain name service provider Dyn in 2016. In doing so, it took out Netflix, PayPal, Amazon, Visa, Reddit and Airbnb for the best part of a day.
Contrary to some of the claims we have heard from those on the Opposition Benches, the UK has always been a world-leading cyber-power. Back in 2011, we were one of the first countries in the world to publish a cyber-security strategy. It recognised the risks and opportunities that cyber-security brought to nation state relationships, critical infrastructure, business, consumers and society as a whole. We have always been out in front when it comes to protecting people, businesses and critical infrastructure.
In the 2016 refresh of the national cyber-security strategy, the Government moved from relying on a market-based approach to protect consumers, to a more active role through the UK’s active cyber defence programme, which makes the infrastructure of the UK’s internet more difficult for cyber-criminals to exploit. It does that through measures such as improving the security of internet protocols—the method by which data is sent from one computer to another—and domain name system filtering that blocks access to sites known to host malware, such as phishing sites. The 2016 strategy also committed to publishing guidance on how to improve the default security of consumer products. There are three measures on that in the Bill. As we know, it forms the basis of similar codes used in India and Australia, but it also forms the basis of the first global technical standard for consumer cyber-security products. So far from being behind, the UK is the leading country in the world on this issue.
As has been set out, the three measures put forward are: banning default passwords; implementing a vulnerability reporting scheme; and informing consumers how long a product will receive security updates for at the point of sale. They are really necessary because, I am sorry to say, we have not seen the response from industry that we should have. Too many manufacturers are still not taking responsibility for ensuring their products have the basic security that our constituents need. Too many still shunt their security responsibilities on to the users of their products.
We need to call time on this. The digital economy is growing and holds huge opportunities, but those who benefit from its growth should also be investing in the safety and security of its users. We are still, in my view, only on the cusp of the fourth industrial revolution, the fusing of our digital and physical worlds. Cyber-security needs to be a part of that revolution to ensure that the inevitable risks are outweighed by the opportunities.
Matt Warman (Boston and Skegness) (Con)
As the shadow spokesperson, the hon. Member for Manchester Central (Lucy Powell), said, this is a technical Bill, but it is hugely important and will make a real difference. It will build on the incredible speed of the gigabit roll-out programme—up to 65% from just 11% two years ago. That is, whether she likes it or not, the fastest roll-out in the world, delivered under the Minister, and indeed under her predecessor—but I will leave that to the rest of the House to judge. She is right, however, to say that we should be doing everything we can to go as fast as we possibly can. I humbly submit that setting the large number of broadband providers that operate in this country in competition against each other to get as much of the country connected as possible, is one of the ways that is delivering that incredible roll-out speed and I think she should welcome that.
None the less, it is important to make sure that the operators that seek to deliver the roll-out are able to access the land they need. My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) made a passionate speech, possibly one that none of us was expecting in this kind of debate, in defence of landowners. Landowners are a crucial part of getting the roll-out right, but I say gently to him that there has been an incredibly successful lobbying campaign on behalf of those landowners, who, for a very long time, have had a very good deal. The 2017 proposals to cut the amount of money they receive, bringing it in line with other utilities—we could argue about whether broadband is technically a utility—was absolutely the right thing to do. It is what will speed up the roll-out programme.
Matt Warman
I will let my right hon. Friend intervene in a minute. He talked about the benefit to landowners. When we get the roll-out right and get masts at as many locations as possible, the benefit accrues not to landowners primarily but to all the communities that live around them. That is where we should be focusing, not primarily on the small number of landowners who are concerned.
Sir Desmond Swayne
I am only interested in the lobbying of my constituents who have been so harshly affected. We have heard the stories of the 90% and 95% reductions in income. This has made things very much less expensive for the companies concerned. Where has that money gone? It has certainly not been invested in the programme.
Matt Warman
My right hon. Friend does not make a wholly unreasonable point, but ultimately that money is going into an incredibly rapid roll-out of 5G. In rural areas in particular, we are seeing the industry putting in half a billion pounds of its own money alongside half a billion pounds of Government money to get to some of those hardest to reach places, so I fundamentally do not accept his premise, which is that the industry is not investing as it should. I would like the Government to go even further to see even more investment. He is right to focus on some of the small areas that rely on this income. However, that cannot be the main economic driver for the roll-out of 5G.
Simon Hoare
Does my hon. Friend accept that the reverse seems to be happening and that the roll-out seems to be slowing down? Does he also accept that this is a rather mature market of providers in an increasingly profitable arena, with ever-greater demand for their services from a growing population? Therefore, it may be worthwhile revisiting this de-incentivisation—obviously that was not the intention but it seems to be the result—to see whether restoring the proper remuneration that people had expected may speed up this much-needed roll-out.
Matt Warman
Ultimately, I think reducing it in the predictable and long-announced way is what will speed up the roll-out. However, to give my hon. Friend and my right hon. Friend the Member for New Forest West, who is no longer in his place, a little succour, the industry should be on notice that if the currently voluntary dispute resolution system does not work and does not deliver fair settlements, perhaps the Government will think about giving the system some more teeth. There is a balance to be struck, and this Bill strikes it in the right way. However, there is another step that one could take.
Simon Hoare
My hon. Friend is being characteristically generous with his time. We had this sort of debate about the water companies and sewage. Unless their toes are held to the fire, they will exploit a system—I do not criticise them for so doing—for as long as they can. If the Government were more robust in bringing this forward as a clear commitment and making it binding and obligatory, that might help unblock the logjam.
Matt Warman
Ultimately, I simply say, from a Conservative standpoint, that I would like regulation to be as light touch as possible. This is the right step down that road. It may be necessary to be more robust, but we are not there yet.
Moving on to “secure by design”, my hon. Friend the Member for Rushcliffe (Ruth Edwards) asked the Opposition which of the other 13 points they would bring in. This Bill introduces three of them, and they are immensely welcome, but they are the lowest hanging fruit when it comes to cyber-security. I would not jump immediately to all 13, and the world has somewhat moved on since the 2017 report to which she referred, but there is a clear direction of travel. I welcome how the Government are introducing the proposal, but the industry should be looking at what more there might be to do.
Finally, my hon. Friend also talked about cyber-security in a much broader sense than this Bill. A huge number of businesses will rely on cyber-security professionals in future to ensure that they are provided with the kind of security that they need and that which their insurance companies’ policies might require to guard them against the potential costs of hacking. In due course, some of the people operating in that profession will require greater regulation. The UK Cyber Security Council, which the Minister oversees, is welcome, but further regulation, perhaps in the manner of the Bar Council, is what will allow the cyber-security profession to grow, flourish and continue to preserve Britain’s place as a world-leading cyber-power, which we all want. This Bill helps us to get ever closer to that goal, and I commend it to the House.
Siobhan Baillie (Stroud) (Con)
I applaud the Government for the energy they are putting into trying to improve our connectivity. There are undoubtedly still notspots in my rural constituency. Having Zoomed constantly in my River Severn village throughout the pandemic, I find that the pizza wheel of doom—when the tinternet is struggling and people freeze in strange positions—is no longer funny; it is just annoying. I recognise that improvements are needed, and I see what the Government are trying to do, but many of my constituents are experiencing a David and Goliath situation, which I am worried about. That is where I will focus my comments.
Trying to deal with the might of the telecommunications companies is a pretty scary feat for any constituent, even before some of the tactics that I have sadly seen deployed. In my short tenure as Stroud’s MP, since the 2019 election, I have dealt with a number of mast issues; some people are amazed by how many mast issues have come up locally. I will summarise a couple. The Minister has been kind enough to look at case studies in my area. There have been issues with masts in Painswick village, where, sadly, Stroud District Council infamously missed a deadline that effectively led to permission being given by default on a controversial site. That matter rumbles on and has caused a lot of upset and stress for neighbours and the landowner. I understand other councils in the country have faced this issue.
There have been local applications in little villages in areas of outstanding natural beauty that effectively rely on terrifying elderly landowners. A village clubbed together to get professional advice to support a landowner to deal with that. A Stroud farmer currently receives a £10,000 annual rent payment for an existing mast but has been offered a significantly lower amount. We know that farmers struggle to make ends meet and that the Government are telling them to diversify, so these incomes can be fundamental to getting food on their own tables, let alone putting food on ours. Negotiation is limited—this farmer is a big, burly guy who does not feel bullied and told the company to take the mast away—but it goes on and on, and he does not feel like he is in a strong position.
If the Bill relies on the courts for remedy, I believe the roll-out will continue to stall. Courts are the remedy only for those who can afford it. Disputes have drastically increased, as have stress, frustration and anger, since the 2017 changes, and I fear it will get worse. The electronic communications code—this is a bit more technical—grants code operators the right to access land to install and maintain apparatus and to seek such rights to be imposed by the courts where agreement cannot be reached. One key change introduced in 2017 was to modify the pricing mechanism that the court should apply; as we heard, there has not been a proper look at pricing and valuation, even in the consultation on the Bill. The pricing mechanism was changed from market value to realign it along similar principles to compulsory purchase—we all know how painful compulsory purchase has been for many of our communities, not just Stroud—with statutory assumptions to place the valuation in the no-scheme or network world. That change was against the findings and recommendations of the Law Commission, and effectively of Nordicity and Analysys Mason, which is beyond my pay grade but I am told is important.
We are now in a situation where code operators typically portray landlords as a grasping group who cause delay to hold them to ransom for more rent. That is not my experience. Where code operators seek to acquire new sites, there are a range of different reasons why challenges are put up by constituents, local villages and local communities. I will give a few of the common themes I have come across. High on the list is the potential effect on, or conflict with, the landlord’s own use of the wider landholding and other tenants’ activities. The potential impact on the landlord’s own future development aspirations and the visual impact of unsightly and often poorly designed electronic communications apparatus on the wider landholding or host building are high up the list before rent comes into it, along with: adverse impacts on neighbours or disputes with neighbours about a mast going up; adverse effects on the marketability of other land or buildings; adverse impacts on the investment value; structural issues and future maintenance of a building or structure on the site; the extent of extended health and safety or drop or fall zones; and the implications of further development granted as permitted development. All those are on the list. It is not just about rent or money.
Stroud constituents inform me that the code operators have sadly proved generally insensitive and unsympathetic to addressing such issues. Instead they have interpreted the ECC changes as granting them rights over any third-party land almost for free and on terms that they can dictate, so that they can do almost anything at any time. It is that mindset of entitlement over private rights, and the blinkered belief that digital communications are the only important thing, that are influencing decisions.
The code operators are looking to acquire large numbers of sites and to renew hundreds of leases. Given the process-orientated targets internally, no doubt the resource is driven by objectives and milestones, and less by humans—the people it affects. I fully accept that we are thinking about humans all over the country when we are trying to improve connectivity, but I worry about the balance. Bullying local people is not acceptable. No matter how much my Stroud constituents want faster this, that and the other—and, in many cases, how much we need connectivity actually to work—they do not want their neighbours to be bullied and they expect Government legislation to protect the weaker party. By any analysis, it is usually the constituent landowner, not the telecommunications organisation, that is usually the weaker party.
Local councillors tell me that they feel pretty impotent on this issue. Constituents do not feel that their local councils have any power, so there is a disconnect between who they feel protected by and the changes with the legislation. I will give the House a bit of an overview of the process that constituents have outlined. Mr Deputy Speaker, please shout or nod at me if you want me to wind up, because I realise that I am taking some time, but these are important points.
The process starts with a landlord being approached by a site acquisition agent—not necessarily a well-known company—seeking access to land to undertake a survey. That request is then accompanied by a threat, effectively, to gain access via an application to the upper tribunal, and this is pointed out as almost impossible to resist, with the likely cost of a vast sum of money to the landowner in the case of resistance. I am thinking not about my big burly farmer, but about the elderly landowner who is worrying about this. Access is often granted unwillingly, which confuses neighbours and starts arguments locally. A survey is then undertaken and the landlord is sent a set of heads of terms, sometimes with an imploding offer of capital payment if they are agreed within a short period. Without any real attempts to negotiate or listen to concerns raised, notices are then served under the ECC, which cock the gun for reference to an upper tribunal again for the imposition of an agreement.
Sir Desmond Swayne
I thank my hon. Friend for so clearly summing up the process of what the Secretary of State called “community engagement”.
Siobhan Baillie
I only wish I was as beautifully dramatic and exciting as my right hon. Friend when I spoke. I am conscious that I am reading a list to the Chamber, but it is an important list because it shows the experience of so many constituents. It may be dull, but it is scary, and it is a very worrying time for our constituents.
If residents and businesses are lucky—some of my constituents have been—it is usually at around this stage that they instruct professional support, because they are so worried. They start to think about how to object to the application. It is pretty late in the game—a long way down the track—but often people do not realise that it is an option and a lot cannot afford it. However, I am being told that people are successful in getting the applications refused in most cases where professional support is provided.
The lack of investment by the code operators in good-quality design, and the lack of mitigating features such as screening or structural landscaping, reflect the arrogant assumption that they can simply pass on societal costs of their development to the public at large, while simultaneously claiming that planning is a barrier to deployment. All those things are often lost in that long process before we get help to understand what really should be brought into the planning applications.
It is clear that, where planning permission is granted, landlords come under the real threat of a reference to the upper tribunal, and given the extremely high costs of litigation, quite a lot of people will fold at that point, regardless of the merits of their case. I have to believe that the code operators do not set out to behave in an egregious manner. I have met so many staff from telecommunications companies who come to consultations, and they are good people who want to find solutions, but time and again, these are programmes that the agents, acting on their behalf, are running through. My fear is that the totality of the changes we are looking at now, far from redressing the balance of power, will tip the scales further in favour of the code operators. As a consequence, the proposed changes in the Bill will actually exacerbate the marketplace issues being experienced, even if they try to resolve some of the legal anomalies.
I fear that we have lost sight of the mission, which is how best to deploy networks in the most appropriate places. We are trying to fix the issues we have experienced since 2017 with a piece of misused and, in effect, abused legislation that was supposed to be used as a last resort, but is now very much used de rigueur by the companies. I do not think that is the way to make improvements for the landowners and the companies, nor is it a way to roll out the improvements the country wants to see.
I want to know from the Minister how the Bill addresses what has become the main issue with the framework, which is the way costs fall on landowners and have in effect become the latest bludgeon to beat them with. The cost of seeking advice is high and will often far outweigh any consideration that is offered, even over a 10-year period. Whatever the merits of the landlord’s position, to contest any matter in the courts is very costly, and the extreme costs associated with losing mean that few but the largest with much at stake will be able to take that step, as I have mentioned. However, I think we have to keep hammering the point home.
I want to know, given that we have the experiences of things such as the water companies and the environmental fights happening all over the country, and given that we know that the Human Rights Act 1998 and article 6 provide the right to a fair hearing, why we are not seeking to strengthen the alternative dispute resolution option and thinking about making it mandatory. I disagree with my hon. Friend the Member for Boston and Skegness (Matt Warman), who is learned, in that I do not see why we should wait to see if the measure fails before we make improvements that will support everybody to achieve the goals.
Finally, I was really disappointed that we have not worked harder to think carefully about the valuations. The information coming forward is that it is not about a slight chunk off what there is already or even an attempt to rebalance the ability to look at utility companies; the offers coming out to people with masts on their land is a dramatic change. It does not feel fair and will not achieve the goals, and I would like to hear from the Minister whether we can take another look at the valuation structure.
This has been a negative speech, but I thank the Government for the work they are doing. However, I think we can do better for everybody involved, and by doing better we will achieve some serious connectivity throughout the country, particularly in rural areas.
Edward Timpson (Eddisbury) (Con)
I am conscious that I am the last Back-Bench speaker in the debate, and I see a number of hon. Members who have shown a late curiosity in it over the past few minutes, so I will try to keep my remarks as pithy as I possibly can.
I will confine my contribution to part 2 of the Bill, on the changes to the electronic communications code and, in particular, the Government’s measures to improve digital connectivity and meet their target of delivering gigabit-capable broadband to 85% of UK premises by 2025. I think it is fair to say that we have made real strides in that direction, underpinned by the universal service obligation. Locally, we have Connecting Cheshire, the BDUK delivery partner, working to ensure that that is being met; the gigabit broadband voucher scheme, which I know many of my constituents have taken advantage of; and more recently the addition of Cheshire to Project Gigabit, which will hopefully mean that we secure more of the significant funding that has been committed to that project.
I argue that Eddisbury is a good test bed from which to judge the success of the Government’s commitment. It is the 92nd largest constituency geographically, and 57.9% of it is classed as rural. It is 599th out of 650 constituencies for superfast broadband coverage. Some 23.5% of my constituents are aged 65 and over, against the national average of 18.6%. As we know, isolation is an issue for that age group, and therefore digital connectivity is particularly crucial. We also have a high number of small businesses scattered across the constituency. Some are run by people from their home, not least the many farmers in Eddisbury, or from a local commercial building, so the roll-out of gigabit-capable broadband is fundamental to the whole of my constituency and the local economy moving forward.
For all those local residents and businesses, reliable and resilient broadband and mobile coverage of a more than decent speed has become ever more essential, accelerated, as we know, by the covid pandemic. Simply put, as my hon. Friend the Member for North Devon (Selaine Saxby) said, it is now one of life’s necessary utilities. It is therefore pleasing to report that in Eddisbury we have seen significant improvements in our broadband infrastructure. I pay tribute to my hon. Friend the Member for Boston and Skegness (Matt Warman), who did some sterling work to try to make those figures move in a very positive direction. We now have 89.7% of premises with superfast broadband availability. Some 56.2% are gigabit capable, which is up 15% in the last year alone, and I think up from just 7% in 2018.
However, as we have heard, there is still much to do, particularly in the many villages and rural areas of south Cheshire. For example, 9.4% of premises in Eddisbury receive broadband speeds of under 10 megabits per second, compared with 6.4% across the whole of the north-west. Since my election in December 2019, I and my staff have dealt with more than 100 cases of poor connectivity raised by frustrated constituents. The local survey that we carried out on the issue revealed that 55% of those who took part felt that their broadband provider did not meet the level of internet speeds that it had advertised in its plan. Respondents also fed back frustration about the real difficulty, and exasperating delay, in reaching agreements that allow for fibre cables to be laid across private land to connect properties—a frustration that the Bill seeks to address.
To give the House a short local example, there are 12 properties in a semi-rural location that sit between two areas where fibre has already been installed. Their broadband is delivered through copper telephone lines at very slow speeds of between 1 megabit and 5 megabits per second. In 2019, BT Openreach considered installing fibre as part of a wider project in the local area, but subsequently withdrew because of the incessant delays in obtaining wayleaves. To compound the problem, Openreach has estimated the cost of installing fibre via trench in fields adjacent to the lane that the properties are located on to be £55,000—a sum well beyond the amount that could be raised through the gigabit voucher scheme. In any event, both BT Openreach and Connecting Cheshire have, for some as yet unexplained reason, deemed that the 12 properties are not eligible for the vouchers. As a consequence, we have a stalemate. My team and I are doing all that we can to unlock the impasse, including on potential top-up funding and inclusion in the Airband project. I ask the Minister what assistance she and her team may be able to provide to ensure that those in the properties get the broadband that they want, although it may well be that without this legislation a solution may be a long way down the track.
I support the proposed reforms to the electronic communications code that include the introduction of a faster procedure to allow telecom operators to get temporary rights to access and install infrastructure on land, as well as the sharing of equipment as part of any upgrade. In doing so, I am of course mindful of, and have sympathy with, the concerns raised by a number of Members, including my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) and my hon. Friend the Member for Stroud (Siobhan Baillie), off the back of the 2017 reforms that resulted, in some cases, in reductions in rents for hosting infrastructure, which can affect the resolution timeframe.
As we have heard, those issues were not revisited in the 2021 consultation, and I think that many of us would like some reassurance from the Minister that the Government will continue to monitor the issues of both valuation and dispute resolution in order to understand the consequences of the changes in the code arrangements. That will ensure that my landowner constituents feel they are getting the right value for their commitment, while my local residents can expect to have their gigabit broadband as quickly as possible.
Overall, this is an important Bill, bringing about the ever more pressing digital connection of our entire country. In Eddisbury we are taking significant steps in that direction, but there remains much more to do, and to that that end—with the help of the Bill— I will continue to do all I can to make it happen.
Chris Elmore (Ogmore) (Lab)
It is a pleasure to close this Second Reading debate. The first job of any Government is to keep their citizens safe, and I am glad that the security elements of the Bill were developed in conjunction with the National Cyber Security Centre and the Department. Her Majesty’s Opposition have the utmost confidence in our national security services, which go to such incredible lengths to keep us all safe in an increasingly difficult online world.
A number of speeches have been made by Members on both sides of the House, but let me deal first with what was said by my hon. Friends the Members for Ealing North (James Murray) and for Luton South (Rachel Hopkins), both of whom spoke about the notspots in their constituencies and the increasing problems with access to tech. People may have the “plumbing” that can provide a good standard of broadband, but they may not have, indeed may not be able to afford, the equipment that would give them access to it.
We in the Labour party put security at the heart of everything we do, and it is owing to that desire to see people in this country safe in cyber-space that we will not oppose the Bill. However, there are issues that we feel should be addressed in it, some of which have already been mentioned today.
The product security measures in part 1 contain proposals that Labour fully supports. They include a ban on devices that come with easy-to-guess passwords such as “default” and “admin”, and oblige firms to make such vulnerabilities public knowledge, with those failing to comply being threatened with large fines. That is especially prudent as it institutes common-sense rules for sellers to follow, and ensures that consumers are more engaged in cyber-security. Basic cyber-hygiene is paramount, and measures such as changing default passwords would do a great deal to improve devices’ security by, in theory, adding an additional layer of protection. However, we agree with many in the industry that certain measures could have gone further, and we will continue to hold the Government to account in the areas where we believe that to be the case.
While the pursuit of increased security on devices is laudable, there are concerns about the practicality of such changes. If each device is now legally bound to have a private password, who will be responsible for managing it? Given the plethora of smart devices that we all use, I am sure that we have all forgotten a password or two; I certainly have. If a device needed to be repaired and the user had forgotten the password, how would the specialist repairing the phone gain access? Many in the industry believe that that could potentially lead to a situation in which manufacturers might have to provide “super-user accounts” or “backdoor access”.
The Bill also introduces the mandating of manufacturers to tell consumers at the point of sale about the product’s lifespan and for how long it will receive security updates. While we can all agree that more transparency is a good thing for customers, if security updates are available for a few years—as is the case with Android phones, for example—surely that will lead to built-in obsolescence, meaning, in this case, smart devices being excluded from key security updates after a relatively short lifespan.
Ruth Edwards
The point is that the companies providing the devices will stop giving out security updates anyway. All that the Bill is doing is ensuring that users are informed of when that will happen. It is not forcing in any obsolescence; it is merely giving consumers choice by enabling them to know when those security updates will be stopped.
Chris Elmore
I take the hon. Lady’s point, but not everyone can afford simply to keep on replacing their technology. [Interruption.] I gave way to the hon. Lady, so she should at least give me the courtesy of allowing me to respond. It is quite simple, is it not? [Interruption.] Government Members do not like it, do they? Perhaps this is not an issue in her constituency, but I bet it is. If a company says, “You will not receive security updates after X amount of time”, people will naturally assume that they have to replace their device. We have heard from Members from across the House today that not everyone can afford to keep replacing devices based on the security that is put in front of them.
All I am asking of the Minister is to work with the industry to ensure that if updates could be taken over a longer period, it is not simply a binary issue of saying, “This device will no longer be updated.” It is as simple as that: we are just trying to make sure that people can afford to keep the devices they own. In many cases, people will save for years to pay for devices or do it through hire purchase.
Chris Elmore
I will not, no, because the hon. Lady does not like the answer—that is the problem, is it not?
We must also consider the wider view that part 1 of Bill is limited in scope. However, it is clear to all of us here today that no one nation can legislate the internet. Part 1 does provide some desperately needed security responsibilities for the consumer, combined with giving them the necessary information to make informed choices about how they manage the basics of their own digital lives. The pandemic has only served to accelerate the shift to digital, and with that comes the question of increased security and safeguards online.
Now let us turn to part 2 of the Bill. I do not often say this, but I am in almost complete agreement with the right hon. Member for New Forest West (Sir Desmond Swayne)—that is an odd experience, after so many years in the House with him. A number of Members have spoken about constituency issues relating to the changes to the code in 2017, including the hon. Members for North Dorset (Simon Hoare) and for St Albans (Daisy Cooper). It is a good job I am a Welsh MP, because the hon. Members for Ceredigion (Ben Lake) and for Carmarthen East and Dinefwr (Jonathan Edwards) have also done so. I pay particular tribute to the hon. Member for Stroud (Siobhan Baillie), who spoke honestly about what many community groups, farmers, landowners, churches and many other organisations across her constituency are facing, and I agree with her.
We are asking the Government for a review, for it to be fair and for it to provide assurance to those organisations, many of which were the backbone of supporting communities up and down the land during the pandemic, whether through feeding us, taking us in collective worship or offering support to our children and young people. These community organisations deserve our support and we need to ask the Government to follow through on their commitment to undertake a review this year, which was part of the original commitment from a number of years ago. I pay tribute to the hon. Lady for saying that.
On part 2 and the current state of our country’s telecommunications infrastructure, we do have some concerns, as set out by my hon. Friend the Member for Manchester Central (Lucy Powell), the shadow Secretary of State. Having inherited a world-leading position from the last Labour Government, since 2010 the Conservatives have cultivated a culture of missed targets, stunted ambition, and ultimately, stagnation when it comes to our telecommunications infrastructure. The last Labour Government recognised the central role that connectivity would play in the economy of the future, and rightly placed the issue front and centre. As a result, we delivered first-generation broadband to about 13 million UK households by 2009, which shows that large digital infrastructure projects can be delivered at breakneck speed.
To put it simply, we had a vision that we made a reality. Ambitions can be delivered at this sort of speed only when there is real effort, action and long-term planning on behalf of Ministers. Unfortunately, we are not getting that from the current Administration. As has become the norm with this Government, bold and exciting-sounding targets are made in public, only to be quietly watered down at a later stage. The Prime Minister came into office promising full-fibre broadband “by 2025”. His Government then realised that they were not going to be able to deliver it, so they reduced the target to full gigabit broadband by 2025. Realising they also could not deliver that, they landed at the current target of 85% gigabit broadband by 2025. Several bodies, including the Public Accounts Committee, the Select Committee on Digital, Culture, Media and Sport, and many industry experts, now doubt that the Government are even going to achieve that. Dither, delay, disappointment—this has become the norm under this Conservative Government.
The primary concern is that this Bill fails to address the fundamental flaws introduced in the ECC. The code did not receive the necessary scrutiny, resulting in an imbalance between mobile operators and property owners. The Law Society’s analysis makes it clear that the Bill fails to address fundamental flaws in the code that are holding back the roll-out across the country. We are now concerned that the measures in this Bill may slow the 5G roll-out further by disincentivising small building owners and landowners, such as churches, community groups, sports clubs and farmers, from hosting phone masts.
This all began when the Government introduced the ECC in 2017, permitting telecoms firms to renegotiate rents for phone masts down by as much as 90%. Despite promising that the reductions in rent would, in reality, be no more than 40%, this has not held true and the rent reductions have far exceeded that figure. It was deeply disappointing to hear the Secretary of State say to the right hon. Member for New Forest West that there will be no review, despite there being promises to the contrary—yet another broken promise to the people of this country.
The Government have created a framework that allows telecoms companies to dramatically reduce their costs at the expense of businesses, sports clubs, farmers, small landowners and community organisations. I know the Minister will have heard at first hand from a number of organisations across the country that rely on this small but crucial source of income. It is therefore of the utmost importance that the Government review the Bill to make rental valuations for telecoms masts fairer.
We heard from the hon. Member for Stroud about the David and Goliath issue of a big telecoms company versus a church, sports club or scout hut. It surely cannot be in the Conservative Government’s interest simply to ignore all the groups across the country that are in desperate need of the regular income that has been ripped away from them for reasons they still do not really understand.
I finish with a couple of questions for the Minister. Will the Government stand by their 2017 commitment that rent reductions should be no more than an absolute maximum of 40%? Will she look to make a statement, or at least issue guidance, to establish a clear expectation of land valuation that removes the impasse between telecoms companies and site owners? Finally, will she commit to looking at the evidence base and undertake a full economic review of the code by the end of 2022, as was promised during the passage of the previous Bill?
The Opposition want to ensure that every community across the UK has the very best opportunities when it comes to connectivity, whether it be in people’s homes or to allow small businesses to start up right across the United Kingdom. We want the Government to share in that ambition and to keep their promise to deliver improved digital infrastructure. We ask the Minister to step up and deliver these much-needed improvements across the UK.
The Minister for Media, Data and Digital Infrastructure (Julia Lopez)
I thank all hon. Members for their valuable contributions to this debate. I am pleased that the Bill commands cross-party support, which underlines the commitment of this House to make sure that every household and business in our country can access faster digital connectivity and feel assured that our tech is secure. I pay tribute to my hon. Friend the Member for Boston and Skegness (Matt Warman) for laying the foundations for this Bill and for bringing his expertise to bear in today’s debate.
This Bill comes at an opportune time when cyber-attacks are on the rise and the pandemic has underlined the increasing importance of digital connectivity to how we live, work and socialise. The quality and security of that connectivity has an impact on people’s life chances today and even more so in the future, so we have to grip these issues now. That is why we have to view fantastic telecoms infrastructure as more akin to a key utility, notwithstanding the need for different regulatory approaches.
In that way, this should not be seen as a dry debate about technology. I appreciate the valiant attempts to spice up this debate, which is about people and how we give them and their communities the fundamental tools to live good lives and prosper. These networks are vital for the UK’s future competitiveness. We cannot stay at the heart of the global economy if our connections are not world class, which is something we want not just for pockets of our nation but for every community.
We must not see a digital divide emerge between well-connected urban areas and poorly connected rural areas. I know how passionate Members are about the connectivity of their regions, and I welcome their highlighting of the challenges. I pay particular tribute to my hon. Friend the Member for North Devon (Selaine Saxby), who is tireless in her pursuit of better broadband for her county. I encourage ongoing engagement with my Department so that we get high-quality intelligence about what is really happening on the ground as our operators roll out new networks and upgrade existing. I ask my hon. Friend the Member for Eddisbury (Edward Timpson) to write to me in detail with some of his concerns about particular streets in his constituency.
As tech becomes a central driving force for our economy and our society, we have to be able to trust it without ordinary citizens needing deep expertise in cyber-security. That is why we want to make connected devices more secure by design, whether baby monitors or malevolent toasters, as highlighted by the hon. Member for Ochil and South Perthshire (John Nicolson)—perhaps not as perilous a nightmare as that offered by my hon. Friend the Member for Rushcliffe (Ruth Edwards), who discussed pictures of nude US Presidents. Cyber-attacks continue to be a serious and current threat to businesses and states, but this is also increasingly a phenomenon that is affecting all sorts of organisations, from local authorities and public bodies to individuals. The hon. Member for Ogmore (Chris Elmore) raised an important point about the service of cyber officials and the tremendous work they do, and I echo his words.
My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) made a typically zesty contribution, but I am glad that he has at least accepted that we ought to be debating these issues, as yesterday he was considering not allowing that. He is very concerned about lowered rents for landlords who are hosting telecoms infrastructure. We have discussed these issues in person. As he knows, the electronic communications code was changed in 2017. I should make it clear again—I know this will disappoint hon. Members—that we are not seeking to alter that pricing structure again. In our view, the prices being paid for rights to install communications apparatus prior to 2017 were much too high, and with digital communications becoming an increasingly critical part of daily life, that really needed to be addressed.
The argument has been made that delays in digital deployment are primarily a result of changes to the code in 2017 because the amounts offered by some operators are reduced, thereby disincentivising landowners from letting land be used. We do not think this is the case. We maintain that the 2017 valuation provisions created the right balance between public need for digital communications and landowner rights.
But that is not to say that the valuation changes did not create challenges, and the Bill is designed to make a positive difference to some of the David and Goliath situations raised by my hon. Friend the Member for Stroud (Siobhan Baillie). To help ensure that fair outcomes are reached, we are introducing changes to encourage more collaborative discussion. The alternative dispute resolution provision will offer a particularly useful means of tackling situations involving either unreasonably low offers or unrealistically high payments. I am none the less happy to continue this discussion as the Bill progresses through the House.
My right hon. Friend the Member for New Forest West suggested that the Government are on the side of rapacious telecoms operators over landlords. I wish to assure him that that is not the case. We are getting good digital infrastructure to as many people as possible, as quickly as possible. I challenge the idea raised by my hon. Friend the Member for North Dorset (Simon Hoare) that the telecoms operators are making a quick buck out of the networks they build. These are long-term investments, and the Government are pushing them very hard to deliver more, including by stripping high-risk vendors from their networks and rolling out infrastructure to communities that are not within easy reach.
I dare to suggest that some of the rarer and more emotive cases about community organisations receiving reduced rents are being used by certain lobbyists, some of whom are former Labour MPs, to obscure a larger, pretty hard-nosed commercial interest from companies that have bought up large numbers of telecoms sites and are concerned about receiving a lower return on their investment. Some of the same interest groups that oppose rent changes have written to me to express their support for better connectivity in rural areas. We should therefore not pretend that better connectivity does not rely on better access to sites and more realistic pricing for network operators who wish to deploy their services. Some hon. Members have pushed for the Bill to go further, particularly in relation to renewals and operator rights. Our policy aims align with that; we just need to make sure that the legislation is working as we hope. If amendments are required in Committee, we will actively consider them.
The hon. Member for Manchester Central (Lucy Powell) mentioned the recent report by the Public Accounts Committee on gigabit roll-out.
I thank the PAC for its detailed work. It expressed concerns about the absence of legislation, but here is the legislation, which the Secretary of State and I have championed since our arrival in the Department, building on the fantastic work of my predecessor. We have also launched a series of procurements in the hardest-to-reach areas and Building Digital UK will soon be established as an executive agency to drive that work. I am glad that the impact is already being seen in areas such as Eddisbury.
On the product security part of the Bill, I welcome the expertise of my hon. Friend the Member for Rushcliffe and I encourage her to engage in the new national cyber strategy, because we would benefit from some of her points. The hon. Member for Manchester Central expressed concerns about whether we are taking future technological developments into account. There are a number of secondary provisions in the legislation. Technologies are changing all the time and it is important that the legislation can change with it.
Finally, the Bill is not a silver bullet to address all the cyber challenges that we face. It is an important tool in our arsenal. The UK has established global leadership in the area and we are the first to develop domestic legislation that creates cyber-security requirements for consumer connectable products. The Bill will allow us to protect people across the UK, even as the world changes around us, and to keep pace with technology as it transforms our everyday lives. Combined with the measures on telecoms infrastructure, it will do a huge amount in the coming years to benefit our constituents and society at large.
I am sure that we can continue to work together to bring this important piece of legislation into law as soon as possible. We care passionately about connectivity for every community in our country and I am sure that the same spirit will continue as the Bill makes it passage through the House.
Question put and agreed to.
Bill accordingly read a Second time.
PRODUCT SECURITY AND TELECOMMUNICATIONS INFRASTRUCTURE BILL (PROGRAMME)
Motion made, and Question put forthwith (Standing Order No. 83A(7)),
That the following provisions shall apply to the Product Security and Telecommunications Infrastructure Bill:
Committal
(1) The Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Tuesday 29 March 2022.
(3) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
(4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.
Other proceedings
(7) Any other proceedings on the Bill may be programmed.—(Michael Tomlinson.)
Question agreed to.
PRODUCT SECURITY AND TELECOMMUNICATIONS INFRASTRUCTURE BILL (MONEY)
Queen’s recommendation signified.
Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),
That, for the purposes of any Act resulting from the Product Security and Telecommunications Infrastructure Bill, it is expedient to authorise:
(1) the payment out of money provided by Parliament of:
(a) any expenditure incurred by a Minister of the Crown under or by virtue of the Act; and
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided;
(2) the payment of sums into the Consolidated Fund.—(Michael Tomlinson.)
Question agreed to.
PRODUCT SECURITY AND TELECOMMUNICATIONS INFRASTRUCTURE BILL (CARRY-OVER)
Motion made, and Question put forthwith (Standing Order No. 80A(1)(a)),
That if, at the conclusion of this Session of Parliament, proceedings on the Product Security and Telecommunications Infrastructure Bill have not been completed, they shall be resumed in the next Session.—(Michael Tomlinson.)
Question agreed to.
Parliamentary Works Sponsor Body
(2 years, 10 months ago)
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Mark Tami (Alyn and Deeside) (Lab)
I am sure that the Leader of the House has other things on his mind at the moment, but as a north Wales MP, I welcome the hon. Member for Aberconwy (Robin Millar) to the board. I am sure that he will play an important role.
The Leader of the House of Commons (Mr Jacob Rees-Mogg)
I thought it was better if I replied to the debate rather than speaking at length beforehand, but I promise that I will not detain the House long. I am grateful to the right hon. Gentleman.
The Parliamentary Buildings (Restoration and Renewal) Act 2019 established a sponsor body that has overall responsibility for the restoration and renewal of the Palace of Westminster and acts as a single client on behalf of both Houses. The body is comprised of parliamentarians and external members, including the chairman. The intention is to ensure the right balance between cross-party and cross-House parliamentary support for the works and the appropriate professionalism and expertise.
As required under the terms of the Act, the motion before the House today seeks to appoint a Member of this House to the board of the sponsor body. The vacancy arose from the appointment of my hon. Friend the Member for Blyth Valley (Ian Levy) to his position as Parliamentary Private Secretary to the Cabinet Office. I thank him very much for his excellent work on the sponsor body. He worked exceptionally hard.
It is with equal pleasure that I propose, with the support, I hope, of the House, my hon. Friend the Member for Aberconwy (Robin Millar) who, although only recently elected to the House, will provide valuable insight and perspective to the sponsor body. We know that the work is important and that this House needs it, so I commend the motion to the House.
Question put and agreed to.
Business without Debate
(2 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text
15:34 - The House divided: - Ayes: 298 / Noes: 176 - Question accordingly agreed to.
15:48 - The House divided: - Ayes: 297 / Noes: 182 - Question accordingly agreed to.
Chris Elmore (Ogmore) (Lab)
On a point of order, Madam Deputy Speaker. I wonder if you or Mr Speaker could clarify whether he has received notification from the Prime Minister of when the Gray report will be published and whether we should expect a statement from the Prime Minister either this afternoon or tomorrow.
Madam Deputy Speaker (Dame Rosie Winterton)
I thank the hon. Gentleman for his point of order and for giving me notice of it. I have had no notice of a request for a statement. As Mr Speaker said earlier, he is insistent that important announcements are made first to this House. I know he will do everything he can to facilitate that, but, as I say, to date there has been no such request for a statement.
Mr Peter Bone (Wellingborough) (Con)
Further to that point of order, Madam Deputy Speaker. If we move to the Adjournment debate, which could of course go on for many hours and probably will, am I right in thinking that it would be impossible to have a statement tonight?
Madam Deputy Speaker
I thank the hon. Gentleman for that point of order. As I understand it, if a request comes during the debate, it may be possible to suspend the House and take a statement, but once the question has been put and the House is adjourned, it is not possible to have a statement tonight. If the hon. Gentleman recalls, at the end of the debate, the question is put about the House adjourning and that is the final decision on when it is adjourned.
Chris Bryant (Rhondda) (Lab)
Further to that point of order, Madam Deputy Speaker. Since we are doing hypotheticals, I wonder if we could elaborate a bit more. Obviously, we would all prefer a proper process where the Gray report is published in full and given to the public as soon as possible after the Prime Minister receives it. I think the House would also prefer an opportunity to be able to question the Prime Minister on it, and the Prime Minister himself has very generously said that he would come to the House, but we do need a decent amount of time between publication and the House being able to consider it. I just wonder what your thoughts are, Madam Deputy Speaker. It looks as if tomorrow may be difficult for us to have a statement. It is theoretically possible that we could have a statement on Friday, but would that not be rather inappropriate considering that the vast majority of Members do not anticipate being here on a Friday because they have constituency business?
Madam Deputy Speaker
I thank the hon. Gentleman for that point of order. As I say, we have received no indication that a statement is to be made. My instinct would be that Mr Speaker would want any statements to be at a time when those Members who are interested in the statement were able to be here and participate. I think it is probably best if I just leave it at that.
Planning Permissions and Unauthorised Developments
(2 years, 10 months ago)
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Gareth Bacon (Orpington) (Con)
Speculation about how long I might speak for is rife in the Tea Room. I have been informed by the Government Whips Office that I could take almost three hours with my speech. Tempting though that is, I reassure the House that I will not detain it for as long as that—although I acknowledge that that is a shame.
This debate is a follow-up to the ten-minute rule Bill that I introduced to the House last autumn, which sought to make unauthorised development an offence and to prohibit retrospective planning applications. Sadly, there was insufficient parliamentary time for the Bill to proceed, but the problems with planning enforcements remain.
What is the problem? Rogue developers regularly exploit loopholes in our planning system to build unauthorised developments without planning permission. Sadly, they are getting away with it. Under the current planning rules, development without permission is generally not a criminal offence, whereas failing to comply with enforcement action is.
Local authorities have a range of enforcement powers in their arsenals. Enforcement notices can be issued and, at the extreme end, require demolition and restoration. If they are upheld, there can be a fine of up to £20,000 on summary conviction or an unlimited fine on indictment under the Town and Country Planning Act 1990. Other measures, such as contravention or stop notices, can be used depending on the circumstances.
Elements of the Localism Act 2011 made changes to the planning system, notably by removing an applicant’s right to use two separate defences in a single case. In 2015, the then Minister, my right hon. Friend the Member for Great Yarmouth (Brandon Lewis), outlined a policy to make intentional unauthorised development a material consideration for all applications, including retrospective ones.
The Police, Crime, Sentencing and Courts Bill proposes a new offence for anyone who resides, or intends to reside, on land without permission and has caused, or is likely to cause, damage. The proposals are welcome, but the enforcement action I have outlined comes at a high cost to local authorities. It can take years to restore some sites because of the lengthy appeal processes involved. In any event, many rogue developers are eventually granted retrospective planning permission.
The planning portal goes as far as to state that in respect of breaches, local authorities
“often permit a retrospective application where planning permission has not been sought.”
Even when local authorities do not, the unauthorised development is often at such an advanced stage that the site is never fully restored. When such unauthorised developments have taken place on green-belt land or open land, they can lead to significant and permanent damage to areas that our planning system is supposed to protect.
That means a developer could show absolutely no regard for the legal process yet ultimately still be rewarded.
Bob Stewart (Beckenham) (Con)
I did not intend to intervene but thank my hon. Friend and constituency neighbour for allowing me to do so. Not just developers but private individuals take liberties in this matter, certainly in my constituency of Beckenham.
Gareth Bacon
My right hon. and gallant Friend is, of course, completely correct.
The consequence of the situation I have described is that many rogue developers bypass our planning system, gambling that enforcement action against them will be too slow and that, once built, their unauthorised development will be approved regardless. This is infuriating for the local residents who have to live alongside the developments. It is also frustrating for those who have played by the rules and sought planning permission themselves only to see others bypass the process.
Jonathan Gullis (Stoke-on-Trent North) (Con)
My hon. Friend is making a fantastic speech. In Stoke-on-Trent North, Kidsgrove and Talke, Staffordshire Waste Recycling Centre now has to apply for retrospective planning permission at its McGuinness scrap yard site, where the company is digging up an old landfill site, causing a terrible stink across the north Staffordshire area. Nearby, people are suffering because of Walley’s Quarry in the neighbouring constituency of Newcastle-under-Lyme. Does my hon. Friend agree that not just certain developers but companies are taking liberties and creating distress for the surrounding residents?
Gareth Bacon
I agree entirely with my hon. Friend. That is precisely the sort of abuse of the system that I ask the Government to address. Such abuses have a material and long-lasting impact on local people. When people are seen to get away with it, that just encourages more of the same.
Chris Grayling (Epsom and Ewell) (Con)
I might, if my hon. Friend will allow me, seek to catch the Chair’s eye momentarily after his remarks. As he moves forward with this and as he, I hope, encourages the Government to take up his proposals, could he ensure that they include commercial operations? I have experience in my constituency; it is not just residential developers doing this, but commercial developers and businesses. I echo the points that have been made, but that must be a part of what he does.
Gareth Bacon
I thank my right hon. Friend for the intervention and I agree entirely. The point is very well made and I can see the Minister on the Treasury Bench paying close attention. It is a subject that he and I have discussed on many occasions, and I look forward to hearing what he says in a moment.
The impact of all of this goes beyond local areas, as local authorities that pursue enforcement action against rogue developers have to spend significant sums of taxpayers’ cash on legal battles. When I introduced my Bill back in the autumn, I referred at length to a case in my constituency as an example of what can occur. That case is now subject to consideration by the courts, so I will not go into that detail again, save to make the observation that it has taken more than a year to get to this point and the end is still not in sight. However, it does not impact just my constituency—it is a national problem. Such incidents, as I have heard from my hon. Friends, are widespread.
In another example, in 2018, an unauthorised development was set up around Chelmsford on a Saturday morning, meaning that the planning enforcement team were able to visit the site only on the following Monday, by which time caravans, a digger and lorries carrying materials had all been brought on to the site in a pre-planned and co-ordinated attempt to build as much as possible so that it would become unviable for the council to dismantle the works. Neither of those incidents are easily resolvable. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) has spoken in this House about procedural battles on development sites in Guildford and Leatherhead that have lasted between 14 and 18 years. Green belt land has been acquired and built over without planning permission in both locations.
So what solutions might there be? When I introduced my ten-minute rule Bill, I stated that I believed that the solution lay in legislative change to move unauthorised developments without permission from being a civil offence to being a criminal offence. I made the argument that that would prevent rogue developers from appealing enforcement action and block retrospective planning permission automatically. I stated that any change should not aim to remove certain permitted development rights for private households. Nor should it attempt to single out encampments by certain specific communities. Any fair planning system should recognise that developments could unintentionally stray from the approved plans when constructed. In order to avoid the danger of people who have inadvertently breached planning regulations being criminalised, for example, in cases where an extension is slightly too large or where someone implemented something erroneously, believing that they had permitted development rights, the Bill I drafted distinguished between more minor, accidental planning permission breaches, and egregious breaches where someone repeatedly attempted to bypass the planning system, or where the breach occurred on protected land such as the green belt. In such instances, the rules need to be flexible enough to consider the circumstances of the breach. However, I believe this should be balanced against the need to ensure the system is strong enough to close the loophole that rogue developers are currently exploiting.
There are a range of potential solutions. As I have stated, my solution was to change the law to make unauthorised development a criminal offence. An alternative might be to reform the pre-existing enforcement provisions, for example, by rapidly speeding up the process by which planning enforcement can take place, and perhaps vastly increasing the level of fines applicable and limiting the timescales and grounds for appeal.
Whatever solution we opt for, the case for change is substantial. I have seen at first hand local authorities’ difficulties in deterring and stopping rogue developers from building without permission. I have seen the damage that that can cause. I have witnessed the frustration of local residents who find their local areas threatened and I have heard from local councillors and their officers about the long drawn-out, inefficient and very expensive processes they are obliged to follow in attempting to deal with the problem.
We can strengthen councils’ ability to act, protect the green belt and ensure that communities get their say on local developments by changing the law. When the planning Bill comes to the House, it will be a golden opportunity to take steps to protect local residents, stamp out these abuses of the planning process and right a very clear wrong. I urge the Government to pay heed to the issue. I very much look forward to hearing the comments of my right hon. Friend the Minister.
Chris Grayling (Epsom and Ewell) (Con)
I am very grateful to have caught your eye, Madam Deputy Speaker, and to have the opportunity to make a contribution to this slightly extended Adjournment debate. I promise my hon. Friend the Member for Orpington (Gareth Bacon) that it will be a brief one.
I have a dreadful situation in my constituency. Over the past 12 months, a local chalk pit on green-belt land, which has historically been a combination of an overflow for the local car dealers and a transfer site for local skip dealers, has been transformed by one operator—a local firm, NJB Recycling—into a full recycling centre without planning consent. It is now applying retrospectively for planning consent; I have opposed the application and hope that it will be turned down.
The experience of the past 12 months has highlighted an issue to which I hope the Minister will give some thought in discussion with his colleagues in the Department for Environment, Food and Rural Affairs. Not only is there an unlawful use of the site, and not only is the operator applying for retrospective consent—I absolutely agree with my hon. Friend that someone should not be allowed to set up a commercial operation without permission and get away with it—but the agencies involved do not have the powers to deal with a contravention of planning consent.
The facility is regulated by the Environment Agency, whose performance over the past 12 months has, I have to say, been lamentable. The site is causing massive noise nuisance to local residents; it is a few yards away from houses that are now being subjected to substantial noise all day long. We have had massive dust problems, and there have been huge traffic problems with the dramatic expansion in the use of the site. It is a shocking example of something that simply should not be able to happen.
Not only has the performance by the Environment Agency’s team been lamentable, but it has not used the powers that it has to try to restrain things. Frankly, it has not followed its own assessment of the scale of the problem: it carried out an independent assessment, found out that the operator was in breach and then failed to act on that breach. It has said all along that it cannot act to close down, or withdraw a permit from, an operator that is operating a site unlawfully, even though the operator has changed the nature of its work and is now operating in a way that is unlawful in planning terms.
We need a joined-up approach to regulation. We should not have a situation in which the planning authority receives a retrospective application for an unlawful use of a site, but the regulations that apply to the site’s use under the auspices of the Environment Agency do not permit the Environment Agency to say “stop.” My message to the Minister, to whom I am happy to speak in more detail as he prepares the planning Bill, is that two agencies should not have different enforcement powers and different abilities to intervene in a case of unlawful use and a retrospective planning application.
I would like the whole thing to be stopped. I would like all the agencies involved to act in unison and say, “You ain’t got permission to use the site in this way. It’s against planning law, you don’t have consent, you’re applying retrospectively—you should not be doing what you’re doing.” Everyone should have the power to step in and say, “You must stop.” I am happy to share more detail with the Minister; I have been talking to DEFRA Ministers as well.
I want a joined-up approach so that all the agencies have the same power to intervene when a site is being used unlawfully and when a retrospective application is made. Actually, I agree with my hon. Friend the Member for Orpington that a retrospective planning application simply should not be allowed anyway, but at the moment we have a disjointed situation among the different agencies. I encourage the Minister to work with me to address it in legislation.
The Minister for Housing (Christopher Pincher)
It is a great pleasure to speak in this important Adjournment debate. I congratulate my hon. Friend the Member for Orpington (Gareth Bacon) on raising an important issue on behalf of his and all our constituents, as well as our colleagues and partners in local government.
If we want our country to have a planning system that is prepared for the challenges of the future, we need to keep the conversation going about how the system will work in practice. I admire my hon. Friend’s personal commitment to the issue. If I may say so, there is certainly nothing woke about this bloke, because last year he proposed several interesting changes to the enforcement regime in the private Member’s Bill to which he alluded. We have had some constructive conversations about those changes, and I look forward to further such conversations to determine what we can take forward together. This matter may not generate as huge a number of column inches as other touchstone issues of our day, but I assure the House and my hon. Friend that the Government share his interest in and commitment to improving planning enforcement in this country.
I also share the interest shown by my right hon. Friend the Member for Epsom and Ewell (Chris Grayling), and I am concerned by the ongoing issue he faces. He will appreciate that I should not say too much more about it because of my quasi-judicial role, but I am certainly happy to discuss his worries about inter-departmental connectivity—let us call it that—and how agencies work together to effect appropriate planning decisions. He will know that we propose to bring forward planning reform, and I will certainly talk to my colleagues at DEFRA and engage him in those conversations. He is a distinguished Member of this House with a distinguished ministerial career, and in his 21 years here he has been a doughty campaigner on his constituents’ behalf. He has demonstrated that again this afternoon.
It goes without saying that the overwhelming majority of people across the country will need to engage with our planning system only when they are looking for planning permission prior to any works they may want done. While a small number of works will inevitably slip through the net, with people accidentally undertaking work without realising it requires planning permission—most people, as my hon. Friend the Member for Orpington rightly said, want to play by the rules—some will try to bend the rules to their will by gambling that planning permission will be granted retrospectively.
That gamble should never be allowed to pay off. It shows contempt for the rules that hold the system together, and it is unacceptable to every person who approaches the planning regime with good faith. When the system is gamed, local authorities have an array of powers—my hon. Friend alluded to some of them—in their enforcement arsenal, including strong financial penalties for non-compliance. Councils can step in to suspend works on a site so that proper investigation can take place. Again, if an individual or companies try to subvert that process, they can find themselves facing an unlimited fine for non-compliance.
Bob Stewart
In support of my hon. Friend the Member for Orpington (Gareth Bacon), a close constituency neighbour, he and I both have a problem, because people gamble with the weekend. We must give local authorities the power to take immediate action when people start their work, as my hon. Friend said, on a Friday evening or Saturday morning and then work through the weekend before anyone can actually take enforcement action. Such action should be almost immediate, and the police should be given the power to evict people before they start building too much.
Christopher Pincher
My right hon. Friend makes a practical point, and I will come on to say something about the support we want to give local authorities so that they are better able to enforce the rules. It is all very well regulating, but regulations are only as good as the enforcement capability of those charges with that responsibility—[Interruption.] I note, as I look to my right, that my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) appears to be about to get to his feet, so I shall pre-empt him by sitting down.
Jonathan Gullis
I thank my right hon. Friend. He will know that, when it comes to giving local authorities more powers, it is about tackling not just retrospective planning, but those who own buildings, especially heritage buildings, that they are allowing to fall into a state of disrepair by being either a rogue landowner or an absentee property owner. I have introduced the Planning (Proper Maintenance of Land) Bill—not a very sexy title, I accept—which seeks to increase the fines in section 216 of the Town and Country Planning Act 1990. I have obviously been lobbying the Minister relentlessly, and I could not waste this opportunity to ask him to confirm at the Dispatch Box that, like that of my hon. Friend the Member for Orpington (Gareth Bacon), my ten-minute rule Bill is certainly being considered as part of the planning reforms.
Christopher Pincher
I am never knowingly under-lobbied by my hon. Friend, and I salute not only his indefatigability in campaigning on this issue, but the elasticity with which he has shoehorned it into this particular debate. Let me assure him that the matter he raises is important, and we do want to address his concerns effectively when we bring forward our planning reform. I am sure we will be talking further with him about those matters.
I have said that councils can step in to suspend works and enforcement notices can be served, but if a council needs to go nuclear, it can apply for a planning injunction via a court order that would restrain any actual or expected breach of planning controls. The outcome of this sort of process can lead to jail time, assets being seized and fines being handed down.
Gareth Bacon
The Minister is completely correct in what he has just outlined. The problem, however, is that this all takes time. It takes time to get a court appearance and it takes time for the injunction to be issued. Injunctions can very often be ignored, and further legal action has to take place to issue stop notices or other such action. All the while, development continues and the landscape continues to get scarred, local residents continue to get very anxious, and more time and money is being spent by the council. Would the Minister acknowledge that this is in fact part of the problem, and would he concede that this could be looked at in future, potentially as part of the planning Bill when it comes to the House?
Christopher Pincher
I appreciate and recognise my hon. Friend’s concern. We do want to ensure that the innocent are not caught up in a regime that pursues the guilty, but we also want to ensure that the system is more speedy and has much greater deterrent effects on those who attempt to gamble with the law, those who attempt to bend it and, indeed, those who choose to break it.
We all recognise that the reason why we need the important debate my hon. Friend has brought to the House today is that we believe—we genuinely believe—that there is more that we can do, and there is more that we shall do. As everyone in the House will appreciate, we are committed to improving our planning system and making it one that delivers better outcomes for people in all parts of the country. It is going to be the bedrock of one of our principal missions, which is to level up the United Kingdom and to help revive and regenerate those areas that have long felt forgotten by politicians of all stripes in Westminster. In our constituencies, however affluent they may be on the face of it, we all have areas of our constituency where there is deprivation and where residents feel left behind, and we have to fix that.
When it comes to pulling the handbrake on unauthorised developments in their areas, we want to make it even easier for local planning authorities to step in and make sure that retrospective planning permission is not exploited by those bent on gaming the system. Let me be clear: retrospective applications are only for individuals or businesses that have made a genuine mistake. As my hon. Friend alluded to, the enforcement process needs to work better. We make that happen by closing loopholes, and strengthening the existing powers and penalties at our disposal.
As we modernise our planning system in England, we plan to engage with communities and key stakeholders throughout the planning process. Our ambition is to ensure that the outdated system, which is essentially a relic of the post-war period, is now made fit for the 21st century, with proper digitisation of applications so that residents can easily see the proposed development in their area at the touch of their smartphone screen. As my hon. Friend and others have said, we have all seen and read about egregious examples of people bending the rules on retrospective planning applications. My hon. Friend mentioned the situation of the caravan park in Chelmsford, and my right hon. Friend the Member for Epsom and Ewell mentioned the situation faced by his constituents in Epsom. We see such challenges from individuals and commercial organisations up and down the country.
The simple idea behind retrospective applications is that they give people who have failed to seek planning permission prior to building a structure a fair chance to get the necessary approvals.
Chris Grayling
My right hon. Friend made the important point that a retrospective application should only be for somebody who has made a genuine mistake. May I press him a little bit on that? Should a local authority—and, crucially, the inspectorate—disallow a retrospective application that is clearly not based on a genuine mistake?
Christopher Pincher
Essentially, it should, but of course there are legal interpretations that need to be considered. Therefore, we need to ensure that any rule changes that we make are right, that they do not allow the new system to be gamed and therefore brought into disrepute, and that they do not lead to unintended and unfair consequences for, shall we say, the innocent.
Over the years, the system has been deliberately gamed by cowboy builders creating large structures or even whole developments before trying their luck with the local council to see whether they can get retrospective planning permission. There is one infamous case in Bedfordshire, which saw a local business owner who was originally granted permission to make a modest improvement to his 1960s bungalow end up building a three-storey mega-mansion, complete with a turret and sweeping balconies. That is just not right; it is the sort of egregious development that should not be allowed.
In other cases, we have heard of, as my right hon. Friend the Member for Beckenham (Bob Stewart) has said, lorries and building equipment arriving on site in the dead of night or at the weekend, and people laying internal roads and hardstanding without planning permission. Retrospective planning permission is then sought soon afterwards, and wrongly so. Clamping down on such flagrant planning violations and abuses of the system is going to be a key focus of my Department. It is one of the reasons why we have made intentional unauthorised development a material planning consideration, meaning that local authorities can factor in intent behind the unauthorised development when considering a retrospective application. In other words, it is not enough for builders to plead ignorance when it is plain for all—not least the planning authority—to see that they were well aware that their structure needed planning permission right from the outset.
Legislation also states that retrospective applications must be assessed in the same way as standard planning applications, so that permission cannot be granted retrospectively if there was little or no prospect of it being approved in the first place.
People making small improvements to their own home or garden are human, like all of us. Our constituents might not always think that we are human, but, like them, we are, and we know that genuine mistakes can be made. They will happen, so it would be unfair, where someone built their rear extension a foot too high, for example, or erected a fence in the wrong place, to take a sledgehammer to that work when retrospective planning permission would do. We have to be fair, as my hon. Friend the Member for Orpington said in his remarks.
With that principle in mind, while also accounting for the natural frustration that people and communities can feel about unauthorised development, criminalisation for infringements that fall into the minor or unwitting camp would be disproportionate. That is why we need to make sure that any changes we make are right and do not lead to unintended and unfair consequences.
As the House will know, we are considering a whole suite of possible planning reforms. I reassure my hon. Friend that that includes consideration of whether the current scope of offences is fit for purpose. He mentioned some matters, including using such terms as “egregious” in the law. We would need to look closely at that to ensure that there is a fair and proper legal interpretation of that word. He mentioned the greater use of fines, and we will certainly look at that possibility. The fundamental must be that the system deters retrospective planning applications and also deters the activity that results in those retrospective applications—the building in the first place.
We recognise that these reforms will only be worth making if our local authorities and the wider planning sector have the right tools to implement them and are able to give our planning enforcement regime proper teeth. To that end, an additional £65 million was made available by my right hon. Friend the Chancellor of the Exchequer at the Budget last year. That will help build the skills and capability that we need at the local level to translate our words into deeds on the ground.
As we look beyond the here and now, our commitment in the long term is to digitisation. Digitisation will mean that local authorities and their planning officers have much more space and much more time to focus on the things that really matter, rather than the administrative bumf that goes along with the present planning system. By digitising the system, we can make it more effective, and we can also create the headroom for planning officers and other officials to be more effective in their own work.
I will say a few brief words on appeals, which I know are a bugbear for many communities that find themselves in protracted and exhausting disputes. We certainly want them speeded up. It is absolutely right that everyone should be able to make their case and to have that case heard. Our priority is to accelerate that process by closing loopholes through future planning reforms. We are undoubtedly making progress in that direction. In the 18-month stretch from March 2020—the height of the covid pandemic—the Planning Inspectorate issued some 3,300 appeal decisions on enforcement cases. However, as I set out, there is more to be done to improve how the fundamentals of our appeals process work, and that has to start with removing the incentive for those who set out deliberately to abuse the system to try to delay the appeals process. I will say more about that as we advance our planning reforms, and I am happy to discuss it further with my hon. Friend and other Members to ensure that we get this aspect of our reforms right.
I thank my hon. Friend for championing this issue on behalf of his constituents, and I thank all right hon. and hon. Members who contributed. The concerns raised echo through local authorities around the country, and I assure the House that they echo through my Department. They will have been heard loudly and clearly, and we are determined to act on them. I look forward to working with colleagues from across the House in the months to come to ensure that we get our planning reforms ready, right and on the statute book so that all our constituents are protected.
Question put and agreed to.
Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022
(2 years, 10 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Chair
I remind Members to observe social distancing and to sit only in places that are clearly marked. I also remind them that Mr Speaker has stated that masks should be worn in Committee. Hansard colleagues will be most grateful if Members sent their speaking notes to hansardnotes@parliament.uk.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I beg to move,
That the Committee has considered the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022.
It is a pleasure to serve under your chairmanship, Mrs Murray.
The Health and Social Care Act 2008 requires all providers of regulated activities in England to register with the Care Quality Commission and to comply with the requirements and fundamental standards set out in regulations made under that Act. Schedule 1 to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out those regulated activities, and regulation 1(6) of the 2014 regulations provides that those regulations will cease to have effect from 31 March 2022. The draft regulations are therefore a priority, as they are needed to ensure that the 2014 regulations continue to apply, meaning that providers will continue to be required to register with the CQC and comply with fundamental standards.
The draft regulations amend the 2014 regulations, which are due to expire after 31 March this year, by extending the expiry date to 31 March 2025. That is the only amendment that the draft regulations make; they do not change any existing policy. The 2014 regulations set out the activities regulated by the CQC and the fundamental standards with which all CQC registered providers must comply. Those activity standards are not amended by the statutory instrument.
The extension of the 2014 regulations to 31 March 2025 will ensure that the current regulations relating to CQC registered providers, including which activities are regulated by the CQC, will continue to apply. There will be no change to how the CQC carries out its regulatory functions, and the Government see the CQC’s role as critical in ensuring that the care received by patients is of a high quality and delivered to standards that promote patient safety.
I highlight the fact that if we do not extend the expiry date in the 2014 regulations, they will automatically expire. There would therefore be no regulated activities for the CQC to regulate, and providers that are currently required to register with the commission would no longer be required to do so. Providers that are currently required to register with the CQC would also no longer be required to comply with the fundamental standards set out in the 2014 regulations. Not extending would risk patient safety and compromise the CQC’s ability to monitor providers against the fundamental standards.
In short, the draft regulations will amend the 2014 regulations by extending their expiry date by a further three years to 31 March 2025. This will mean that health and care providers in England that carry out any of the regulated activities set out in the 2014 regulations will continue to be required to register with the CQC and to be bound by the obligations and standards set out in those regulations.
The draft regulations will ensure that the CQC can continue to carry out its valuable role as the regulator of health and social care providers in England, and that services provided by CQC registered providers continue to be required to be carried out safely and to a high-quality standard. I commend the draft regulations to the Committee.
Karin Smyth (Bristol South) (Lab)
It is a pleasure, as always, to serve under your chairmanship, Mrs Murray. I will take a few moments to outline some grave concerns that we have about the legislation. I also have questions for the Minister, which I hope she will answer in her response to the debate.
There is an important reason why the extension is being made. I remind colleagues that the CQC’s work in regulating activities is vital. It is responsible for the registration, inspection and monitoring of health and adult social care providers, including independent providers, under the Health and Social Care Act 2008. All providers of health and adult social care that carry out regulated activities are required to register with the CQC and demonstrate that they meet those fundamental standards, for the safety of our constituents. The scope of regulated activities includes the treatment of disease, disorder or injury; surgical procedures; maternity and midwifery services; personal care; nursing care; and assessment or medical treatment for persons detained under the Mental Health Act 1983.
The CQC inspects and monitors the services that it registers. Although the pandemic brought about the suspension of routine inspections, the CQC still monitors providers using information such as people’s feedback, and it will continue to inspect where it sees evidence of risk of harm, deliberate abuse, systematic neglect or a significant breakdown in leadership.
Clearly, if these regulations were allowed to fall in a matter of weeks, the safety of our health and care services would be in a very serious situation, as indeed would be the safety of our constituents. Although the Government could not bring forward the review any earlier than a last-ditch attempt to change the law, the CQC managed, despite the pandemic, to produce “The state of health care and adult social care in England 2020/21”. It is an excellent report that I commend to the Minister, if she has not yet had a chance to read it. It starts by saying that, despite the challenges of the year before:
“The system has not collapsed.”
Well, for that we are all truly grateful. We are very grateful for the work of those people who made sure the system did not collapse.
However, as every Member here today or reading the report of this debate will know, the system very nearly did collapse. In fact, many of our constituents are falling foul of handed-back packages of care, and local authorities across the country are struggling to maintain those very important services for individuals and prevent the most vulnerable in our society from losing their packages of care.
I will not detain the Committee for long, but we understand the problems with recruitment, pay conditions, the 100,000 vacancies in social care, and the 110,000 vacancies in the health service. I also will not detain the Committee for too long by talking about the number of people we know are dying at home unsupported.
The Chair
Order. I remind the hon. Lady that her comments must remain within the scope of the legislation that we are discussing.
Karin Smyth
Thank you, Mrs Murray. I am just outlining the role of the CQC; if these regulations do not pass today, then all this care will not be provided by regulated services, but I will move on.
Karin Smyth
I will just finish the point about our concerns about coroners’ assessments of the conditions in which people are dying early, perhaps because they could not access care. The CQC’s report, which it did manage to do, outlined ongoing concerns.
To be clear, we will support the Government today, but with grave concerns, because the CQC has itself said that it has ongoing concerns about patient safety. In relation to high-risk mental health services, it is concerned that people are at risk where there are warning signs of closed cultures. Improvements in maternity care are far too slow, with staff not having the right skills or knowledge, or poor working relationships. Other concerns include lack of engagement with women in maternity services and limited action being taken to improve equitable access. Its final area of concern is about the really important issue of deprivation of liberty safeguards during 2020-21. Those are really grave concerns about the most vulnerable people in our society. This is important to all our constituents across the country.
I am really concerned that the Government’s proposals to simply extend the 2014 regulations by three years indicates a disregard for the importance of timely reviews. The CQC and providers need clarity, which is why we will support the Government today. This is not a technical a piece of legislation. We are being asked to extend the regulations without any indication of what the review that the Government have undertaken might be saying, and I am disappointed that the Minister did not say more about that in her opening remarks, so I trust that she will do so when she concludes. If not, perhaps she could write to us—I will write to her formally if she is unable to say more today.
We are being asked simply to extend these regulations, which should have been completed by April 2020. Although the pandemic might have had an impact on the review, I would have expected the review to be ready for the printer in March. Certainly, when I conducted reviews of such a serious nature when I worked in the health and care system, I would be expected to have my draft well and truly ready for publication before the final deadline in April. Perhaps the Minister can say why that was not done before.
The Minister did not mention that the consultation received only 32 responses from health and care provider organisations. They are busy and have other things to do. Of those responses, 19 were in favour of the Department’s proposal, and 13 were against. It was noted that the 2014 regulations should not be extended without also making amendments to reflect the changes in the health and care sector since 2014, which are considerable.
When we are reflecting on those changes since 2014, we should bear in mind, for example, the fitness to hold a licence by some providers, particularly in adult health and social care. It is well documented that we are deeply concerned about some of those providers—they are essentially owned and run by hedge funds located in countries far from here, and are not perhaps paying their due level of taxation. If they did, it might provide the social care sector with a bit more stability.
We have had many years of senior Government Ministers talking about patient safety. Hon. Members recently spent six weeks on the Health and Care Bill Committee trying to improve the oversight of the CQC of whole systems and adult social care. None of this is joined up. If we are pushing this down the road for another three years, how does that align with the current legislative programme, legislation in the other place and anticipated legislation in the adult health and social care sector that is due at any moment? We need to line up some of these things, so that we parliamentarians can provide due process and scrutiny. Ultimately—the Minister knows it well—this is about patient safety.
The Government were unprepared going into the pandemic and I am concerned that this legislation is also tardy, and reflects the fact that they are not taking the timeliness of reviews seriously. Perhaps they are distracted by other matters. The Government have had two years to consider the matter. Why are systems not in place to ensure that such legislation is not left to the last minute? I hope the Minister can address my concern about why these measures were not ready in April 2020. It is not the first example. I do not want to detain the Committee, and I might go out of scope, but there are many examples of tardiness in timeliness and appointments and bringing forward regulations; that really does affect people. Members of Parliament across the House are really getting quite fed up of it.
Sir Oliver Heald (North East Hertfordshire) (Con)
Surely the hon. Lady would recognise that we have been through a pandemic that has caused great uncertainty for the social care sector. Is it not more prudent while we are still in the pandemic to extend the regulations rather than changing the whole system overnight?
Karin Smyth
The measures were due to come in in April 2020. As I said, if I was writing the review, I would have had it ready at the printer’s in March 2020 as the pandemic started. I do not really understand—I am very happy for the Minister to clarify—why, if it was ready for April 2020, which I suspect it perhaps was not, that it has taken this length of time, and why we need another three years. There are clear concerns in the sector as to why we need three years.
We support these measures today—that is the responsible thing to do, because we cannot have the sector unregulated, but we impress upon the Government the requirement that full regulations and good governance are important. We do not expect matters to be left in such a state.
Can the Minister explain why the review was not completed in April 2020? What stage was it at? How much of it was completed by then? What steps is the Department now taking to make sure that this review is completed in a timely manner? Can she provide information on the conversations the Government have had with the CQC regarding further areas of activity that need to be brought within the scope of the Act? We hear rumours, but we would like some certainty.
The consultation received 32 responses from health and care provider organisations. As I said, 19 were in favour and 13 were against. Does the Minister consider that to be a sufficient level of review and engagement? What steps will she be taking to ensure further stakeholder engagement?
Mr Clive Betts (Sheffield South East) (Lab)
It is a pleasure to serve under your chairmanship, Mrs Murray. I shall not detain the Committee long; I just want to put on the record that the Levelling Up, Housing and Communities Committee is currently conducting an inquiry into social care and its funding. I will not go into the details of that as I would be straying from my remit this afternoon.
I want to draw attention to two or three issues that are directly relevant and came up, on which we will be reporting as a Committee in due course. We talked to care users and carers the other day and heard some heart-rending stories: “Please when you reform and review, will you do it with us and not to us?”
Mr Betts
I did mean the Minister; I am sure you would do it only too well, Mrs Murray, without having to be directed in that way. I was explaining what the carers and the people receiving care were saying. I hope the Minister reflects on that message in future.
There are two direct issues to do with Care Quality Commission inspections that came out from our conversations as well; the Minister may at some point wish to think about discussing these with the CQC. One is: “Why does it always announce inspections before they happen? They change the arrangements in our home before the inspectors come, so what’s the point of the inspection? If you’re really going to find out what is happening, go in and inspect without giving the warning.” That is a matter directly to do with the regulations—how they are implemented in future.
The other issue is something that the local government and social care ombudsman said to us at a different hearing. He is really concerned that so many care homes do not clearly demonstrate to the residents, and their friends and relatives who visit, that if things are wrong they can access not merely a complaints procedure themselves but that procedure can lead on to a report to the ombudsman. We are all too well aware of that, but residents often are not.
The CQC could draw attention to that in their inspections and relationship with the sector. The ombudsman is asking for specific parliamentary powers, but this could be done through encouragement from the CQC when it is inspecting, saying, “Have you got your complaints procedure up there? Is there a clear indication to people that they can go to the ombudsman if they are not satisfied?” That is something positive that inspectors could do as part of the regime and regulations that we are discussing today.
Maria Caulfield
It is a pleasure to respond. I am pleased to hear that the Opposition parties will support the statutory instrument this afternoon because it is crucial that the Care Quality Commission, which does an amazing job in maintaining patient safety, is able to continue to do so.
I see that Captain Hindsight has sent a lieutenant here this afternoon. The hon. Member for Bristol South would have had a reform package ready on the table and at the printer’s.
Maria Caulfield
I will continue, if I may. As my right hon. and learned Friend the Member for North East Hertfordshire pointed out, we have been through two years of a pandemic. Health care and social care staff and teams have worked so hard up and down the country but so has the CQC. It does do unannounced inspections; it has not been doing some of them during the pandemic as that puts extra pressure on an already overstretched group of professionals who are trying to keep their services going. There has been compromise with inspections between the sector and the CQC, but the commission very much does do unannounced inspections, which are an important part of the process.
There will be a time to reform and consider the regulations more fully. I have met the CQC. This morning I met the chief inspector for primary care and we were looking particularly at areas where there needs to be some change and reform. But it is important to do that properly. As the hon. Member for Sheffield South East said, it is important to involve all stakeholders in that process and not just rush through a process for the sake of it. The very specific scope of this statutory instrument is to extend regulations by three years so that the CQC is able to carry out its inspections and do its fantastic work to protect patients and support staff when they raise concerns. It does the inspections and makes recommendations to improve care.
I hope that Opposition Committee members will support us and that they will work with us on our reforms on social care or around the CQC to make sure that there are the best outcomes possible for patients across the board.
Question put and agreed to.
Down Syndrome Bill
Wednesday 26th January 2022
(2 years, 10 months ago)
Public Bill CommitteesRead Full debate Down Syndrome Act 2022 View all Down Syndrome Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 26 January 2022 - (26 Jan 2022)
The Chair
The selection and grouping of amendments for today’s meeting is available online and in the room. I have selected the three amendments in the name of the Member in charge of the Bill, Dr Liam Fox. The amendments will be considered alongside the existing content of the Bill in a single debate.
Clause 1
Guidance on meeting the needs of persons with Down Syndrome
Dr Liam Fox (North Somerset) (Con)
I beg to move amendment 1, in clause 1, page 1, line 10, at end insert—
“(4A) The Secretary of State must lay the guidance before Parliament once it is published.”.
This amendment requires the Secretary of State to lay guidance under clause 1 before Parliament.
The Chair
With this it will be convenient to discuss the following:
Amendment 2, in clause 1, page 1, line 12, leave out “(4)” and insert “(4A)”.
This amendment is consequential on Amendment 1.
Clause stand part.
Clause 2 stand part.
That the schedule be the First schedule to the Bill.
Amendment 3, title, line 1, leave out from “syndrome;” to second “and” in line 3.
This amendment brings the long title into line with the content of the Bill.
Dr Fox
Those watching our proceedings may be surprised at the brevity of our discussions today. It is worth explaining to them that that is not due to any lack of scrutiny in Committee, but to the fact that the Committee has reached consensus before we have come here. We have worked together across parties to deal with the issues that we thought were important. This is a very good example to those who watch Parliament that when Parliament really wants to get something done and Members believe that they are engaged in a worthwhile task, the work can happen in the most efficient way possible.
I thank colleagues for their work in bringing us to this point. I thank the Minister for her outstanding work. Having once been the Friday Whip in charge of private Members’ Bills, I am an example of gamekeeper turned poacher—although that does bring some advantages, including how to get the best out of the Minister. We have very much benefited from having a Minister with personal experience of a family member with Down syndrome. It is also a very good example of why our system of constituency MPs, with our backgrounds and experience, is a very good one when it comes to appointing people to ministerial office.
I thank officials for their work. They have been tireless in trying to bring what were initially some relatively large differences to a position of consensus. I thank colleagues from across the House who are not on the Committee for their support on Second Reading and in campaigns across constituencies to gain support for the Bill.
I thank the public for the widespread support that we have had on the issue. I thank in particular those Down syndrome groups who have gone out of their way to provide support to Members, with anecdotes about personal experience and what they expect from our legislation. It is a pity that there seems to be a small number of people out there who were questioning the measures in the Bill even before they knew what was going to be debated in Committee today. I hope that they will recognise that the intent of the Committee is very clear.
On Second Reading, there was a very clear omission in the Bill. We chose to leave it and deal with it in Committee, rather than inserting a half-baked measure that we would subsequently have to change. The omission was that it was not very well set out how the rights in the Bill could be enforced, for those who wanted to exercise them, and how that could best be redressed. There were two things that I really wanted to see and I am very pleased that the Government have accepted them. I look forward to my hon. Friend the Minister recommitting to those today.
First, if we have new integrated care pathways and integrated care boards, should it not be the responsibility of a named individual to ensure the application of the measures in the Bill, should it become law? In other words, should there not be someone to whom those with Down syndrome or their parents can go, to ensure that the process has been properly applied? Not having that provision would be a serious omission. I look forward to the Minister confirming that there will be a named individual on each board who will be responsible for the application of the measures in the Bill.
Sir Robert Goodwill (Scarborough and Whitby) (Con)
Does my right hon. Friend believe that the Bill creates a precedent for other conditions such as 22q11.2 deletion syndrome, which affects a smaller number of people but manifests in a similar way?
Dr Fox
The Minister may say something about that when she makes her remarks, but it is entirely possible that, when guidance is given and there is a named person on the integrated care board, the Bill’s provisions and the measures required to apply it would reasonably be applied to other conditions of that nature.
Again, the fact that the guidance will be laid before Parliament gives us an opportunity in Parliament to deal with the very issues that many Members have reasonably raised. As all colleagues will know, we put Down syndrome as the only condition because of the difficulty of getting a private Member’s Bill through. Getting support requires it to be simple and concise. The fact that the guidance is laid before Parliament enables us to take the legislation forward in a proactive way without too much actually being said in the Bill. That is a good model for how we can take legislation of this nature through in future. I am grateful to my right hon. Friend the Member for Scarborough and Whitby and congratulate him in Committee for the first time on the honour recently—belatedly but very justifiably—bestowed on him.
I go back to the point: the fact that the guidance is laid before Parliament gives us all the chance, on behalf of our constituents, to look at some of these other conditions. If it applies for Down syndrome, why should it not apply in the same way and through the same mechanisms for other conditions? That is an important issue for the Committee to have addressed. With that, I conclude my remarks.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I only want to thank everybody across the parties who worked so hard on the Bill; it has been so heartening to see Parliament come together on something so important. As chair of the all-party parliamentary group on Down syndrome, I have had so many emails from people who are right behind the Bill and think that it will be ground breaking in giving them the recognition that they feel is so important in their lives and for their families.
This is an important piece of legislation, and I thank everybody who has contributed to it. The right hon. Member for North Somerset, who led it, has been exemplary in bringing people together and ensuring that the process is positive.
Layla Moran (Oxford West and Abingdon) (LD)
I add my thanks to everybody, but especially to the right hon. Member for North Somerset, for bringing this Bill. I agree that the emails we have had have been so heart-warming. My constituent Kelli, whose son Aaron has Down syndrome, said:
“I have three children, two older children without Down syndrome and Aaron. I have the same fundamental desire for each of them: that they are able to live happy and healthy lives, as far as possible, given the realities of life for us all.”
She says the Bill gives her enormous hope. I am sure the hon. Lady has had many similar emails.
Dr Cameron
Absolutely. That is the important reason we are all here—to make a difference to constituents’ lives. The hon. Member has shown that the Bill will have a positive impact on her constituent’s life; I am sure that across the Chamber we have all had many similar emails. The right hon. Member for North Somerset addressed some of the hopes for other conditions, which were also raised with me. I am pleased to support the Bill wholeheartedly and to have seen it progress so rapidly.
Karin Smyth (Bristol South) (Lab)
I congratulate my neighbour, the right hon. Member for North Somerset, on his work and on bringing together so many colleagues across the House. Everyone has worked enormously hard on this Bill. I thank the Minister for her co-operation. We should have more poachers turn game keepers—they are all terribly welcome.
As Members have said, the families of the 40,000 people with Down syndrome are all watching and listening to the debate carefully. As my hon. Friend the Member for Nottingham North (Alex Norris) previously said, we take every opportunity to remove all the barriers and to tackle stigma and the poverty of ambition that hold back progress in this area. The Bill is the perfect opportunity to do that, particularly around housing, mental health provision and education—all key areas that can really improve and empower those with Down syndrome across the country.
I welcome the Bill and the amendments. As the Minister said in the last debate, the Government recognise that the legal duties and frameworks are already in place. The duty under the Care Act 2014 is to assess people based on need and not diagnostic categories. It is vital that every person’s needs are met to ensure that they can fulfil their potential in their lives. This Bill is about people, not a condition; as it is implemented, we need to recognise that every individual will have their own specific needs. Social care is facing unprecedented strain, so new responsibilities must come with an assessment of investment.
I welcome the Department’s commitment that new guidance will be formed in consultation with partners, and a new burdens assessment will be undertaken ahead of that guidance. As you know, Ms Elliott, having chaired some of the sittings, I spent six weeks in Committee on the Health and Care Bill throughout the autumn. The provisions about having a named accountable person on the integrated care system and the guidance are very important and welcome developments. If the Government could learn from this Bill and take that approach more widely to the current legislation and other legislation, that would be not only good practice but very welcome for Members of Parliament and our constituents.
Our constituents expect us to see guidance and perhaps be part of scrutinising it, raising objections and problems and improving it—that is the role of a Member of Parliament—before that guidance is developed by organisations that are not accountable in the same way and imposed on our constituents. Bringing that circle back, so that Parliament has a greater role in the guidance, is really a very important step, and I hope that that starts to permeate not only the Department of Health and Social Care but other Departments and, indeed, current legislation.
I very much commend the right hon. Member for North Somerset for introducing amendments 1 and 2. They will be landmark—really important. I commend the Minister for working with the right hon. Gentleman to agree to them, and I thank everybody involved in the Bill. I agree with the right hon. Gentleman: this is an example of how Parliament and the proper role of Members of Parliament can be made real. That is only for the good of our constituents.
The Minister for Care and Mental Health (Gillian Keegan)
It is an absolute pleasure to serve under your chairmanship, Ms Elliott; I think it is the first time. I am delighted that the Bill has received the same endorsement today from across parties as it did on Second Reading. What can I say? My right hon. Friend the Member for North Somerset has really set an example to all of us. I guess that is the voice of experience—30 years in various roles around this place, which have enabled him to optimise and maximise the situation and to get all colleagues rowing in the same direction. It is very important for a Member to do that if they are to get their private Member’s Bill into legislation; as we know, that is not typical.
Some 47,000 people in the UK have Down syndrome. It cannot be right that people with Down syndrome and their families should have to fight for access to appropriate services. I have seen this personally, as my right hon. Friend mentioned, with my nephew Joseph Gibson. Although Joseph is now happy and thriving—he is 15 now —it has not always been easy for my brother Marcus and sister-in-law Sara to secure the support that they need and that meets his needs.
That is what we want to change through clause 1, which provides that relevant authorities will be issued with guidance that they will implement locally. The guidance will enable those authorities to understand the needs of people with Down syndrome and how best to meet them. Of course, we will consult widely on the development of the guidance.
Once the guidance is published, the Government will keep it under regular review and update it periodically to ensure that it remains fit for purpose. It is very important that, when going through the clauses of the Bill, we put the right things in place, and that we do that with wide consultation. I thank my right hon. Friend for tabling the amendment to require the Government to lay the guidance before Parliament upon publication, because people here have a lot of experience and a lot to give. I am pleased to support amendment 1, which will bring this important guidance to the attention of Parliament once it has been published.
Dr Fox
As well as the issue of other conditions, employment and employment law were raised a great deal by the public, although we did not address those issues in the Bill because of the complexity that they would bring. Will the guidance given by the Secretary of State include employment issues, so that those issues can be addressed without requiring further legislation?
Gillian Keegan
First, I will deal with rare genetic disorders other than Down syndrome. We recognise that people with genetic conditions other than Down syndrome may experience problems similar to those of people with Down syndrome, so we will consider the overlaps and linkages between such conditions and Down syndrome through consultation on the development of the guidance. I will go on to address employment.
I commit that the Secretary of State will ensure through statutory guidance that the integrated care boards will have a named lead for overseeing the implementation of the guidance issued under the Bill. That named lead will ensure that Down syndrome statutory guidance is implemented and considered throughout the commissioning decisions of an integrated care board. That will play an important role in ensuring that there is accountability for improvements at the local level and that the intentions behind the Bill are fully raised across Government.
Sir Robert Goodwill
Does the Minister accept that while many Down syndrome sufferers can get into the workplace and make a real contribution, there are others who are very profoundly affected—who cannot communicate and have great behavioural problems? I know that from experience with my wife’s family. These are not the Down syndrome sufferers who we see in the media; these are people who often have to be kept in a controlled environment with 24-hour care.
Gillian Keegan
Down syndrome is a condition that has a very wide spectrum of abilities, as many conditions do—and as we all do, as people. Of course, the right support has to be provided for a whole range of different capabilities. We were talking about a particular case, and how important it is to get early access to speech therapy and to hearing aids so that people can develop language. It is very important to be able to maximise life chances.
Employment will differ for different people. The Government offer a range of programmes to support people with disabilities—learning or physical—to get into and stay in employment. All those programmes can also help people with Down syndrome. This includes the work and health programme and intensive personalised employment support programme, which offer personalised help and support for people with learning disabilities to get into work. The Bill creates the foundations to ensure that people with Down syndrome stay well, receive the right education, secure the appropriate living arrangements—the hon. Member for Bristol South mentioned the importance of the right support around housing—and receive support to transition into employment.
I feel proud that we can already see in our society that people with Down syndrome can secure meaningful employment. That is really important to their life, structure and self-esteem—as it is to all of us here today. We will continue to explore any steps required to make sure that people with Down syndrome can find work, where it is right for them and where that is part of their life’s journey. I expect to return to this issue in the development of the statutory guidance.
I would like to give a few examples, because all of us have met many people and seen the range of capabilities. Dilesh, who my team have spoken with, lives in Barnet with his family. He said he felt total inclusion at school, which was fundamental in providing him with the skills to secure a supported internship as a Project Search ambassador. Dilesh continued this role on a temporary basis and is working closely with his local jobcentre to find another job he enjoys. His mum believes the jobcentre has gone above and beyond to support him to reach his full potential.
We can also see big strides in representation that inspires people with Down syndrome to seek employment that truly matters to them. George Webster joined the BBC at 21 as the broadcaster’s first ever children’s presenter with Down syndrome. Ellie Goldstein, who has been a model since she was 15, has recently been in big campaigns for Gucci and Vogue while also studying performing arts.
On a world stage, George and Ellie are making big strides for representation and inspiring children, young people—not just with Down syndrome but with learning disabilities in general—and adults everywhere. Of course, we must also mention Tommy Jessop, who was very much part of a fantastic show that we have all enjoyed, and of this Bill as well. There are many role models now, and it is fantastic that they are being celebrated and seen much more in roles on our TV screens and in the media.
Dr Cameron
The Minister is making some extremely important points. Would she agree with me that it is very important that as many hon. Members as possible also engage in the disability confidence scheme in the workplace, to help employ and offer work-experience placements to people with disabilities in their constituency offices? Is it not also important that Members consider supporting the Speaker’s disability internship programme, which has been very successful in this House?
Gillian Keegan
As one of the Ministers who is a disability champion, I completely agree. It is only when one tries to take a view from the perspective of someone who has some kind of disability that it becomes possible to understand how difficult it is to do many daily things. Whether it is people with physical or learning disabilities, the more that we understand their perspective the more we can accommodate them. That, of course, makes a massive difference for somebody who has more to deal with on a daily basis than perhaps we do. It is important that we all take up the training that we are offered.
I thank my right hon. Friend for tabling amendment 3, which updates the long title of the Bill. I agree with those proposals. As outlined, this guidance only applies to England, as healthcare, education and housing are all devolved matters. I know there is also firm commitment from my counterparts to improve the outcomes for people with Down syndrome in Scotland, Wales and Northern Ireland, including through legislation. I look forward to working collaboratively with the devolved Administrations on this matter.
Regarding the schedule, it is important to have clarity within the Bill about who the relevant authorities are, and what functions the guidance will apply to. The list of authorities and their functions has been drawn from existing legislation, such as the Care Act 2014, the Children and Families Act 2014 and the Housing Act 2004. For that reason, the Government support the schedule.
This Bill is hugely significant. It will improve the lives of people with Down syndrome, improve their prospects and improve their families’ lives. I am proud to support it on behalf of the Government as it progresses through Parliament. I thank all the hon. Members for their support. To be in this privileged position, and to be able to use that privilege to make a massive difference to people, is probably what brought most of us here. I thank everybody for their support of the Bill.
Dr Fox
One question that was often asked before Second Reading, and continues to be asked, is: “Why Down syndrome?” Many have written to all members of the Committee, I imagine, saying, “Why pick a particular condition? Why not simply have it lumped in with learning difficulties?” The point is that those with Down syndrome and their families know that it is much more than “just” another learning difficulty.
There is the addition of complex health conditions—very complex, in many cases. The changes in demographics, which we discussed on Second Reading—for the first time, many of those with Down syndrome will outlive their parents—bring an element of the importance of care into the equation. Rather than singling out a single grouping, we have shown the increasingly complex needs that a range of different conditions will require, as medical science improves and we have greater life expectancy, which is something we should celebrate, as a society.
The point has been made, as it was on Second Reading, that this Bill is not about a condition, but about people—people who have a particular condition, their families, and the people who care for them. We are talking about individuals who, I believe, have for too long been more vulnerable than they need to be, and were overlooked by a series of pieces of legislation, which did not adequately take into account the combination of needs that they uniquely have.
We all come to this Bill from our personal experiences. As I said in the Chamber, my personal experience is through growing up next door to someone with Down syndrome, from working with people with Down syndrome and, as a doctor, coming into contact with a lot of them. I would like to say a couple of things about what this Bill is not. First, it is not a UK Bill; we purposely took that decision very early on. We could have made it a United Kingdom piece of legislation, and effectively confronted the Welsh, Scottish and Northern Ireland Governments, saying, “You must give us the legislative consent.” That would not have been in the interest of people with Down syndrome. It would have made it a constitutional Bill, with the arguments becoming about constitutional propriety and not about those who are actually involved.
I hope that, with the House of Commons taking this decision, we will see legislation from the devolved parts of the UK giving equal rights to those who live under those devolved systems. It should not matter where someone lives in the United Kingdom; they should have access to the same quality services, the same representation, and the same parliamentary remedies as anybody else. That is why the Bill was designed as it has been.
Dr Cameron
I thank the right hon. Gentleman for bringing those issues to the attention of the Committee. The Scottish Government are well aware of the Bill and its merits. They have had discussions and indicated that they will be taking similar types of legislation through their own processes, to see progress made.
Dr Fox
I am obviously aware of the discussions that we have had around that. I hope that the devolved Administrations will look at the timetable of the Bill’s passage through Parliament and when it is likely to get Royal Assent, to ensure that there is no time gap between the rights of those with Down syndrome in England and those in other parts of the UK. Those who the devolved Administrations represent should expect no less.
My final thought is that, as with any piece of legislation, this Bill will not be perfect. No Bill is perfect and no Bill requires no further work or changes, but getting the legislation on the statute book is, in itself, a statement of intent. It is a statement of recognition of the needs of those with Down syndrome. We know that private Members’ Bills will generally be limited in scope if they are to get through the House of Commons, but I believe the amendments to the Bill have, as I said earlier, taken it from being a good and well meaning Bill to a landmark Bill: we have signalled not just intent, but how we will give effect to that intent.
All too often we pass legislation in Parliament that sets out great rights and therefore expectations, but we do not set out the mechanisms by which those expectations can be realised. That is the real importance of the amendments. They may look small today and may not be commanding the front pages tomorrow, because they were not accompanied by bottles of wine, but it is important that the Committee understands the importance of what we are about to vote for. We have shown, by setting the guidance in front of Parliament, that there is a link between those who require change and those who can institute the change. That is as it should be, and that is exactly what those we represent have a right to expect.
Amendment 1 agreed to.
Amendment made: 2, in clause 1, page 1, line 12, leave out “(4)” and insert “(4A)”.—(Dr Fox.)
This amendment is consequential on Amendment 1.
Clause 1, as amended, ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
Schedule agreed to.
Amendment made: 3, title, line 1, leave out from “syndrome;” to second “and” in line 3.—(Dr Fox.)
This amendment brings the long title into line with the content of the Bill.
Dr Fox
On a point of order, Ms Elliott. To end our proceedings, I thank you for chairing the Committee, the Clerks for all the work they have done behind the scenes, the Hansard officials, the departmental officials, the Minister and all our own parliamentary teams, who have done a great deal of work. We may be the ones who get the front row seats, but we would not be here without those in our teams, who do all the work on our behalf. I thank all of them on behalf of the Committee for getting us to where we are today.
Bill, as amended, to be reported.
Westminster Hall
(2 years, 10 months ago)
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Automatic Pension Enrolment
(2 years, 10 months ago)
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Peter Dowd (in the Chair)
Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a lateral flow test before coming on to the parliamentary estate. Please give one another and members of staff space when seated and when entering and leaving the room.
Gareth Davies (Grantham and Stamford) (Con)
I beg to move,
That this House has considered the matter of automatic pension enrolment.
It is a pleasure to serve under your chairmanship, Mr Dowd. We are considering the matter of automatic pension enrolment, but let us not speak too loudly about it. For the past decade, this has been one of the most remarkable success stories, yet also somehow one of our best-kept secrets. It all began in 2005 with the pensions commission looking out on a bleak private pension market. It knew that we had to act to boost the number of savers and savings in the UK to give people greater security in their retirement. The commission formally proposed, as part of its work, that those over a certain age and income be automatically enrolled in a pension. The Labour party, the Conservative party and the Liberal Democrats all agreed, and after the Pensions Act 2008 was passed the coalition Government carried this through.
The results have been remarkable, transforming the UK pension landscape. For example, whereas the rate of workplace pension participation fell to 55% between 2009 and 2012, that rate is now a remarkable 88%. Today, more than 19 million eligible employees participate in a workplace pension and, together, save more than £100 billion in a single year. More than 10 million people are now saving or saving more, increasing pension savings by an incredible £17 billion. Two million fewer people are under-saving for their retirement than would otherwise have been the case. There has been a 50% increase in participation among the young, between the ages of 20 and 29. The greatest increases in pension participation by earnings have come from low to moderate earners. Let me put it simply. Savers are up. Savings are up. Men and women are participating equally. And the lowest earners have benefited the most.
That is perhaps a sign of what we can do when we work together but other, indirect benefits have been seen. For example, studies have shown that auto-enrolment has eliminated the mental health participation gap. Our fight against climate change has been bolstered: with savings volumes increased, UK pension funds now have more assets to invest in high-growth technology that is green or in renewable energy.
Paul Howell (Sedgefield) (Con)
Does my hon. Friend agree that the opportunity to invest that money exists and could be pushed further, into local communities—particularly ones such as Sedgefield?
Gareth Davies
My hon. Friend is a great champion of Sedgefield. I am grateful for that intervention, and he is absolutely right. I have spoken before about the many ways in which we can use and mobilise private capital to pay for green technology and renewable energy, but decisions about where those infrastructure sites are have to be taken by local authorities wherever possible.
Today, though, the top point that I want to make in terms of all these benefits is that auto-enrolment has helped to bring about a cultural change in our society. When our economy does well, our savers do well. Automatic enrolment helps to democratise capital. It creates millions of new investors, millions of new capitalists. It is part of what, over many decades, people have called the property-owning democracy, ensuring that most of those who can vote have a stake in our economy. When they put an x in a box on a ballot paper, they have that in mind—they have skin in the game.
However, when a policy has such an impact and is so successful, it is right that we debate and discuss how we can build on that success. Many in this place have put forward suggestions—I pay great tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his excellent private Member’s Bill—the Pensions (Extension of Automatic Enrolment) Bill—and to the work that Onward, in particular, has done—so let me add my name to those calls. Of all the options the Minister has in front of him, expanding automatic enrolment to those aged 18 to 21 will have the most material impact for our country. Automatic enrolment should be extended as a priority to young workers, because for them the potential compound interest is greatest, the pressures of demographic change are most acute, the challenges of mental health and climate change are especially relevant and the need for greater financial inclusion is most pressing.
The challenge for this age group is stark. Only 18% of eligible 18 to 21-year-olds are currently enrolled in a workplace pension.
Paul Howell
Does my hon. Friend agree that we need to ensure access to pensions for not just young people but those in multiple jobs who do not reach the £10,000 threshold in a particular occupation? In Sedgefield and the surrounding villages, there are many people in low-paid work who do multiple jobs to try to reach a certain earnings level.
Gareth Davies
My hon. Friend makes an important point. For the purposes of my remarks I want to focus on young people because, as I said, that will have the most material impact, but I know that others will speak about the points he raises.
Today, over four out of five 18 to 21-year-olds are missing out on the benefit of compound interest, despite belonging to the very group for whom the potential for exponentially increasing savings is the greatest.
Alan Brown (Kilmarnock and Loudoun) (SNP)
I agree with the principle of extending automatic enrolment to young people, and I realise that the 2017 review of automatic enrolment recommended extending it to 18-year-olds. What does the hon. Gentleman think about the merits of extending it further, to 16-year-olds, who might well have left school and be in full-time work? If we are talking about the benefits of compound interest, an extra two years could make a huge difference.
Gareth Davies
The hon. Gentleman makes a good point: the earlier one starts saving, the greater the impact of compound interest. However, for me, balancing all the factors—particularly the impact on businesses—I think we should start where we can, with 18 to 21-year-olds. But it is not the case that we should not discuss his point at a later stage.
Is it any wonder that we find ourselves in this situation, given the general lack of savings culture in this United Kingdom? We have a culture, developed over decades, of relying on quick cash, quick results and tangible output. Although many talk about the aspiration to own a home, few talk about securing their retirement through a pension. Auto-enrolment will help with this, but we must also look at other ways to ensure that the option of saving for the future is more apparent.
Preparing for today, I was shocked to find a study by the National Association of Pension Funds that found that just 12% of job adverts mention the employment pension scheme that is offered. That compares to 71% of ads that mention the salary—even though the pension contributions can amount to about a third of total take-home pay. We need to look at this more broadly.
There is so much potential for our pension system to effect change, whether addressing the need for long-term savings, as I have discussed today, the need to tackle the fact that 10 million people have less than £100 in short-term savings or the fact that so many young people today never even get close to building a deposit for their first home. I believe that our pension fund market could provide the answers to those challenges. As such, given that it is now nearly 17 years since the Turner commission, I would like us all to agree cross-party that whoever is in government in 2024, we will look to launch a new pension commission, looking specifically at the long-term challenges I have discussed and the opportunities the UK pension fund market can provide to citizens across this country.
Jim Shannon (Strangford) (DUP)
It is always a pleasure to speak on these matters, and it was especially a pleasure to hear the hon. Member for Grantham and Stamford (Gareth Davies) set the scene so well. We are here to endorse his words, and we look to the Minister for a response on the issues that still concern us and on which we wish to see action taken. It is also a special pleasure to say that I am one of those who bought into a pension at an early age, and I want to emphasise the importance of pensions to young people who do not fully understand the necessity or the benefits of having one.
I am pleased to see the Scottish National party shadow Minister, the hon. Member for Kilmarnock and Loudoun (Alan Brown), and the Labour shadow Minister, the hon. Member for Reading East (Matt Rodda), but I am especially pleased to see the Minister in his place. I had the opportunity to have him visit my constituency some two and a half years ago, before covid. That visit was to the local credit union. George Proctor was the manager, and the staff were there. We are very pleased to have them there. We were also very pleased to welcome the Minister, and we invite him to come back and get an update, if at all possible—if he has space in his diary.
The Parliamentary Under-Secretary of State for Work and Pensions (Guy Opperman)
It is an honour and a privilege to be able to intervene on the hon. Gentleman, who is a legend in this House for the fact that he intervenes every single night in the Adjournment debate. I well remember the trip in July 2018, I think it was, to Newtownards Credit Union. It is particularly memorable—colleagues will understand about ministerial visits—because when I arrived I was presented with a ginormous slice of home-made lemon drizzle cake, made by one of the team there. In my view, that is how all Ministers should be greeted.
Jim Shannon
I think I can say on behalf of Newtownards Credit Union that when the Minister does return, the slice of lemon drizzle cake will be even bigger than the last one he had. I will send today’s copy of Hansard to the staff and let them know what his expectations are. Joking aside, the Minister understands these issues and is always keen to address the concerns we have. Before we have any debates, he will always come and say to me personally, “Is there anything at all you want to bring forward today?” and then he tries to address those issues, which is something I especially appreciate. I wish all Ministers were the same, but I congratulate this Minister on doing that.
Provisions in the Pensions Act 2008 placed a responsibility on employers to automatically enrol job holders into, and contribute to, either a qualifying pension scheme or a new personal account scheme. Those duties apply to all businesses, regardless of size, which I for one welcome because it is the right thing to do. In his introduction, the hon. Member for Grantham and Stamford encapsulated the thoughts of us all about the growth of pension enrolment and how it benefits people. It is crucial that those eligible to put small amounts of money aside into a pension pot, whether they work in a small local café or in a large mechanical chain company, do their bit.
That legislation has reversed the decline in workplace saving. There has been a drastic increase in the total membership of defined contribution occupational schemes, from 2.1 million in 2011 to an outstanding 21 million in 2019—if that does not take Members’ breath away, I do not know what else would. I am of pension age, but at approximately the age of 20, I remember my mother saying to me, “Jim”— or James, as I am on my birth certificate—“we need to go and start a wee pension for you.” I said, “Oh, Mum, I’m too young to deal with that. I am not going to bother.” Mum insisted, and whenever your mother insists, you do not have any choice. We trotted down to the local place and I enrolled in a pension, some 45 years ago. At the time, I may not have understood that pension, but I understand the benefits of it today as it comes to its culmination.
So often, people find that they have been paying into a couple of pensions. Only a couple of years ago, I found out that I had being paying into four different pensions along the way. It is great way of saving. I may not have seen that at the time, but I see it now.
Paul Howell
I am an accountant by trade. I contributed to a pension for a long time. My wife also contributed to a pension for a short number of years before we had our daughter. When I came to retire aged 56, just before I came to this place, we looked at the balance of the pensions and found she had made a disproportionate contribution in relation to the time that she had spent working, because it was right at the start. Does the hon. Gentleman agree that communicating with people about the importance of early and continuous contributions is vital? It is not just a triviality, as it is so important to the outcome at the end. Personally, I am benefiting massively from what happened at that early stage. I do not think we get the message out about how important this is for people. Does the hon. Gentleman agree that communications are important?
Jim Shannon
I thank the hon. Gentleman for his comments. He is right that it is best to make contributions from an early age. I can speak to that and the benefits of it. Even though I may not have understood that at that time, my mother was insistent, so I enrolled. Today, we see the benefits of all the things we did in the past.
To be eligible for a compulsory pension scheme in Northern Ireland, a worker must be at least 22, under state pension age and earning more than the minimum earnings threshold. I know some young people who have been paying into pension pots from as young as 18, but that is down the employer and employee discretion. I do not see a reason why young people who are in consistent work should not be contributing to their future, as referred to by the hon. Member for Sedgefield (Paul Howell).
As this subject is not taught in schools, young people feel unaware of the importance of taxes and pensions. I urge the respective Ministers to think about that in relation to schools. There may be a way of suggesting to young people at an earlier stage that they need to be making contributions, perhaps through an introduction provided while they are at school.
Rob Roberts (Delyn) (Ind)
I find it difficult to believe that the hon. Gentleman started his pension contributions 45 years ago, as he cannot possibly be of that advanced age. He reminisced about how his parents drilled into him the importance of starting early. In his opinion, what has happened since those years? How did we go from the point of saying that it was a personal responsibility? How did we go from the point of our parents drilling into us the importance of saving for deposits for a house, as we heard earlier, and for retirement? Is the situation we have now on automatic enrolment satisfactory in terms of getting us back to where we were before?
Jim Shannon
I think the figure gain tells it as it is. We went from 2.1 million people to 21 million people; the increase was massive. People from my generation were very responsive to what our parents told us and we did what they suggested because they knew best. Today the companies are trying hard and encouraging people but, as the hon. Member for Grantham and Stamford said in his introduction, education might be another way of helping us get even beyond where we need to be.
In February 2021, a report from the National Employment Savings Trust looked at the impact of the covid-19 outbreak on its 9.5 million members. It found no significant changes in average contribution levels; the majority had continued to save, with around one fifth contributing more than the minimum contribution rate. That tells us that the scheme is successful for some—potentially, everyone—and helps people to save. I find those figures reassuring and proof that this legislation is beneficial, which may answer the question raised by the hon. Member for Delyn (Rob Roberts).
There is absolutely no doubt that this legislation has brought many benefits. Pensions help people maintain their standard of living in retirement, and savings provide important supplemental income for unforeseen expenses. Pensions are an economically efficient way to fund retirement, which means they are a prudent use of taxpayer money.
Others have expressed a few concerns about the lack of pension provision for the self-employed, and I have a question for the Minister. How and when should pension contribution rates increase above the 8% minimum? It is important that there is provision for the self-employed. There are 134,000 self-employed people in Northern Ireland. In Strangford, and perhaps in other constituencies as well, we have a tradition of many people being self-employed. I had a period of self-employment but continued to pay the pension contributions. That was probably when I increased the number of pension schemes I was in. Perhaps the Minister could indicate how we might encourage the self-employed to be involved. That is my question for the Minister, and I know I will get the response I wish for.
I want to conclude because I am conscious that others wish to speak. Automatic pension enrolment for workers makes sense and is a good deal. Pensions not only help the local economy but are a win-win situation for employers, employees and local business owners. The figures are astonishing: since 2012, more than 10.2 million workers have been automatically enrolled in pension schemes and that is on the increase.
The scheme is a success, and we thank the Government for their encouragement and promotion of it. I only suggest that it could be approached educationally at an earlier stage. I urge the Department for Work and Pensions to look at the issues others will raise on pension enrolment and to step in to solve them. None the less, I thank the Minister and Government for all they have done.
Peter Gibson (Darlington) (Con)
It is a pleasure to serve under your chairmanship, Mr Dowd, and to be called to speak in today’s debate, which has been so ably led by my hon. Friend the Member for Grantham and Stamford (Gareth Davies). The debate raises an important issue and I congratulate my hon. Friend on securing it. It follows on from the excellent ten-minute rule Bill recently introduced by my hon. Friend the Member for North West Durham (Mr Holden).
When auto-enrolment was introduced, I recall being fearful of the impact it might have on my business at the time, and of the costs that it would pass on to me as an employer, but auto-enrolment has proved to be a huge success, reversing the decline in workplace pension saving and ensuring that millions more people are now saving for their future. I saw at first hand the benefits that the scheme has had on the lives and futures of my employees. Employees who would never have considered being part of a pension scheme were put in a position where it became a simple and easy process. For the first time, they were ensuring that they did not fall into the trap of under-saving for retirement, encouraging self-reliance and responsibility.
There are still huge numbers of hard-working people who are not auto-enrolled in pension schemes, with many excluded on the basis of youth or purely because they are not working enough hours or earning enough. For those under the age of 22, the numbers are woefully low. Among those in part-time employment, although some will earn more than the £10,000 threshold, the numbers auto-enrolled are still significantly lower than among those who are in full-time employment.
The minimum age of 22 simply does not work for those who choose not to go to university. Why should someone who chooses to start working at 18 not pay into a pension from that age, in the same way as someone who is 22 does? They would have so much to gain from auto-enrolment being extended to them; we have already heard about the magic of compound interest.
The current system also disproportionately affects women and the poorest in our society, who are more likely to be in part-time work and have multiple part-time jobs, like many in my constituency of Darlington. Although Darlington has 1,820 employers, with 26,000 employees auto-enrolled, I am encouraged that the proposed extension advocated by my hon. Friend the Member for Grantham and Stamford would add almost 900,000 extra savers across the country. Those workers are often employed in industries, such as hospitality or retail, that have faced huge difficulties during the pandemic, but are in many cases the backbone of our workforce. It is only right that we do all we can to ensure that they do not miss out on future financial security; that is levelling up.
Extending auto-enrolment could add trillions to the nation’s pension pot. It is a chance to ensure that people start to save for their future while they are young. It also allows us to ensure that the poorest in society have a more secure future and takes steps towards closing the gap between men’s and women’s pension savings.
In 2019, I stood on a manifesto to level up communities across the United Kingdom and the extension of auto-enrolment is a policy that has the potential to have a really positive impact on people’s futures. It would be a commitment to level up for the long term.
As we contemplate how auto-enrolment can help us deliver on our levelling-up agenda, we must not forget the role of pension companies and the positive impact that these changes could have on their work. Auto-enrolment increases the resources available to them and provides a steady, long-term stream of capital for investment across the UK—investment that can be directed to the communities that are home to those who currently miss out on auto-enrolment, letting them see the benefits of their own savings.
I know that the extension of auto-enrolment would have huge benefits for many people in Darlington and across the country, so I hope that the Government will give this policy real consideration, as we continue to build back better from the pandemic and level up our country.
Peter Dowd (in the Chair)
For the benefit of Members, if you do wish to speak—notwithstanding that you have asked to speak—would you rise? Thank you.
Duncan Baker (North Norfolk) (Con)
I thank my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for getting us all up so early—9.30 am on a Wednesday—to talk about our favourite subject, which is clearly auto-enrolment.
I will start by being very rude and saying that we often see private Members’ Bills introduced that are nothing more than political graffiti. However, the one recently introduced by my hon. Friend the Member for North West Durham (Mr Holden) on this issue is far from that, and we should give a great deal of consideration to how it fits with this debate. People might expect me to say that, because I am an old bean-counter. Before I came into this place I was a former finance director, and I remember with utter dread the systems and processes that we had to implement to deal with auto-enrolment.
Although most people tend to glaze over when we talk about pensions—present company excepted, obviously—this idea is really sound. That is because, let us face it, we are living in an ageing population all of the time, and in any person’s view the need to save for our retirement is extremely important; and the crux of the matter is that the sooner someone does it and has the opportunity to do it—two important parts of what we are discussing today—the better for society. After all, many people will have in their pension savings the highest asset that they will ever hold.
The other reason that this debate is so important to me is because I am going to do something that not many MPs do in this place—admit how wrong I have been about things. Yes, I will now say that I made a mistake. That is because I remember the days when auto-enrolment first came in—my hon. Friend the Member for Grantham and Stamford makes me feel very old, because 2005 feels like a very long time ago—and I remember that at the time I thought, “What a waste of time auto-enrolment is.” I bemoaned how much it would cost us as a company, and the meaningful contributions that people would make were so small when auto-enrolment first started that it was a total nuisance to administer and I wondered whether it would really make much of a difference, precisely because people’s contributions were so low. In addition, I expected that people would simply opt out—that there would be a knock on the door three months later and someone would ask, “Duncan, can you please take us out of this scheme?” But people did not, and that is because the Government got it right. They made those initial contributions so low that people got used to it.
So, on those two counts, I got it completely wrong. That is why I back what my hon. Friends the Members for Grantham and Stamford and for North West Durham are proposing, because with nearly 90% of people now participating in a workplace pension, old cynics like me have been proved totally wrong. The fact that we now have 10 million workers in an auto-enrolment scheme in this country is a testament to how extremely good auto-enrolment has been. It has created momentum—momentum for people to take responsibility and save for their retirement.
My constituency of North Norfolk is very beautiful, but we have a disproportionate number of lower earners. It is a coastal community; hospitality and retail are very important, and therefore form a chunk of lower earners. Why are we not making it easier for everybody to contribute, to allow younger people—that rump of my workforce—to have that chance earlier? All the statistics show that they will reap the benefits of getting started on that ladder earlier. It is a very simple proposal, but it has far-reaching consequences. If it opens up more people to take that responsibility, to be able to earn for their retirement, I think it is extremely worth considering and I am very happy to back it.
Simon Baynes (Clwyd South) (Con)
It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for bringing this very important debate to Westminster Hall this morning. I am not declaring an interest but, like other hon. Members present, I was involved in the financial world in a previous life, having worked for 25 years in the financial services industry. I have also been a trustee of several charitable investment portfolios, and served as a member of the pensions and investment committee on Powys County Council during my time in local government.
I fully support the point made by my hon. Friends the Members for Grantham and Stamford and for Sedgefield (Paul Howell) that the issue of auto-enrolment is not only about benefiting employers and employees, but about the huge amount of capital that builds up in those funds and the constructive way that it can be invested for social and environmental good, and for the general improvement of the economy.
Much mention has been made of the statistics showing the remarkable transformation of the pensions industry since the introduction of auto-enrolment, so I will not go on at length about them. However, I would like to pull out one or two contrasting statistics. We have heard that nearly 90% of employees are now workplace pension members, compared with only 50% in 2012 before auto-enrolment was introduced. Auto-enrolment has resulted in a significant increase in pension membership, particularly of defined contribution schemes—another very important aspect. The statistics carry on; they are extremely impressive. The hon. Member for Strangford (Jim Shannon) has alluded to that, so I will leave it there.
The introduction of auto-enrolment has been what I would consider to be a quiet revolution. It has helped to normalise pension saving in my constituency of Clwyd South and elsewhere in the UK, increasing the proportion of people who see pension saving as a good thing and who say they know where to go if they want more information.
That is another vital aspect of auto-enrolment: it is about not only the amount of money and the level of take-up, but a cultural change that has huge benefits for the country in the long term. A recent British social attitudes survey found that 79%—a majority—of individuals interviewed viewed automatic enrolment as a good thing for them, 77% agreed that saving into a workplace pension was normal for them, and 75% knew where to go to find out more about workplace pensions. That reinforces my point about the cultural change that is so vital in this process.
Another point that is vital to draw out in this debate is that the latest data suggests that auto-enrolment has reduced some of the regional disparities in workplace pension participation. Figures from 2020 show that rates of employee workplace pension participation are fairly consistent across the UK, with little geographic variation. Regional data prior to auto-enrolment is not available, but the continued roll-out of auto-enrolment over the last five years has been accompanied by increased rates of participation by private sector employees in regions other than London and the south-east, which is hugely important to many hon. Members who represent seats far away from the south-east of England.
Another important point emerged from the 2020 study by Karen Arulsamy and Liam Delaney, “The Impact of Automatic Enrolment on the Mental Health Gap in Pension Participation: Evidence from the UK”. It showed that, particularly for people who are not particularly experienced in financial matters, auto-enrolment has completely removed the mental health gap in pension participation.
Finally, the private Member’s Bill introduced my hon. Friend the Member for North West Durham (Mr Holden) is absolutely vital, particularly for my constituency of Clwyd South, where auto-enrolment figures are good but could be higher. There are 1,040 employers involved in auto-enrolment and 3,000 job holders. That is, in a sense, connected to the points raised by my hon. Friend the Member for North Norfolk (Duncan Baker), because my constituency has a real mix of different employment patterns. Like his constituency, tourism and hospitality are important parts of the employment make-up of Clwyd South. There are many young workers and people working part time who fit their jobs around their families and other considerations.
I am sure my hon. Friend the Member for North West Durham will be speaking later, but I want to quote one thing that he said:
“three quarters of those aged 22-plus are auto-enrolled into pension schemes, but under the age of 22 it is only 20%...of people in work, not students. That is a big difference, and the difference that auto-enrolment has made since 2012. For part-time workers, while some will earn more than the £10,000 threshold, auto-enrolment is 57.8% compared with almost 90%”
—as has been established earlier—
“of workers in full-time jobs. If we assume a similar take-up, the Bill could see an extra 30% of the part-time workforce auto-enrolled”.
The other point he makes, which again goes back to a point I made earlier, is that an
“extra £2.77 trillion…would be invested in our pensions for the lower-paid and younger workers”.—[Official Report, 5 January 2022; Vol. 706, c. 81.]
It benefits not only them and their families, but the general economy.
In conclusion, I am delighted that we are discussing this important issue. As I said, it is a quiet revolution that brings hope and comfort to many families, particularly among those who are not particularly experienced in financial matters, and adds greatly to the prosperity and health of the economy of the United Kingdom.
Rob Roberts (Delyn) (Ind)
It is a pleasure to serve under your chairmanship, Mr Dowd. I give credit to my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for securing the debate and, indeed, to the Minister; it is always a pleasure to see him responding to a debate. He must get tired of hearing from everyone, every time we have a pensions debate, “Auto-enrolment has been wonderful and the things the Government are doing are outstanding, but we could always do more.” We are always asking for more. That is the way of things, and I think he has come to appreciate that over time.
As everybody else has done, I pay tribute to my hon. Friend the Member for North West Durham (Mr Holden) and his private Member’s Bill. When I read back through the Bill last night, I saw that it contained many of the things I wanted to cover, so I shall be very brief, which will please everybody no end. I will just mention three points that I hope the Minister can cover later.
My hon. Friend the Member for Sedgefield (Paul Howell) mentioned excluded people. Someone earning £9,000 in each of two different jobs would not be enrolled despite having £18,000-worth of income, which would otherwise clearly qualify. Like those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for Clwyd South (Simon Baynes), my constituency is very rural, and we have lots of people in those circumstances. Something as simple as taking away the £10,000 qualifying point would be a real benefit to those people.
On the under-22s, I was a financial and pensions adviser for a decade and a half, and one of the key things that we always said—the hon. Member for Strangford (Jim Shannon) mentioned it earlier—was, “Start as early as you can.” An extra five years will add in the region of 26% to 30% to the end value of a pension pot. The hon. Member for Kilmarnock and Loudoun (Alan Brown) used the golden words “compound interest”. Those extra years at the start make such a huge difference at the end.
That is particularly relevant in my own situation. My daughter is 17 years old. She has decided that university is not for her and has gone into full-time work, but she is not being auto-enrolled. Of course, she can opt to be enrolled when she gets to 18, but, as my hon. Friend the Member for North Norfolk mentioned, it is easier when it is done for us; it is harder to opt out than to opt in to something. I completely appreciate that.
My second point is on qualifying earnings. People may well be under the illusion that if they are earning £30,000 a year, they are contributing 8% of £30,000. Sadly, that is not the case. The lower earnings limit, which is £6,240, is taken off before that 8% is calculated, so someone earning £30,000 grand is only paying 8% of £23,760. Getting rid of the lower earnings limit and making pension contributions start from zero would add another 26% to the final value of someone’s pension pot by the time they come to retirement. Just those two changes—making auto-enrolment available to under-22s and making it count for all earnings—would add 29% and 26% to the final value of a pot. That is a huge amount and would make a huge difference.
My final point, which is very simple, is about complacency risk. We hear that auto-enrolment has been transformative—my hon. Friend the Member for Grantham and Stamford used that word, and we have all heard the statistics—but has it? Eight per cent. is not enough. Even if it was 8% of all earnings, it would not be enough. My cousin is a financial adviser over in America. I talked to him over many years about how I did my processes and worked out how much people should save, with the calculations and the risk levels and all the interesting bits that go into forming a conclusion. He said, “I don’t do any of that. I just tell people, ‘Just do 20% and you’ll be fine.’” He advises people of relatively high net worth, and 20% is a relative amount to different people, but 8% just will not do it.
We have this complacency: because the Government have mandated 8%, people think, “Well, that must be okay, then; that must be what I need to do to get a good standard of living in retirement.” Somebody earning £30,000 per year, leaving out the earnings that do not qualify, will be contributing £1,900 per year over 35 years. Assuming 4% growth, they will have amassed a pot of about £140,000 after 35 years. That does not sound a terrible amount, but when we adjust it for inflation, in today’s prices, that is a pot of about £86,000. That will not buy a lot in retirement.
This is where the two things that I mentioned earlier will come in. If we added 29% and 26% to that pot, while it would still not be a massive amount, or enough to get people to where they need to be, it would certainly be something. As was mentioned earlier—I spoke about personal responsibility—people need to go and see a financial adviser and take the guidance that is available from the Money and Pensions Service.
What we are doing is not enough. People must wake up and open their eyes; what we are doing is great, but we could absolutely be doing more. There are a couple of ways we could do more. Back when we had defined-benefit pensions, the employer would pay about £3 for every £1 that the employee paid. That was unaffordable, and it was the main reason that most defined-benefit pensions were closed down. Under the defined-contribution schemes that existed before auto-enrolment, employers paid about £2 for every £1 that employees paid. Now, that figure is 60p or 70p. Although I talk about personal responsibility, there is a lot more scope for employers to do more, as they used to.
Another potential option would be to roll the principle of auto-enrolment forward into other savings options. Why can we not have an auto-enrolment individual savings account? Why can we not do what my hon. Friend the Member for Grantham and Stamford said about saving for a house deposit? Why can we not use the same principle in other arenas? Why can we not make pensions a bit more flexible, as they are in the United States, where the 401(k) product can be utilised in a lot more ways a lot sooner? That could provide the deposit for a house or be used at other crucial times in life. There are lots of things we could do.
I have offered a bit of a sandwich, with a nice opening and a nice ending, and bit of a demand in the middle. We are doing wonderful things and they have been successful—everybody says so. We can do more and we probably should, and I think the Minister knows that.
Mr Richard Holden (North West Durham) (Con)
It is a pleasure to serve under your chairmanship, Mr Dowd. I pay tribute to my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for securing this debate. I have been trying to secure one for a couple of months, but he seems to have managed to pip me to the post.
I thank so many hon. Members for mentioning my ten-minute rule Bill to look at extending auto-enrolment. Everyone who has spoken has pointed to the success of auto-enrolment. It has been a cross-party success, as my hon. Friend the Member for Darlington (Peter Gibson) said. It is slightly sad that there are not more Scottish National party or Labour Back Benchers here to welcome that success and talk about the future, but this is something we can proceed with on the basis of those on all sides of the House coming to an agreement.
The main point, which has been made by many Members, is that an extra 10 million people are now looking to save. The reason they are saving is that for every 50p they put in, they get £1 in their pension pot, because they get the tax relief plus the employer’s contribution. That is seen as a simple and straightforward thing. For every £4 an employee puts in, their employer puts in £3 and they get £1 in tax relief. That is a simple, straightforward way of explaining it to people. It is important for us to have this debate and to look at the success and the future of auto-enrolment.
Many hon. Members made the broader point that we want people saving for themselves, their families and their futures. This is a small “c” conservative principle that cuts across working class communities across the country, including mine in North West Durham. It provides a really important stake in society when people save into a pension over time and see that money invested in UK companies, as well as in companies across the world—although my hon. Friend the Member for Darlington made the important point that if we are looking to expand auto-enrolment, we need to enable people to see the benefits of those savings in their communities.
I therefore hope that the Government will look at ways to ensure that that patient capital can be invested more in things such as social housing projects and transport infrastructure schemes. I do think it is time to expand. I could understand why, in the past, employers were concerned about auto-enrolment, but it is great to hear from my hon. Friend the Member for Darlington, who ran his own business, that he has seen those concerns alleviated by the impact that it has had on his employees.
Let me say to my hon. Friend the Member for North Norfolk (Duncan Baker) that, as the hon. Member for Strangford (Jim Shannon) may know, Luke 15:7 states that
“there will be more joy in heaven over one sinner who repents than over ninety-nine…persons who need no repentance.”
I am glad to see my hon. Friend on board and helping to drive the agenda; as he mentioned, it is so important for those lower-paid part-time workers in his constituency and mine. I will come to that in a moment.
There are two groups that future changes could really affect. One, as my hon. Friend the Member for Grantham and Stamford said, is that younger age group. It is unbelievable to me that someone of my age—any person in this room, in fact—will benefit from the employer contribution and tax relief, but someone aged 18, 19 or 20 will not. That seems demonstrably unfair, and it is something that we really need to get a grip on. As the hon. Member for Strangford said, compound interest created by saving early makes a real difference in retirement.
Reflecting on what my hon. Friend the Member for Clwyd South (Simon Baynes) said, the statistics from before and after auto-enrolment kicks in are stark. Before it kicks in, a fifth of people are enrolled; after it kicks in, 17 out of 20 are enrolled. That is a massive change. We need to bring those figures into line, particularly for people who do not go on to university but choose a different path. As my hon. Friend also mentioned, that is a very important factor in the regional disparity of where people pursue their careers. My hon. Friend the Member for Sedgefield (Paul Howell) also made a very good point: how can it be right that those earning £50,000 or £80,000 per year get the tax relief and employer contribution, but others—particularly part-time workers—do not?
I mentioned some examples when I introduced my private Member’s Bill in the House. Women are particularly disadvantaged. Part-time workers often juggle multiple jobs around childcare or other caring responsibilities; it seems to me totally unfair that someone doing two part-time jobs that are above the threshold just does not get the tax relief and employer contribution. If we could reduce the age of auto-enrolment to 18, we would be looking £25,000 in younger workers’ pension pots. That is not going to be transformative in and of itself, but taken together, the changes will be transformative. Getting young people auto-enrolled early is crucial to allowing them to see their savings start to build early, and that is what we need to see.
In addition to what hon. Members have already said, I say to the Minister that we need to see an age reduction, we need the qualifying earnings amount to be reduced, and we need the threshold for earnings to be lowered too.
Guy Opperman
I thank my hon. Friend for his speech. I was ill when he introduced his ten-minute rule Bill, but I read his speech in Hansard. He will understand that Ministers are not able to respond to a ten-minute rule Bill in the normal course of events. Cleary, he is in the process of drafting his grave and weighty Bill, but am I led to believe that the intention is not to introduce the extension until the mid-2020s, which was the original intention of the December 2017 automatic enrolment review?
Mr Holden
Yes, it is. I think that it needs to be introduced in a phased way, exactly for the reasons that my hon. Friend the Member for North Norfolk and others have mentioned. We need to phase it in over time so that employers can be ready for the increased cost, but also so that we do not burden young employees very quickly with an enormous extra cost.
Phasing in the extension is exactly the right thing to do; that is how auto-enrolment has been such a success so far. If we had hit people by taking a large chunk of their income at one point, people would have withdrawn and auto-enrolment would not have been the success that it is. Instead, we are seeing take-up rates for full-time workers of nearly 90% now. The phased approach is so crucial. I would like to see it on that sort of timetable—phased in throughout the mid-2020s. That is where we need to be to ensure that as many people as possible take it up and can save for the long term.
We have come such a long way over the last few years. We saw the proportion of people saving for their pensions drop to around 45% before auto-enrolment was introduced. It had been between 55% and 45% for the previous 20 years or so. We have seen the proportion rise rapidly due to auto-enrolment; it is now well above 70%. If we can include part-time workers as well, as my hon. Friend the Member for North Norfolk alluded to, we could see the proportion reach 80% or 90%, which is exactly what we want. Some 6,000 employees in North West Durham are already auto-enrolled, with 1,500 employers. We need to see more people auto-enrolled to save for their retirement.
Overall, extending auto-enrolment is probably the strongest levelling-up measure that we could deliver. I want people across the country who work and play their part in our society to see the same response from the Government, with support to pay into their pensions, and support in their old age and retirement.
Alan Brown (Kilmarnock and Loudoun) (SNP)
It is a pleasure to serve under your chairmanship, Mr Dowd. Like everybody else, I congratulate the hon. Member for Grantham and Stamford (Gareth Davies) on securing the debate. There have been a number of Tory Back-Bench contributions; I was worried that I would end up agreeing with all of them, but I have managed to find a couple of aspects to disagree with—I am pleased about that.
I agree completely that auto-enrolment has been a success. The hon. Member for Grantham and Stamford set out well its history and success. I agree, too, with the principle of creating larger pots for investment in infrastructure. That is an age-old argument, but we never seem to get there; I agree that that needs to change. I am slightly concerned about the talk about pension savings funding housing deposits. I know that people want access to the housing market. However, I worry that, depending on how deposits are funded, that will not take the heat out of the housing market, but will actually increase it, because more people will be chasing a smaller pot of houses. We need more affordable houses as much as new ways to get people deposits.
The hon. Member for Grantham and Stamford made the interesting point that only 12% of job adverts advertise pension contributions. If we are talking about advice and people understanding the benefits of pension contributions, we need to look at that. The hon. Member for Strangford (Jim Shannon), who would have been surprised to have been called so early, further set out the success of the scheme, and talked about his personal experience and, importantly, education—that is clearly important for everybody. It was brave of the Minister, in the current climate, to intervene on the hon. Member for Strangford to talk about cake—fair play.
We heard from the hon. Members for Darlington (Peter Gibson), and for North Norfolk (Duncan Baker). It was very good to hear the employer’s and the director’s points of view. Both Members admitted that they had concerns, but they were pleased to see how successful automatic enrolment is. It is good to have that buy-in.
The hon. Member for Clwyd South (Simon Baynes) spoke about access to advice; I will come back to that, because I agree with him on that point. The hon. Member for Delyn (Rob Roberts) made a good point about complacency. We need to make sure that people understand that they might need to increase their contributions and pay more. That is very important, and it links to the point about getting proper advice.
Finally, we heard from the hon. Member for North West Durham (Mr Holden). I, too, congratulate him on his efforts in bringing forward his private Member’s Bill. He set out his stall really well on that day, as he did, briefly, today. His key point—that for every 50p somebody contributes, they get £1 in their pension pot—sums it up perfectly; it is a great illustration.
As we have heard, auto-enrolment has clearly been a good thing, and a success in getting way more people to save for their retirement. In fact, it has been so successful that we have to ask why it took so long to bring in such a scheme. The Association of British Insurers states that automatic enrolment has brought a further 10 million people into pension saving. As we have heard, 88% of eligible employees participated in their workplace pension in 2020, which is up from 55% in 2012. That is a fantastic step forward.
However, there are concerns that an estimated 12 million people are still under-saving for retirement, and that needs to be addressed. Given what we have heard today about the success of auto-enrolment, and given that the Government think it is important that people save for retirement and believe that auto-enrolment is a success, the Government should logically ensure that as many people as possible are eligible. That means implementing the recommendations of the 2017 review as soon as possible. During the passage of the Pension Schemes Bill, Labour and the SNP worked together to introduce amendments that would do that, so it was disappointing that the Government voted those down. The Minister did commit to implementing the recommendations of the 2017 review by the mid-2020s, but rejecting the amendments does not give confidence.
We know how unstable UK Governments have been in recent years, and now the Leader of the House is threatening us with another general election, so it seems to me—without being too flippant—that there is a risk, if action is not taken sooner rather than later to get legislation through the House, that matters could slip further. As I said, the hon. Member for North West Durham has his private Member’s Bill, which we would support. I am still concerned, though, that we are looking at the mid-2020s. If we agree that this change is so good, we need to look at bringing it forward and getting things moving much quicker.
Rob Roberts
The hon. Gentleman makes an excellent point about bringing forward measures, but if we make these changes, is it not really important to give businesses enough lead-in time to plan properly and budget for them, rather than springing a significant change on businesses?
Alan Brown
There is a point there, but we have heard from an employer and a finance director that their concerns were allayed once the scheme came in, so I think that there will be fewer concerns as we go forward. Speaking of giving employers notice, we need only think about national insurance contributions. That rise was introduced in a short space of time, so we should not be too concerned about how we phase this in. If we do not do it, more people will lose out, which defeats the purpose.
Everybody here agrees that we should lower the age threshold for auto-enrolment to below the age of 22. I have said that I would rather have 16 than 18 as the threshold. I would be content with a two-stage process on that; we could review the situation with regard to 18 to 21-year-olds, just to see how successful it was, and to check that they were not opting out, but in the long term we definitely need to move to 16-year-olds, who could be in full-time employment. We also need to look at removing the lower limit of the qualifying earnings band, so that contributions are payable from the first pound earned. As we have heard, its removal would benefit the low-income workers who otherwise would have little prospect of a decent private pension.
To repeat what other hon. Members have said, the issue is particularly acute for women, who are more likely to be lower paid, in part-time work and doing multiple jobs. We have a massive gender pensions gap. In a recent report, the Pensions Policy Institute found the following:
“Men have substantially more private pension wealth than women, with disparities increasing across age groups. For those aged 65-69, median pension wealth for men is just over £212,000 compared to just £35,000 for women…Divorced women’s pensions are much lower than divorced men’s.”
The Association of British Insurers states that the average pension pot for a woman aged 65 is one fifth of that of a 65-year-old man. Women receive £29,000 less in state pension than men over 20 years. The deficit is set to continue unless further action is taken. We also need to look at expanding the contribution rates beyond the 8% statutory minimum, to allow people to maximise their pot. That builds on what the hon. Member for Delyn was saying.
As I have said, further delays are unacceptable. I hope that the Minister will say that the UK Government will set a clear timetable for their plans for expanding automatic enrolment. Morally, they should do that, given that they have made other decisions that are affecting pensioners both in the here and now and in the long term. We have a cost-of-living crisis, and I note that Tory Back Benchers are now using it as a defence for keeping the Prime Minister in his place, even though the cost-of-living crisis happened on his watch. They are arguing that there is a cost-of-living crisis that warrants our attention, but they still voted through the removal of the triple lock in the November Budget, costing pensioners more than £500 this year alone and a cumulative £2,600 over the next five years. That cut comes despite the fact that UK pensions are already the least generous in north-west Europe in comparison with the average wage.
We have just had the report on the shocking state pension underpayments, and there are comments that the system for state pensions is not fit for purpose. We have seen 118,000 people underpaid as regards benefits. We still have the injustice faced by the WASPI women—Women Against State Pension Inequality—and there are very low take-up rates for pension credit, which the UK Government acknowledge is an issue, but have not remedied.
The SNP continues to demand that the UK Government introduce a proper take-up strategy for pension credit, as the Scottish Government have done for devolved benefits. We continue to call on the UK Government to establish an independent savings and pension commission to ensure that pension policies are fit for purpose and reflect the demographic needs of different parts of the UK.
Another aspect of auto-enrolment that needs to be addressed relates to the self-employed. We have heard about the massive increase in employees in defined contribution schemes, but the trajectory for the self-employed has been the polar opposite—for them, the numbers have gone down: 48% of the self-employed contributed to a private pension in 1998, but the figure went down to only 16% in 2018.
Another key point is about professional advice. It makes no sense for people to save for retirement, or for support for when they are older, but to remain at risk when accessing their pension pots. That important matter was covered by the Work and Pensions Committee in its report “Protecting pension savers”, published last week. I support the calls for the Government to set a goal of ensuring that at least 60% of people use the Government’s Pension Wise guidance service or receive paid-for advice. That is a key consideration.
Pension Wise has proven to be a success. We need to make sure that more people access it. There should be a trial of automatic Pension Wise appointments, in order to encourage more people to access advice that will benefit them. The UK Government should initiate two trials: one in which people automatically get an appointment when they access their pension for the first time, and another in which they get an appointment at age 50, before they access their pensions—a mid-life MOT, as it has been called.
Auto-enrolment has been a good measure, but it needs further action to make it even better, so that it can benefit millions more people. Action to implement the 2017 recommendations should be a priority. I hope the Minister will agree, and will say that they will bring legislation forward at the soonest opportunity.
Matt Rodda (Reading East) (Lab)
It is a pleasure to serve under your chairmanship, Mr Dowd. I thank all colleagues for taking part in today’s debate. We have had a rounded discussion of this important issue, and it has been heartening to see so much engagement from Members across the House.
As I know colleagues appreciate, pensions are a very long-term policy area. The decisions we make today have profound effects over many years. Encouraging sustainable and sensible saving now makes for much better retirement in the future. It is therefore right that we actively explore ways to help those who could benefit from further opportunities to auto-enrol in pensions. We must work with businesses to understand their needs, and to build a system that is fair and sustainable for all. We should be ambitious and responsible at the same time, particularly in the years following the covid crisis.
Auto-enrolment has proven to be one of the most positive developments in recent memory for savers, and for securing people’s long-term prosperity. It has been transformative in encouraging millions of people to save earlier in their careers. That will dramatically improve outcomes later in life, as hon. Members have mentioned.
I remind the House that it was the Labour Government in 2008 who first introduced legislation on auto-enrolment—a contribution of which my party should be very proud. However, the measures have cross-party support, and I pay tribute to colleagues from across the House who mentioned that. It is important that we work together, and that we remember the contribution made by those in the other place, who also recognised the policy’s potential and helped develop it before it came into practice. More than a decade since its inception, it is natural that we look again at auto-enrolment.
In conversations with the pensions industry, I have heard experts call for us to consider lowering the qualifying earnings threshold and the minimum age requirement. The People’s Pension, for example, endorsed those proposals. It argues that millions of new savers would be created, many of whom would be women and people from ethnic minority backgrounds. The Association of British Insurers found that employees would be able to save an additional £2.6 billion a year if the earnings trigger was scrapped.
There is justification, as well as a desire in the sector, for policy makers to look at all available options. That is especially true in the light of the Government’s commitments in 2017 to reviewing the situation, and to getting workers to save early by considering removing the lower earnings limit and reducing the age threshold for automatic enrolment to 18 by the mid-2020s, as we have heard reiterated today. The deadline is approaching fast, so I ask the Minister to clarify what stage the Government have reached in their consideration.
I also ask the Minister to set out the work his Department has done to understand the wider implications of last year’s decision to freeze the earnings trigger and only modestly increase the upper limit of the qualifying earnings band. Understanding those consequences is important for tackling inequality and helping more workers to get into the habit of saving, as has been mentioned. Studies have shown that only 37% of female workers and 28% of black and ethnic minority workers are eligible for the scheme. Finally, I reiterate the importance of this debate, and thank colleagues from across the House for taking part. I hope the Minister will respond to the points made.
The Parliamentary Under-Secretary of State for Work and Pensions (Guy Opperman)
It is a pleasure to serve under your chairmanship, Mr Dowd. It is genuinely hard for me to disagree with anything that my hon. Friend the Member for Grantham and Stamford (Gareth Davies), who is an esteemed member of the Treasury Committee, put forward in his outstanding speech. I thank him for bringing this matter forward for debate. Contrary to popular opinion, I am always keen to debate all matters pension. I have done this job for about 1,680 days and continue to make the case for the change that we are driving forward.
I will address in more detail the speech of my hon. Friend the Member for North West Durham (Mr Holden), my constituency neighbour, who is a vast improvement on his predecessor. He helpfully enlightened us with the fact that St Luke is the patron saint of pensions, which I did not know. I will return to his ten-minute rule Bill and private Member’s Bill in due course.
I listened carefully to the speech of the hon. Member for Kilmarnock and Loudoun (Alan Brown). It is a bit like taking an SNP horse to water and trying to make it drink; his speech started so well, with the statement that, by and large, he could not disagree with anything that had been said, but that sentiment disappeared in general criticism of the Government. He will know that the state pension is up by more than 5% in 2021-22. He will know that pension credit take-up is increasing. He will know that winter fuel payments and cold weather payments are well in excess of £2 billion. He will know that there are free eye tests worth £900 million and free bus passes of £1 billion. I could go on to address various other points he raised, but I want to focus primarily on the automatic enrolment issues raised by my hon. Friend the Member for Grantham and Stamford.
I am slightly concerned that the story of today’s debate may be, “Minister admits that in 2018 he, too, was ambushed by a cake—a lemon drizzle cake—while on a ministerial trip to Newtownards, Northern Ireland”. There are many points that the hon. Member for Strangford (Jim Shannon) made that I want to address. It was an honour and privilege to visit his local credit union. I would love to take him up on his kind offer and return to Northern Ireland. Because of covid, so much has happened as regards ministerial visits and progress on so many things. Our country has acquired approximately £400 billion on the nation’s credit card, and there are difficult fiscal choices to make, which have clearly impacted the roll-out of many economic and fiscal policies. Certainly, in 2022, provided I continue to hold this job that I enjoy, I hope to make the case across Northern Ireland. I have not visited Derry/Londonderry; the credit union there is one of the most successful in the UK and it would be a great pleasure to visit it.
The hon. Gentleman mentioned consolidation and said that he had four pensions. It is right to celebrate and laud the fact that probably the second biggest project that the Department for Work and Pensions is rolling out is the pensions dashboard. Auto-enrolment is the first, and I will come to that in more detail. The pensions dashboard will be transformational: he will be able to see his four pensions on his mobile phone, laptop or iPad. Just as people have a savings app or banking app, we will be able to take the tens of thousands of pensions out there, access that information and understand what an individual has. Crucially, so many colleagues raised the issue of awareness, and the dashboard is the key to understanding that.
There are other things that we are doing, and I could talk in detail about our plans—which will come forward this October—for what are called simpler statements, which basically amend the traditional, very complex pension statements that very few people understand, save for independent financial advisers, which some colleagues present have worked as in the past. The man or woman in the street simply does not understand those statements in sufficient detail, so we are putting them into a two-page form that tells people what they have and gives them proper information; it will do what it says on the tin. We in the DWP and, to be fair, people across industry believe strongly that that is the right way forward, in order to enlighten members, so that they have a better understanding of what they have.
The dashboard will come forward in 2023 and simpler statements will come forward in October 2022. There is much that we could say on the issue of financial education. It is a credit to my right hon. Friend the Secretary of State for Levelling Up, Housing and Communities that he introduced financial education in secondary schools, but we need to do more to enhance awareness about all matters of finance—that does not need to be pensions: it is about all matters relating to money and the usage of money—in primary schools, and to encourage wider understanding of that among our children through their education. I would certainly support that.
The hon. Member for Strangford raised the issue of the self-employed, as did other Members. I will make a couple of points on that issue. The first is that there are already plenty of self-employed people who can perfectly properly sign up to a private pension. I am an example. I was a self-employed jockey—I was not very good at all and did not make much money—and then I was a self-employed barrister and helped to run a charity before coming to this place. However, it is much more complicated for those people, because they do not have any of the benefits of automatic enrolment.
There is a way forward, and we are working on a trial with HMRC to explore the opportunities presented through Making Tax Digital. There is a clear solution for how to change the tax system, on which we are working with HMRC and the Money and Pensions Service. It will almost certainly be a drop-down box with an automatic deduction, which will allow people to do what they can presently do on their manual tax return, and it will make self-employed automatic enrolment much easier. It is a work in progress. Today is Australia Day; it is appropriate that we laud the fact that Australia has showed us the way on so much of automatic enrolment. Certainly, the Australians have addressed the question of how to enhance self-employed take-up of automatic enrolment in a variety of ways, and I am looking at that closely through the HMRC trial. I hope to update the House and parliamentary colleagues on that point in the very near future.
Several colleagues raised the point about 8% plus, which I will come to in a second. Let me first deal with the issue of the 2017 automatic enrolment review, which is also largely the subject matter of the work in progress that is my hon. Friend the Member for North West Durham’s ten-minute rule Bill. The simple truth is that when I acquired this job, back in the dim mists of time in June 2017, I was given two primary responsibilities by the late, lamented David Gauke, who was the Secretary of State. The first was, “Get us to 8%”—bear in mind that automatic enrolment was not even at 5% at that stage. It is a massive triumph for this country, the employers, the employees—who quite clearly have not opted out—and government on a cross-party basis that we have got to 8%. The world has not come to an end and drop-out rates are really low, so without a shadow of a doubt, that is a massive success story. However, my hon. Friend the Member for Delyn (Rob Roberts) is totally right that more needs to be done, and I am going to address that point in a second.
The second thing that happened, pretty much as I arrived in the DWP as Minister, was that I received a copy of the 2017 review in the autumn of that year. We took the decision that we would support it without a shadow of a doubt. It was an independent review; we did not have to support it, and Governments often do not support them. However, we then made the decision that the measures should be introduced on a phased basis.
Clearly, events have got in the way—the past four or five years have been somewhat complicated—but the practical truth is that the Government have an unquestioned commitment to bring forward the 2017 review measures: the lower earnings limit and the 22 to 18 threshold. The way in which we do that and the phasing of it is still a matter of ongoing debate within Government.
People above my pay grade have to make decisions on that—it is dependent on other pieces of legislation and other considerations. Clearly, a consultation would have to take place, but in broad terms the timetable would involve primary legislation to introduce the primary measures and enabling powers, secondary legislation and a consultation to follow, and timings thereafter. Certainly, my hon. Friend the Member for North West Durham was seeking confirmation that the measures would be introduced in a phased approach after the next election, in the mid-2020s, and I hope that is helpful for his understanding.
It is not for me to decide what is in Her Majesty the Queen’s speech, either this year or next, but clearly there are a variety of ways in which we can progress such legislation. First, there is a private Member’s Bill. That is not impossible, but it is be complicated for Government business for primary legislation on a large matter, particularly given the timings of this Session. I welcome my hon. Friend’s ten-minute rule Bill, but it comes very late in this Session. Obviously, there will be future private Members’ Bills.
Secondly, we are clearly looking to bid for a third or fourth Session pensions Bill that can take these matters forward as normal Government business. My intention is to bring forward the legislation, subject to all the usual provisos about being a Minister with larger collective responsibility.
Guy Opperman
The fact that there is cross-party support is relevant because, quite rightly—but sometimes wrongly—Oppositions oppose many pieces of legislation. Clearly, this legislation has the support of all political parties. I cannot speak for the one Member of the Green party, but I know that the Liberal Democrats and other smaller parties support the legislation. That is very relevant and needs to be shouted from the rooftops.
This matter has an impact, particularly on low earners, in every single constituency in the country. As my hon. Friend the Member for North West Durham said in his eloquent speech, such measures would be a really good example of levelling up in low-earning communities. Clearly, people above my pay grade—whether the Chancellor, Prime Minister or others—will decide what goes into the Queen’s Speech this coming May, and I wish them all good fortune with that. Some of the clarifications that my hon. Friend made will help, as will the way in which he is trying to bring legislation forward. Airing the matter in the House helps, confirming to all parties that such measures have cross-party support. So much pension policy is so long-term that the impact of pulling a lever is not felt until three to five years later, so it makes a massive difference to have cross-party support.
I will touch briefly on a couple of other points. With regard to longer-term plans to go higher than 8%, I totally agree with my hon. Friend the Member for Delyn that 8% is not enough. Again, subject to the ability to travel in future, I hope to engage with American colleagues to look at their 401(k) and the way they deal with it. Subject to the ability to take those things forward, the next goal after the 2017 review is clearly a discussion and a debate on how much above 8% is enough.
I am wearing my Australia Day tie, which was given to me when I and my hon. Friend the Member for Daventry (Chris Heaton-Harris) triumphantly crushed the Australians in the parliamentary cricket match a few years back. The Australians have got to 12% and are doing so much, particularly in utilising the defined contribution and automatic enrolment to do the things that my hon. Friends the Members for Darlington (Peter Gibson) and for Sedgefield (Paul Howell) mentioned —namely, safely investing those savings in local communities so that individual savers can say, “That is what is happening in my area.”
I can give examples. I have set up two banks, as colleagues will be aware: Atom bank, which I was a founder member of, and the Northumberland Community Bank. Another good example is the Cambridge and Counties Bank, which utilises the pension reserve to loan on asset-backed lending to assist with investment in the Cambridge local area. There are other examples—the Sparkassen in Germany do this all the time—of only lending to local communities in that way. Such examples will proliferate, which is a good thing, because this comes to awareness. Members are then aware of what their savings are invested in and are so much more engaged, and that can apply across the country.
I accept that we need to do more on awareness. The Money and Pensions Service is clearly doing great work, and I support totally what Pension Geeks is doing with Pension Awareness Day, and what Scottish Widows is doing with its pension awareness road trip. The reason I am a supporter of the statements season is that I do not think that pensions awareness or engagement is good enough, quite frankly. We have to have a product or process whereby people are engaged, much as we do in tax or educational results, so that they understand better what they have got at a time when they can really get engaged. Obviously there is a working group on statements season, and it is a matter of discussion with the industry, but we have to do more to create greater engagement.
In my last minute or so I want to try to address some of the final points. Clearly, consolidation is a matter that we are working on, and I can happily give colleagues more on that. My hon. Friend the Member for Grantham and Stamford raised two final points about the nature of savings and what we are saving for. The traditional product has clearly been a pension, but our parents and grandparents would all have had much greater awareness of rainy day savings. We should unquestionably laud and support all the companies that are already running a 1% savings club or working with credit unions and other organisations to ensure that our employers and constituents have the capacity for rainy day money. If that was a problem pre covid, it is a particular problem post covid. There is also a wider policy issue about how we enable products to be developed to ensure that people are saving for deposits, although that is about the wider culture of saving in the longer term.
To finish, I thank the 10 colleagues who came along this morning to make the case for pensions savings and the many who support this policy and are driving it forward. Certainly, we can find very little in my hon. Friend’s speech to disagree with. I thank all colleagues for coming along and making the case and for supporting our reforms. I accept that there is more to be done, but this Government are utterly committed to ensuring that that happens.
Gareth Davies
I pay tribute to the Minister, who is one of the longest-serving Pensions Ministers we have had in this country. As somebody who came from the fund management industry to this place, he is respected not just in this House but in the industry, too. I also thank all hon. Friends and hon. Members for their contributions. We heard from the hon. Member for Strangford (Jim Shannon) about the importance of getting in early and financial literacy. We heard informed speeches from my hon. Friends the Members for Darlington (Peter Gibson) and for North Norfolk (Duncan Baker), giving the perspective from business. We also heard from my hon. Friend the Member for Clwyd South (Simon Baynes) about the benefits of increasing the size of the pensions pot for social and environmental investment.
Of course, let me congratulate once again my hon. Friend the Member for North West Durham (Mr Holden) on his excellent private Member’s Bill. He is enjoying a tremendous amount of support today. I maintain that we should focus on 18 to 21-year-olds. If nothing else, we should take away from today the fact that our pensions system has a great deal of power in what it can bring to our communities. Let it be said that this should not be a hidden secret any more. The power of compounding and savings benefits everybody, and people should start as early as possible.
Question put and agreed to.
Resolved,
That this House has considered the matter of automatic pension enrolment.
Vehicle Ownership: Fatal Accidents and Rural Crime
(2 years, 10 months ago)
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Peter Dowd (in the Chair)
Before we begin, I remind hon. Members that they are expected to wear face coverings when not speaking in the debate, in line with current guidance from the Government and the House of Commons Commission. I remind hon. Members that they are asked by the House to take a covid lateral flow test before coming on to the estate. Please also give each other and members of staff space when seated and when entering and leaving the room.
Mr Richard Holden (North West Durham) (Con)
I beg to move,
That this House has considered fatal accidents, rural crime and the adequacy of vehicle ownership restrictions.
It is a pleasure to serve under your chairmanship, Mr Dowd. I pay tribute to the family of Andrew Rowlands, one of my constituents who died in 2020. His parents, Karen and John, are here today. I have met them before, as well as their daughter, Becca. Andrew was killed in a car crash in June 2020. The car he was travelling in was bought not long before for £100. It had no valid MOT and was described by the judge at the time as a wreck. The driver of that vehicle had no driving licence—they had not even had a driving lesson—yet they had still been able to buy the vehicle. They were jailed in June 2021. Later that year, I met John in my constituency surgery.
My request of the Minister today is to look at one simple change to the law. If a person wants to buy a car, they should have to have a driving licence. That means a simple change to the V5 form. At the moment, filling in the date of birth and the details of the driving licence of the person purchasing the car is voluntary. All we want is for that to be made mandatory. That would prevent people without driving licences being able to buy cars.
To buy a shotgun or rifle, the buyer must provide a licence and be over the age of 18. To buy an alcoholic drink, lottery scratchcard or lottery ticket, the buyer must provide ID. To scrap a car, a person must provide ID and have a UK bank account, yet to buy a car—even a totally unroadworthy one, such as the one driven on the day Andrew was killed—a buyer does not have to do those things. It is taken on trust, on the V5 form, that the buyer is a suitable person and able to own a vehicle.
In the modern day, it is totally unacceptable for somebody without a driving licence—without even having had a driving lesson—to own a car, and there are three reasons for that. The first, obviously, is the death of one of my constituents. We do not want to see more young people being killed because other people can buy totally unroadworthy vehicles and use them on a public highway.
Secondly, it has broader implications. Since I met John in my constituency office, I have been talking more broadly to Durham police and the rural community to find out what other impacts such a change could have. For example, Durham police are very concerned about so-called community vehicles. Basically, what happens is that I buy a car off anybody, but I do not provide my address or details, because I can sort of fill it in. There is no requirement to check a driving licence and no requirement to put down a date of birth—it is just an option. Those vehicles are then used in county lines drug trafficking; they are used to move people around the country. They are often parked up somewhere slightly out of sight, and they are easy to use. There is a real crime angle there for towns and cities.
Thirdly, I have spoken to local farmers, and there is a real rural crime angle as well. Since I was elected, I have lost count of the number of farmers who have got in touch about people trespassing on their land. This is not trespassing in the form of a poacher with a couple of pheasants under their jacket, like something from the 1940s. This is people driving through farm gates, smashing up land, destroying crops, worrying livestock and allowing animals out on to the roads.
Dr Neil Hudson (Penrith and The Border) (Con)
I applaud my hon. Friend for bringing forward this debate on this important issue and for highlighting the tragic case in his constituency. Does he agree that the rural crime he talks about is part of a bigger picture that people in rural communities face? It could be vehicle crime, property damage, fly-tipping, poaching, farm machinery theft or animal theft—they are all part of a bigger picture that our rural communities have to suffer. It is great that Cumbria police and Durham police are working hard to support communities, but these crimes have a major impact on the mental health of people in rural communities.
Mr Holden
They do have a big impact on people in rural communities, particularly on their mental health, because of the isolation element of living in a rural area. My hon. Friend makes a broader point about the use of such vehicles for other crimes. The police have told me in conversations that if people are involved in what some might consider low-level crimes, such as lamping or poaching, they are usually involved in other crimes as well. It is a major issue that they are able to move around almost at will by using vehicles that nobody can trace. That is exactly the issue that I am trying to point to.
Some of the farmers I recently met over in Satley in my constituency face these issues on a regular basis—so regular that they have set up their own local WhatsApp group. Fences have been driven through, causing thousands of pounds of damage for the farmers, but even if they spot the vehicle and get the number plate, it is impossible to trace the ownership because the vehicles have basically disappeared into the system.
In Stanhope and all the way up in rural Weardale, farmers have faced similar issues. It was at one of my first constituency surgeries after being elected, in Stanhope town hall, that this issue of rural crime and untraceable vehicles was brought to me. More recently, down in Muggleswick, during the pandemic, when people were meant to be staying at home, there were people driving such vehicles—totally untraceable—to do drug deals in rural areas. People phone the police to say, “We have the number plates”—people have done the right thing on their farms and rural homes and put up CCTV—but that is totally useless if the ownership of the vehicle cannot be traced.
This proposed change would mean the traceability of vehicle ownership, and it would therefore prevent people being able to use such vehicles to commit rural crime. Thirdly, it would stop people without driving licences from using such vehicles.
We have seen the impact of changes to the scrappage scheme. We used to hear all the time about people nicking bits of railway and trains having to be stopped. We used to hear about people dying in substations when they were trying to nick expensive metals. We used to hear regularly about lead being stripped from church roofs. All of that ended with a simple change in the law that meant someone had to provide ID and bank account details if they were selling scrap metal—a really simple change. All I seek is a similar change for people when they are selling cars.
I am not asking the Minister today for an immediate yes or no to a piece of legislation; I am asking to meet her in order to talk in more detail and find a suitable legislative vehicle for addressing this issue. I cannot see why the Government would not want to push forward with this, because it would tackle rural crime and the criminal exploitation of young people in our towns and cities, and it has the ability to stop more tragic deaths, like that of Andrew, from happening in the future. It is a sensible change that I cannot see the Opposition opposing. Will the Minister today commit to meeting me to talk about this further, to see what we can do to make this very sensible change, which will save lives?
The Parliamentary Under-Secretary of State for Transport (Trudy Harrison)
I thank my hon. Friend the Member for North West Durham (Mr Holden) for opening the debate and for his continued championing of rural issues. I also thank my neighbour in Cumbria, my hon. Friend the Member for Penrith and The Border (Dr Hudson). As the Member of Parliament for Copeland, in Cumbria, I truly live, breathe and understand the challenges of rurality, rural crime and, particularly, rural roads. I commend the work that has been done by Andrew’s parents, John and Karen Rowlands, who are here today.
As the mother of four daughters aged 18, 19, 21 and 23, who are all on the road, I worry every time they go out on our rural roads, as every parent does. We recognise that in rural areas a driving licence is all too often a passport to adulthood. It is a necessity in order to be able to access college, training, apprenticeships, work and social life, but rural roads have disproportionately more collisions. It is a priority for the Department for Transport to reduce that as far as possible, and we continue to work towards that every day, across the Department.
Today’s debate is primarily about vehicle ownership and fatal collisions, but my hon. Friend the Member for North West Durham also raised a number of questions about rural crime, which I will pick up with colleagues at the Department for Environment, Food and Rural Affairs and at the Home Office. His overwhelming request was for a meeting with me to discuss the issue in more detail, which I am very able and willing to have, in short order.
I start by expressing my sincere condolences to Andrew’s family, to John and Karen and to his sister, Becca. I reassure right hon. and hon. Members that the Government take road safety and deaths occurring on the road incredibly seriously.
It is true that a driving licence is not needed to purchase a vehicle. To make it a requirement of a purchaser to show a valid driving licence would, in our view, be impracticable in many vehicle purchasing transactions. However, I say that with the caveat that I am very willing to meet my hon. Friend to discuss ways in which this could assist or may be possible. Examples of such transactions include fleets purchased by companies to be sold on or leased, companies that acquire vehicles for the use of employees and those for whom a licence is not required, as their vehicles are only driven on private land, not to mention the many private vehicle sales that occur every day, in which it would be difficult, if not near impossible, to verify the authenticity of a driving licence.
Instead, the responsibility lies with the buyer of a vehicle to ensure that they behave within the law and only drive it if they are legally able to do so, as well as ensuring that the vehicle is roadworthy and has a valid MOT certificate. It is of course unfortunate that some individuals choose not to obey these laws, endangering themselves and others on the road or in the vehicle. In some cases, that has very tragic consequences, as we have heard this morning.
Ben Lake (Ceredigion) (PC)
I heard what the Minister said about the practical difficulties of authenticating a driver’s licence at the point of sale. When she meets the hon. Member for North West Durham (Mr Holden), I wonder whether she might consider another way of doing things. If it is too difficult to authenticate a driver’s licence at the point of sale, perhaps a driving licence would have to be presented when a vehicle goes for an MOT, for example. That is another way of ensuring that whoever is using a vehicle and is responsible for it has, as the hon. Gentleman so eloquently said, the skills and the responsibilities to do so safely.
Trudy Harrison
The hon. Member makes a valid point. Although I am not the Minister with responsibility for roads—that is Baroness Vere of Norbiton—I will discuss exactly that point with her. I know that there have been significant improvements in the way that police and the Motor Insurers’ Bureau are able to check, for example, on motorists’ insurance, using technology, software and interoperable connectivity to improve safety and check the eligibility of people to be behind the wheel on UK roads. I thank the hon. Member for his intervention.
Any death or serious injury on our roads is, of course, unacceptable. My deepest condolences go to the victims of road collisions and their families, and I pay particular tribute to John and Karen for their work to raise awareness of the importance of young drivers in particular, and all they do to support our THINK! campaign, as well as generally improving awareness of the dangers of driving and the responsibility involved in being behind a wheel.
The Government take uninsured driving very seriously. Driving without insurance is, of course, a criminal offence. Since 2005, the police have had the power to seize vehicles driven by someone without insurance. By 2020, 2 million vehicles had been seized in Great Britain and the level of uninsured driving has dropped by 50% over the last 10 years.
Mr Holden
I appreciate that the Government are considering ways to try to tackle issues such as driving without insurance. However, should there not be a change to ensure that we know who owns a vehicle, which would make it even easier to prosecute people for crimes such as driving without insurance? If we do not know who owns a vehicle, it is very difficult to bring a prosecution against somebody for driving without insurance.
Trudy Harrison
I thank my hon. Friend for that intervention. That is all part of the conversation that he and I will have when we meet. Over the next week, I will look at arranging that meeting, which will happen certainly by the end of this month. I am very happy to involve officials in that meeting as well, so that we get the full breadth of the Department for Transport’s understanding of all the issues pertaining to his request.
Under continuous insurance enforcement, or CIE, the Driver and Vehicle Licensing Agency works with the MIB to identify those who are driving without insurance, enabling enforcement action to be taken.
I turn to driving on private land. I know that is a burden to so many farmers and landowners across Cumbria, and indeed in all rural areas. For some landowners, it is a real problem that they face all too often, so I will continue to engage with colleagues in the Department for Environment, Food and Rural Affairs to find solutions to it, and I understand that concerns have been raised about it today.
Vehicles that are driven illegally on private land may be seized, of course, by a police officer. However, any change in the law to cover driving offences occurring on private land would be significant and require legislation that had potentially wide-ranging impacts. We have a regime of licensing, which ensures that only people who have demonstrated a competence to drive a vehicle on the highway are permitted to do so.
I am grateful to my hon. Friend the Member for North West Durham for his championing of these rural issues in my Department and all other Departments. Driving on private land is not subject to the same licensing regime. To change this would have consequences for many people who only drive on their own land, most notably the farming community.
Mr Holden
I am not proposing that we change the requirements for driving on private land. I am just proposing that, to own a vehicle, someone has to have a driving licence. That would mean that they could give the vehicle to another, perhaps younger, person to drive on private land or for stock car racing or something like that. I am not proposing that we require a driving licence for driving on private land.
Trudy Harrison
My hon. Friend makes a powerful case. I know that more can be done; I absolutely acknowledge that. Our calls for evidence will be published before this summer, so now is a good time to discuss the issue, and we would welcome any evidence given to support that. We all recognise that more can be done.
We are delivering on our commitment to change the law on a number of matters at the moment, including causing death by dangerous driving or careless driving while under the influence of drugs or alcohol. The Police, Crime, Sentencing and Courts Bill introduces changes to increase the maximum term of imprisonment to life. The Department is introducing an increase to the minimum disqualification periods for those two offences in the Bill to reinforce the seriousness with which the Government view them. Instead of two years, they will be increased to five years.
We are working on a call for evidence on parts of the Road Traffic Act 1988. We expect to be in a position to publish that in the first half of this year. While details are still being worked up on the scope of that particular issue, I know that officials are paying close attention to the points raised in this debate. We would welcome thoughts on where issues could be tackled by the call for evidence, and that is why I think that that meeting will be particularly helpful at this time. The evidence is expected to include drink and drug driving offences and the offence of failing to stop and report. My hon. Friend has not referred to that in this debate, but I wanted to set that out, and when we meet, we can discuss validation ahead of purchasing a vehicle.
Rural roads account for nearly 66% of all fatalities, while carrying only 33% of the traffic, with casualties mostly being vulnerable road users, such as young drivers and motorcyclists. My Department is developing a new road safety strategic framework, which will outline our ambitions to improve road safety in the UK. We are considering how we can best incorporate rural road safety into it.
We have also just concluded a consultation on the potential for creating a road collision investigation branch. That independent safety body would work to better understand the root causes of road collisions, learning lessons and making recommendations for interventions and policy changes that could help reduce collisions and their severity and improve rural safety for all road users. We hope to be able to set out the next steps over the coming months. It is my aim that these developments make a real difference to road safety in the UK, including reducing road traffic collisions and the tragic deaths and injuries that they cause.
I thank John and Karen Rowlands for their presence today and for the courageous way in which they are trying to prevent collisions, serious injuries and fatalities, particularly among young road users. I also thank them for their work in supporting the Department’s THINK! campaign.
I thank my hon. Friend the Member for North West Durham, who so eloquently champions rural issues. Today, he has drawn attention to rural crime and demonstrated the importance of identity in preventing further incidents. I welcome his interventions and the conversation we will have with officials shortly.
Question put and agreed to.
Health Inequalities: Office for Health Improvement and Disparities
(2 years, 10 months ago)
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Derek Twigg (in the Chair)
Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the parliamentary estate. Please also give each other and members of staff space when seated and when entering and leaving the room.
Peter Dowd (Bootle) (Lab)
I beg to move,
That this House has considered the Office for Health Improvement and Disparities and health inequalities.
It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.
Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.
Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to
“commence the socio-economic duty, section 1 of the Equality Act 2010”
and to
“adopt a ‘child health in all policies’ approach.”
The Health Foundation notes:
“Public health funding grants to councils have been reduced by £700 million in real terms from 2015/16 to 2019/20. In the Spending Review published in October 2021, the Government said it would maintain the public health grant ‘in real terms’ until 2024/25, but has yet to confirm the amount for 2022/23.”
We are only a couple of months away from the beginning of that financial year. The Terrence Higgins Trust asked me to ask whether the Minister can confirm when local authorities will have their public health grant allocations published. Other organisations also asked that question.
The Institute of Alcohol Studies said:
“People from the most deprived groups in England are 60% more likely to die or be admitted to hospital due to alcohol than those from the least deprived… We believe that for any levelling up agenda to be comprehensively successful, it must address alcohol harm as a top priority.”
The LGA said:
“Councils have seen a significant reduction to their public health budgets in the period between 2015/16 and 2019/20. The recent announcement of a real-terms protection of the public health grant is welcome, but is unlikely to address the impact of the past reductions to funding.”
Cancer Research said that its modelling estimates suggest that
“30,000 extra cases of cancer in the UK each year are attributable to socio-economic deprivation. The two biggest preventable causes of cancer—smoking and overweight and obesity—are more prevalent in deprived groups.”
Kidney Research said:
“Around 3 million people in the UK have kidney disease and every day, 20 people develop kidney failure…. There is also a gender bias associated with kidney disease—women are more likely to be diagnosed with kidney disease and are at higher risk of developing end stage renal failure than men.”
Judith Cummins (Bradford South) (Lab)
My hon. Friend is making an excellent speech. On that point, I want to ask him about gender inequality in terms of health. As a member of the all-party parliamentary group on osteoporosis and bone health, he will know that fracture liaison services are key to prompt and timely diagnosis of osteoporosis, but only 51% of NHS trusts in England have an FLS and only 41% of all NHS trusts have permanent and sustainable funding in place for their FLS. That means that every year an estimated 900,000 people miss out on the medication they need to prevent avoidable fractures. Does he agree that this health inequality, or postcode lottery, needs to end?
Peter Dowd
My hon. Friend is completely right and she has been a real champion of osteoporosis services, pushing them in her own area and as chair of the APPG. One figure shows that half of women over the age of 50 suffer a broken bone due to osteoporosis. That is the kind of stark figure that we have to face. I thank my hon. Friend for that intervention.
The NHS Confederation has made comments similar to those I have mentioned:
“The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward... Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic.”
Maternity Action says:
“Vulnerable migrant women face charges of £7,000 or more for… maternity care. Charges are levied on women with insecure immigration status, including destitute asylum seekers whose claim has been refused and who are not in receipt of Home Office support, women whose relationship has broken down and who were dependent on their partner for their immigration status, women on fiancee visas and women who have been unable to afford to renew their visas. This policy disproportionately impacts on minority ethnic women, who make up 85% of women using Maternity Action's Maternity Care Access Advice Service, which advises women”
on such matters.
The British Heart Foundation said:
“The prevalence of heart failure, stroke, and mini stroke in adults with learning disabilities in England is higher than the general population, and circulatory diseases are one of the main causes of death in people with learning disabilities. For the most part, this can be attributed to differences in the social determinants of health.”
The Royal College of Paediatrics and Child Health said:
“Child health outcomes in England are some of the worst in Europe… Our State of Child Health 2020 report reveals a widening gap between health outcomes across nearly 30 indicators. It shows that children living in more deprived areas have worse health outcomes than their peers living in less deprived areas… The COVID-19 pandemic has also highlighted and accelerated the devastating impact of health inequalities.”
Apsana Begum (Poplar and Limehouse) (Lab)
My hon. Friend is making an excellent speech. Does he agree that, given that the largest number of covid-related deaths have been experienced by ethnic minority communities, it is imperative that the Minister provides clarity on whether the Office for Health Improvement and Disparities and the Health Promotion Taskforce will be given a remit outside the Department for Health and Social Care?
Peter Dowd
I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.
The UK vaping industry said:
“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”
It is important that that is factored into these debates.
The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:
“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”
This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.
Marsha De Cordova (Battersea) (Lab)
I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?
Peter Dowd
My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.
As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.
Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.
We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.
Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.
However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.
As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.
In his foreword to the report, the then Secretary of State said:
“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”
That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.
Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.
Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.
If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.
Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.
These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?
Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.
When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:
“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”
He was absolutely right.
This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.
In 1980, the Government responded to the Black report by saying:
“you might be right about the solution, but it’s going to cost too much.”
After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.
Derek Twigg (in the Chair)
A good number of Members want to speak today. I do not intend to impose a time limit, but it would helpful if you could keep your speeches to around six minutes. That will ensure that everybody gets in. I intend to call the Front Benchers at no later than 3.40 pm.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.
I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.
I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.
In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.
Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,
“the high and unequal death toll from COVID-19”,
which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.
The term “health inequalities” refers to the increasing mortality and morbidity that occurs with declining socioeconomic conditions. In my Oldham East and Saddleworth constituency, the health inequality gap is more than 12 years. Those health inequalities are systematic and socially produced, and are a result of the differential distribution of income, wealth, knowledge, social status and connections. There is overwhelming evidence that those factors are the key determinants of health inequalities, influenced by written and unwritten rules and laws across our society, rather than biological and behavioural differences. I have always been disappointed by the focus always being on the individual: “It’s your fault if you get ill; it’s your fault if you get a disease. It’s your lifestyle choices.” It is not. There is overwhelming evidence on that.
There is no law of nature that decrees that the risk of a baby dying is 94% higher for children born into poor families than for those born into rich families, but that is the reality. We know that infant mortality, which had been declining for nearly a century, has started to rise again. As my hon. Friend has said, there are consequences to inequality and the austerity that has been imposed on so many families.
To my first point, given that health inequalities are socially produced, there is hope because that means that they are not fixed or inevitable—we can do something about them. If the Government are committed to levelling up, will the Minister comment on why the Gini coefficient has increased over the past few years? As my dear friend Frank Dobson famously said, nothing could be more unjust than someone knowing that they are going to die sooner because they are poor. Will the Minister comment on the socioeconomic factors that are driving health inequalities? Why they have they got worse over the past two years?
On my second point, Sir Michael Marmot was very clear in his analysis of the covid death rate that there have been four drivers of the high and unequal death toll in the UK: the governance and political culture detrimentally affecting social cohesion and inclusivity; the widening inequalities in power, money and resources; the regressive austerity policies over the past decade; and the declining healthy life expectancy of the poorest, particularly women, which is among the worst of all comparable economies. Deprived communities have also been hit particularly hard in that regard.
On my third point, as important our NHS is in treating and caring for us when we get ill, reducing inequalities must involve all Government Departments, as my hon. Friend has said. That was reflected in Sir Michael’s recommendations to address those inequalities. He said that we must build back fairer from the pandemic, with multi-sector action from all levels of Government, and increase investment in public health. Since 2015, there has been a 24% cut in public health budgets.
One thing we know about the NHS and its impact on inequalities relates to the privatisation and marketisation of health services. We know that that helps to reduce access to health services for those on lower socioeconomic groups. On top of that, there is the inequality in health outcomes. I fear that the 2021 Health and Care Bill will make a bad situation even worse, adding to the issues resulting from the Health and Social Care Act 2012.
Not only do countries in which there is a narrow gap between rich and poor have high life expectancy; they also have better educational attainment, social mobility and trust, lower crime and a fairer society as a whole. I appreciate that I have gone over time and apologise for that.
Navendu Mishra (Stockport) (Lab)
It is a pleasure to serve under your chairship, Mr Twigg. I will keep my remarks as brief as possible. I am grateful to my hon. Friend the Member for Bootle (Peter Dowd) for securing this important debate, at a time when the NHS is under enormous strain and facing a clear and present threat of relentless cuts and privatisation under this Conservative Government.
As well as leaving our beloved health service on its knees and struggling to cope after two years of a crippling pandemic, this Government have presided over a period of austerity that has seen health inequality become even more prevalent and extreme.
Last week, the other place started its Committee stage of the Health and Care Bill and began discussing proposed amendments about health inequality. Speaking at that Committee sitting, peers from across the House made clear that the Bill is a huge opportunity to eliminate health inequality and for the Government to demonstrate their commitment to tackling the “disease of disparity”, to quote the Secretary of State for Health and Social Care, who pledged to address the issue when he took office last year. However, in the months since, there has been little evidence that the Government are taking the bold steps required to address the crisis.
The Government cannot say that they are not aware of the issue, because research published in 2019 by the Department for Work and Pensions revealed that the highest reported rates of poor health in those under the age of 55 was overwhelmingly in the poorest percentiles, with the bottom 20% of the population having worse health outcomes by a staggering 1,100%.
Three years and a pandemic later, the situation is even bleaker. In 2020, life expectancy in England fell more dramatically than at any other point since world war two, as a result of the covid pandemic. In the poorest areas, life expectancy declined nearly twice as much as it did in the wealthy ones, while ethnic minority people died from covid at much higher rates. Sadly, those with disabilities faced a significantly higher death rate.
In my constituency, the gap in mortality and reported serious illness is stark. In the most affluent areas such as Heaton Mersey, life expectancy for women is 84 years, while for men it is almost 83. However, just a short distance away in central Stockport, the average life expectancy for a man is a staggering 12 years shorter, while in Brinnington a woman’s life will, on average, end a decade sooner. For life-threatening illnesses such as cancer and heart disease, it is a similar picture. On average, the limited life chances of my constituents are particularly acute. Research by the King’s Fund reveals that the north-west experienced a far higher proportion of deaths from covid-19 than the south-west, to give just one example.
Significant investment in our NHS is needed to halt the rise in health inequality. That includes hospitals, which unsurprisingly play a significant role in health outcomes for many people. That investment could be put towards the facility’s funding or its catchment area, or it could improve accessibility for the vulnerable. With the NHS already at breaking point following 12 years of Conservative Government austerity and a crippling pandemic, we cannot afford to be wasteful—a point I have made consistently since my maiden speech, when I criticised this Government’s underfunding of Stockport NHS trust by £170 million in recent years.
Ultimately, I welcome any decision that improves public health outcomes and ensures the best quality healthcare for the people of Stockport. To build a healthier, happier and more equal society we must do more than simply increase NHS funding. I therefore urge the Minister to give a genuine commitment to truly universal healthcare that is fit for purpose for everyone, enabling the NHS to continue to be the envy of the world.
Mary Glindon (North Tyneside) (Lab)
It is an honour to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on an excellent, well-researched speech and on securing this important debate.
Before turning to the exact subject of the debate, as vice-chair of the all-party parliamentary group for vaping, I want to reflect on the role of the predecessor body of the Office for Health Improvement and Disparities. Public Health England sought to be a practical institution, with evidence and pragmatism at the heart of its approach to public life. I want to pay particular attention to its work on tobacco harm reduction, which I have witnessed not only as a member of the APPG but personally. Since 2015, across seven evidence reviews, PHE reports on the role that e-cigarettes can play in a healthier society have captured the ethos of the organisation in its entirety.
The first report was a landmark publication for the vaping industry. It concluded—I hope that everyone in this House heeds this fact when reflecting on reducing inequalities born from smoking cigarettes—that vaping is “95% less harmful” than tobacco. In its report, PHE went on to look favourably on e-cigarettes, while others have sought only to fuel misinformation, risking lives by claiming vaping and smoking to be one and the same. They are not. It is because of that evidence-based endorsement of vaping that millions of smokers across England and—dare I say it?—across the world, who have exhausted all other routes trying to quit smoking, have a fighting chance with an incredibly successful product that is helping smokers to quit.
Smoking is perhaps one of the biggest contributors to inequality in our society, causing considerable damage to private and public health, and it has a high impact on physical and mental health. It is an expensive and addictive habit, particularly for those most disadvantaged in our society, where smoking prevalence is highest. Vaping is less expensive and is an effective way to stop smoking. It is therefore critical that the Office for Health Improvement and Disparities recognises the role of vaping, picks up the torch left by Public Health England and continues to be a stalwart champion of tobacco harm reduction.
This could not be more important as we continue to wait for the Department of Health and Social Care to publish, first, its review of the Tobacco and Related Products Regulations 2016—that review is now eight months late—and secondly, its new tobacco control plan, which is also late and nowhere to be seen. The APPG for vaping’s door is always open to the Minister, and I know that leading bodies such as the UK Vaping Industry Association would welcome the chance to work with Government to secure a future in which the health benefits of switching from smoking to vaping are fully realised. The UKVIA has industry-led solutions to many of the remaining concerns that prevent people from finally making the switch to vaping. Those solutions include the guidance it produced on introducing restrictions on packaging and branding. I support that paper, and can share it with the Minister if she wishes.
The UK is seen by many across the world as a world leader in tobacco harm reduction, with countries, smokers and vapers looking to the UK for guidance in this space. That reputation should not be compromised by the loss of institutional knowledge during the transfer of resource from Public Health England to OHID, and it should not come at the cost of a Government Department delaying publications once again. If the Government are serious about levelling up and wish to support endeavours to improve people’s lives, they must ensure that OHID adopts the same evidence-based approach as its predecessor to finding solutions for life-debilitating problems.
I once again express my gratitude to my hon. Friend the Member for Bootle for having secured this debate. I hope that in responding, the Minister can provide clarity about the timeline for responding to the TRPR review and for the publication of the new tobacco control plan. I also hope that she agrees that the OHID must remain independent, with its institutional knowledge protected.
Rebecca Long Bailey (Salford and Eccles) (Lab)
It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Bootle (Peter Dowd) for having secured this important debate, and for his eloquent and detailed speech. Salford is currently the 18th most deprived local authority area out of 317 in England, yet it is a tale of two cities: more than 30% of the city’s population reside in a highly deprived area, yet we are also home to some of the wealthiest suburbs in Greater Manchester. That disparity is shown starkly by our life expectancy. It has been improving over the past few decades, but there remains a gap between Salford and the rest of England of three years for males and two years for females.
Male residents living in the most affluent areas of Salford can expect to live more than 11 years longer than those in the most deprived areas, while females in the most affluent areas can expect to live seven years longer. I think we can all agree that that is morally wrong. Sadly, we have known for decades—from the Beveridge report to the Marmot report—that poor health, discrimination, housing, employment and income are inextricably linked, yet we have seen very little action in recent years. Of course, there was a burst of radical policy development in the late 1940s, with the creation of the welfare state and the NHS, for example, and we saw policy approaches in the late 1990s and early 2000s, but since then we have lacked a comprehensive health inequality strategy. What is worse is that austerity has resulted in the unravelling of many of the positive policies put in place and the undermining of the remaining ones.
The creation in October 2021 of the new Office for Health Improvement and Disparities and the announcement of a new cross-Government agenda to track the wider determinants of health and to reduce disparities were met with cautious optimism. However, since the creation of the OHID, there has been little information on what it will actually do or what it has done so far. Will the Minister clearly set out how the Office for Health Improvement and Disparities will reduce health inequalities? Indeed, what is the new cross-Government agenda? Can she confirm that the Health Promotion Taskforce will be given a remit to act outside of the Department of Health and Social Care, to address the true socioeconomic causes of poor health? Finally, can she set out how OHID will work with the new integrated care systems, and how it will support them to address health inequalities in their area?
As the Inequalities in Health Alliance states:
“If we are to prevent ill health in the first place, we need to take action on issues such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. All parts of government and public services need to adopt reducing health inequality as a priority.”
Of course, I fear that the Government will not do that. It would show that an active state that supports communities, industry and workers to increase living standards for all within a new, democratic economy is the only way to do this properly, and that goes against everything the Government believe in. None the less, I hope that the Minister will at least address some of the questions I have asked today.
Siobhain McDonagh (Mitcham and Morden) (Lab)
It is a pleasure to serve under your chairship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on securing this particularly important debate.
The Minister will be aware of the Tudor Hart law: the areas with the best health are more likely to receive better health services. As my late mum—a lifelong nurse—would have said, “Much gets more.” There can be few greater examples of that than in south-west London, where an imminent planning application proposes to open a new hospital in healthy, wealthy Belmont, but at a cost: the downgrading, in the heart of a pandemic, of both Epsom and St Helier Hospitals. In the wild west of south London’s NHS, it is almost as if coronavirus never happened. Under those reckless plans, St Helier will lose its A&E, intensive care, children’s unit, maternity services, renal services and 62% of its beds to a wealthier area of considerably better health—so much for levelling up.
We have seen this plan on repeat. Funding is allocated and everyone pretends that three possible sites are being considered for development: Epsom, St Helier or Belmont. Evidence of widening health inequalities is presented by the bucketload, but a reason is always found to choose Belmont as the winning site. The reality is that, at the time of the latest decision, there were more than twice as many people with bad or very bad health within a mile of St Helier than within a mile of Belmont. The local population is significantly larger, with considerably more dependent children and elderly people. It is a plan that flies in the face of any supposed commitment to tackling health inequalities.
The programme points to its deprivation analysis—a document that considered deprivation by borough, rather than by proximity to each of the possible sites. Why does that matter? It matters because it disguises huge inequalities within boroughs, such as the 10-year difference in life expectancy between parts of Merton.
The true analysis of deprivation could not be clearer. Some 42 of the 51 most deprived areas in the catchment are nearest St Helier. Given that, hon. Members can surely see how ridiculous it is that the Belmont site received a higher score for supposedly tackling deprivation. Is it any wonder that health inequalities keep widening? While the programme considered old age as a decisive factor in the location of acute services, the depressing reality is that old age in Mitcham looks very different from old age in Belmont.
Health inequalities in south London are stark, and not just by geography. Black, Asian and minority ethnic residents are more likely to have underlying conditions such as diabetes, lupus and kidney failure and are at a higher risk of developing heart disease and hypertension. Black women are five times more likely to die in childbirth than white women, and are more likely to require neonatal or specialist care baby units. Such facts are of paramount importance for this hospital reconfiguration, as 64 of the 66 areas across the catchment with the highest proportion of BAME residents are nearest St Helier. Just one is nearest Belmont. Under those plans, many women will see maternity services moved further away. The programme’s solution is to encourage more women to have a home birth, which is obviously dependent on the risk to mum and baby and is currently chosen by just 3% of women in the catchment area.
The reality is that my constituents will not travel to Belmont. It is quicker from every corner of Mitcham and Morden to reach St George’s Hospital or Croydon. That is a completely terrifying prospect, because St George’s is already coping with too many women having children there, its A&E is in the bottom quartile for space standards, and the Care Quality Commission has demanded that fewer patients attend the site.
Where does this leave us? The planning application for the Belmont site is imminent, and the cost of the proposals is soaring—the latest estimate is almost £600 million. Improving St Helier would not only keep services where they are needed most, but save £161 million. I ask the Minister to take the unequivocal evidence that I have presented and, if she genuinely wants to close health inequalities under her watch, insist that these proposals are reconsidered. Stop wasting taxpayer’s money and leave these vital services at St Helier’s current site.
Taiwo Owatemi (Coventry North West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech and on securing this important debate. As we know, the Office for Health Improvement and Disparities was officially launched in October as part of a wider Government restructuring of public health bodies in England. Back in September, the Health Secretary announced his vision for what the OHID would prioritise. He listed three goals: preventing poor mental and physical health; addressing health inequalities and improving access to health services; and working with partners within and outside of Government to respond to wider health determinates.
It is welcome that the Government have set out to alleviate health inequality. However, in order to truly tackle the disparities in health outcomes, the Government must change course and more closely consider the health outcomes for illnesses associated with stigma, misunderstanding or insufficient public awareness. I am speaking specifically about those living with HIV in this country. Despite accounting for less than 2% of the British population, people of black African heritage accounted for 13% of new HIV diagnoses among heterosexuals in 2020, and 64% of these diagnoses were of women. People of black African heritage are also significantly impacted by late HIV diagnosis, which is particularly frustrating, considering that those who are diagnosed late are much more likely to die from the disease.
I am increasingly concerned by the state of HIV testing in this country, given that the proportion of people who are eligible for a test but are not offered one more than doubled in 2020. That is completely unacceptable, and it is a systemic problem that falls under the remit of the OHID. I want to use this debate to urge the OHID to monitor the provision of commissioned services for people who are disproportionately likely to be diagnosed with HIV, and to consider how they could be improved. In particular, I want it to look closely at the availability of testing, both at home and in A&E departments, especially in areas of high HIV prevalence, and to consider the extent to which that might be acting as a barrier to achieving its aim of ending HIV transmission by 2030.
If the Government truly want the OHID to tackle health inequalities, then its work needs to have a laser-like focus on improving health outcomes for those living with stigmatised illnesses, such as HIV. It goes without saying that the Government cannot fulfil their pledge to end HIV transmission by 2030 without taking the measures that I have outlined today.
Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Bootle (Peter Dowd) for setting the scene. He is a man known for setting the scene well, and we appreciate his contribution—I think every one of us will have been heartened by what he has said today. I wish to make a contribution as my party’s health spokesperson. I am pleased to be here to discuss the evident disparities and inequalities in our health system, both on the mainland and back home in Northern Ireland. I know the Minister is not responsible for health in Northern Ireland, but I will give examples that will hopefully spur those who speak in this debate.
We must ensure that everyone has access to efficient healthcare. I will speak about three groups of people: those with mental health issues, those who are homeless and those with addictions. The Office for Health Improvement and Disparities officially launched in October 2021, as part of a restructuring of health bodies in England and throughout the UK. I am pleased that the OHID will co-ordinate local and central Government to initiate improvements in public health. The purpose of the OHID is clear. If it delivers on that purpose, everyone present will be more than pleased because many of the issues would be addressed.
I thank the Government for listening and learning from the lessons of the pandemic, and that information has now been taken ultimately to improve our health service. The Minister has said that our Government have three priorities to work on. The first priority is preventing poor mental and physical health. One in four people in the UK—25% of the population—and 19% of adults in Northern Ireland suffer from poor mental health, so that should be prioritised. The second priority is addressing health inequalities. Health is devolved, but this must be a priority for the Department across the whole of the United Kingdom. The third priority is working with partners within and outside Government to respond to the wider health determinants. These partners also have a responsibility for public health outside England.
I will talk about addiction issues and why it is so important that we address them within this campaign and policy, which the Minister will reply to shortly. In Northern Ireland, and in my constituency in particular, alcohol and drug-related indicators continue to show some of the largest health inequalities monitored in Northern Ireland, with rates in the most deprived areas five times those of the least deprived areas for drug-related mortality, and four times those for alcohol-related mortality. I suspect that other hon. Members will also state those mortality figures for people with drug or alcohol addiction issues. The inequality seems to be, unfortunately, in the areas where people have a poor quality of surroundings and less money, and therefore they are the ones we need to focus on because of the high risk of mortality that is prominent.
The King’s Fund has ascertained that health inequalities are avoidable and depend on people’s access to care; the quality and experience of care; behavioural risks to health, such as smoking and drinking; and wider determinants of health, such as housing circumstances and social factors and decisions. All these things combine to put pressure on people. Crisis, an organisation that campaigns to end homelessness, has contacted me in relation to tackling the disease of disparity. That is quite a term: the disease of disparity. Yes, it is a disease and it needs to be addressed. People who are homeless face some of the poorest health outcomes in society.
Some of the statistics are as follows. People experiencing homelessness are three times more likely to be diagnosed with a severe respiratory health issue. I did not know that until I got that information from Crisis, but it is a fact. The average age of death among homeless people is 46 for men and 42 for women, as the hon. Member for Stockport (Navendu Mishra) referred to. In this day and age that is totally unacceptable. We must address that issue. At the same time, I read in the papers—I do not know whether it is true—that people are living longer. Will someone who is homeless live longer? They will not, and therefore that must be addressed. I hope the Minister can respond to that.
Finally, a recent study found that people facing homelessness in major cities, such as Belfast or London, have levels of frailty like that of a 90-year-old. Again, that is another combination of issues. The barriers blocking greater equality for our health service are just astonishing, and these have only been exacerbated by the pandemic. It is about time that we started prioritising, and that starts with everyone being given the same allowances to access our truly admirable NHS.
Lastly, it is time for the OHID to monitor the provision of commissioned services for those who are socially disadvantaged and cannot access sustainable healthcare. I urge the Minister to commit to producing guidance and support on what actually works in the provision of health and social care services. I believe our duty in this House is to speak up for those who need speaking up for. Today, I am doing just that.
Stephanie Peacock (Barnsley East) (Lab)
It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on securing this important debate. When the Government launched the Office for Health Improvement and Disparities, renamed from the Office for Health Promotion, the Secretary of State said that it was not just a name change but
“a statement of intent—a driving mission to ‘level up’ health and ensure everyone has the chance to live happy and healthy lives.”
That is a mission that I sincerely hope all his Cabinet colleagues will commit to truly delivering on. The issue goes to the heart of the inequalities in communities such as mine. Sadly, it is an issue that has only got worse over the last decade. In the Government’s most recent national deprivation data, Barnsley ranked in the bottom 15% of the country for levels of income. Of the 318 local authority areas in the entire country, Barnsley ranked as the 19th worst for health deprivation and disability.
The Secretary of State has said that the top two priorities for the new office are preventing poor mental and physical health and improving access to health services, as has been discussed in today’s debate. As things stand, Barnsley is well above the national average for diagnoses of depression, arterial disease, learning disabilities, high blood pressure, heart failure, epilepsy, diabetes, dementia, obesity and heart disease. Barnsley East residents are almost twice as likely as residents anywhere else in the country to suffer from chronic obstructive pulmonary disease, much as a result of the thousands of men who worked down the pit. Around 8,000 miners have sadly lost their lives over the last two years.
I have raised the issue of covid death certificates with the Government on several occasions. I directly ask the Minister, again, whether she can give us an update on what the Government are doing to change guidance—it is a very simple ask—to ensure that industrial diseases are recorded on death certificates if someone, sadly, dies of covid. That is important to make sure that families receive the compensation to which they are entitled.
We cannot look at health inequalities in isolation, because income and health inequality are fundamentally linked. The ONS reports that the difference in life expectancy between the least and most deprived areas in England is 9.4 years for men and 7.6 years for women. The difference in the number of years lived in good health between the most and least deprived areas can be as much as 20. While areas such as Kensington and Westminster thrive, northern working-class towns such as Barnsley continue to be left behind.
There can be no justification for the levels of inequality that we face. Whether someone lives in Westminster or Barnsley, they deserve to live well. We have a long way to go if we are to tackle these health inequalities. They are not only an enormous challenge that the Government need to address today; they mean reversing more than a decade of decline.
Tim Farron (Westmorland and Lonsdale) (LD)
It is an honour to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on securing the debate and making an excellent opening speech. I also endorse what has been said by hon. Members on all sides—predominantly those from urban areas, because poverty is a major driver of health inequalities and discrepancies. I hope that my colleagues will understand if I now focus on some rural discrepancies, which are also significant and in some ways overlap with those on which hon. Members have focused so far.
The first area I will look at is social care. Social care is, obviously a huge issue and under massive pressure everywhere in the United Kingdom. There is an extra problem in rural communities like Cumbria. In my constituency, the average house price is 11 times the average household income; there are twice as many second homes in my patch as there are council houses. At this moment, 150 people who should be in social care are stranded in hospital beds, and one of the reasons for that is that the Government underfund social care. Not a penny of the national insurance rise that is coming will go into the pockets of hard-working care workers, so it is hard to retain and recruit them from a relatively small working-age workforce.
That has led to a number of issues. Just the other day, I was speaking to a person who needs a rota of six carers in order to function, but that person has not been able to find more than three for the last six to nine months. That is caused by a number of things, including silly visa rules, which the Government need to look at again, and the massive discrepancy between house prices and income—the availability of anywhere affordable to live for folks in the area.
Secondly, there is the issue of mental health—particularly young people’s mental health. Similar issues are present there when it comes to recruiting and retaining staff. There are wonderful staff—too few of them. When I did a survey of families in my constituency last year, we discovered that more than 50% of young people who presented with mental health conditions that needed attention waited more than three months, and 28% waited more than six months. Some 52% said their experience of that care was poor as a consequence.
If a 15-year-old broke their leg on a football field on a Sunday afternoon, they would be seen immediately, but if something invisible breaks within one of our young people, they wait six months or more. That is intolerable anywhere, but it is fuelled by the fact that we are in a rural area that is underfunded for mental health provision.
When it comes to GPs, a few years ago the Government got rid of the minimum practice income guarantee, which subsidised small surgeries. Small surgeries in rural areas are not small because they are bad, but because they cover the size of a small country but a relatively small population. Coniston, which mourns its doctor, Dr Simon Fisher, who sadly passed away just a few weeks ago, has a roll of just 900 patients, not because its practice is poor quality but because it covers a vast area. The Government took away that money.
The sticking-plaster money, called atypical practice funding, that went to some surgeries just to keep them going will fold when the clinical commissioning groups go and the new integrated care boards come in, in just a few months’ time. I ask the Minister to look carefully at that, as otherwise we may lose dozens, if not hundreds, of rural GP surgeries around the country.
On cancer provision, the National Radiotherapy Advisory Group states that it is bad practice for any patient needing radiotherapy to have to travel for more than 45 minutes for treatment. I can tell the Minister that not a single person in my constituency lives within 45 minutes of radiotherapy, and many of them must make four-hour round trips, day after day, in order to get treatment at an excellent but distant centre in Preston. If the Minister is committed to tackling discrepancies, she will finally do what Government after Government, including the one of which I was part, have failed to do—deliver the satellite radiotherapy unit at Kendal that we have long been campaigning for. That will shorten those journeys and save lives.
My final point is about accident and emergency. The nearest accident and emergency centre to most of my constituency is at Lancaster. There is a lot wrong with the hospital at Lancaster. It is an old site, at the wrong end of the one-way system, and could do with renewing. Talk of hospital improvement money going into it is welcome, but what is not welcome is the Minister’s Government’s continued insistence on looking at the option to close the Royal Lancaster Infirmary, merge it with the hospital at Preston and have a new hospital somewhere in the middle. If the answer is to make A&E for south Cumbria another 10 or 15 miles further away, that is the wrong answer. I ask the Minister to talk to the Secretary of State for Health and Social Care and others to take that option off the table, so that people from my communities do not have to travel dangerous distances to get the treatment they deserve.
I endorse what my colleagues from more urban areas said earlier in the debate, but I want the Minister to focus on the fact that many people in rural communities think they are overlooked by this Government, that their votes are taken for granted, and that as a result we get the situation that I have just outlined.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to serve under your chairmanship, Mr Twigg. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing this debate and on the passionate way that he opened it.
Health inequalities are one of the defining issues of our time and are innately linked not only to how long we live, but to how well we live. Every person across this great country deserves to thrive and live a long, fulfilling and healthy life. That principle informed the creation of our national health service and it continues to drive the work that Opposition Members do.
As colleagues have done, I reinforce to the Minister the perilous position that we find ourselves in with regard to health inequalities. The pandemic has exacerbated the health inequalities that were already widening prior to the first lockdown. Indeed, in February 2020 the King’s Fund reported:
“Males living in the least deprived areas can, at birth, expect to live 9.4 years longer than males in the most deprived areas.”
For females, as we have heard, this gap is 7.4 years. That is not good enough.
Worse, the gap is increasing. Life expectancy has had a steady ascent for 100 years. That ascent began to plateau in 2011. Can the Minister advise what she thinks happened in 2010 that led to that abrupt stalling of life expectancy? It is very real. [Interruption.]
Derek Twigg (in the Chair)
Order. The sitting is suspended for 25 minutes for Divisions in the House.
Andrew Gwynne
Before I was interrupted by the Division bell, I was about to say that I have seen at first hand the injustice of health inequality. Denton, the main town in my constituency, where I grew up and have lived, is not a very large town. It has a population of 38,000 people spread over three council wards, and its area is 2.5 miles by 1.5 miles. I grew up in Denton West, which is one of the more prosperous wards in my constituency and in the borough of Tameside.
My best friend at secondary school lived in Denton South, which, conversely, is one of the poorest. We both went to the same school. We were two kids growing up in the same community, at the same school, doing the same things, hanging around together. Yet according to the average life expectancies, he will live 10 years less than I will. That cannot be acceptable, it is not acceptable, and it is one of the reasons I joined the Labour party and became politically active. Tackling those inequalities, not just in a small community such as Denton but across the country, is absolutely what we should be about, in order to improve outcomes for all.
The last decade has been a disaster in terms of inequality, and I say to the Minister that that is the direct consequence of political choices that her party has made. It is a consequence of a decline in real-terms local authority spending, a consequence of a reduction in per-person education spending—a consequence of 12 years of Conservative government. The fact is that it is impossible to corral health inequality into one box. As we have heard in this debate, it is closely tied to social determinants: where people grow up, their environment, their education and their disposable income all contribute to health inequalities. If we are to tackle the crisis, the Government must recognise that they cannot make policy decisions in a vacuum.
That leads me to the issue of the Office for Health Improvement and Disparities. I note that one of OHID’s key priorities is to
“develop strong partnerships across government, communities, industry and employers, to act on the wider factors that contribute to people’s health, such as work, housing and education”.
That is music to my ears. It is clearly a positive and welcome aspiration, but three months on from OHID’s launch, we have yet to see any clear indication that cross-Department work has actually been prioritised by the Government. This point has been made by the Inequalities in Health Alliance, an organisation with more than 200 members, including the Royal College of Physicians. The IHA has asked the Government to underpin and strengthen OHID’s work with an explicit cross-Government strategy to reduce health inequalities, involving all Departments, and led by and accountable to the Prime Minister. So far, the Government have been resistant to committing to that.
I would be grateful if the Minister, in her response, could advise us what assessment she has made of the request from the IHA and whether her Department will commit to developing a specific cross-Government strategy. In addition, can she set out how OHID will assess its own effectiveness, and what influence it will have on other Departments? Will she also outline what engagement OHID has had with other Departments since it was established back in October? We need to know that OHID is not just more warm words with very little in the way of positive action. The Government cannot point to OHID with one hand and then, with the other, undermine the work that it purports to do.
For example, last October, the very month in which OHID was formed, the Chancellor of the Exchequer ended the £20-a-week uplift to universal credit. That plunged 300,000 children into poverty pretty much overnight. That political decision obviously has a negative public health impact for people across the country, yet apparently that was not something the Chancellor either considered or seemed particularly concerned about at the time. Can the Minister advise us how OHID will prevent further such disastrous policies from being implemented? If she cannot, I simply do not see how it will solve the crisis of health inequality in this country. I would be grateful, too, if she could outline what role OHID will play with regard to the new integrated care systems. Some clarity on that would be very much appreciated, particularly in advance of the Health and Care Bill’s anticipated return to the Commons in the next few weeks.
Finally, I want to touch on the subject of levelling up and its relationship to health inequalities. It has become somewhat of a go-to phrase for the Government. It should perhaps be a cause of concern to the Minister that, more than two years into this Administration, the levelling-up White Paper still has not been published. On that note, I want to press her on what exactly the Government’s priorities are.
In 2020, Professor Sir Michael Marmot published “Build Back Fairer” in Greater Manchester, which called for several policy interventions from the Government. Professor Marmot proposed investment in jobs, housing, education and services, and made particular reference to tackling the social conditions that cause inequalities at local and community level. We saw local authority public health funding cut by 24% per capita in real terms between 2015-16 and 2020-21. That is the equivalent of a reduction of £1 billion, which cannot be right. We need to restore public health funding to local authorities, so that local teams are able to provide vital services that communities need to stay healthy.
In conclusion, we went into the pandemic with health inequalities already growing, which left Britain’s poorest areas, as well as those in black, Asian and minority ethnic communities, acutely vulnerable to covid-19. That is totally unacceptable. We are now in 2022; we should not be living in a society with such extreme levels of health inequality. It is not right, and it needs fixing. The Government must do more and can do more, and they must do better.
Derek Twigg (in the Chair)
The debate will finish no later than 4.25 pm. I know that the Minister is aware of the need to allow two or three minutes at the end for the hon. Member for Bootle (Peter Dowd) to wind up.
The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on bringing forward this extremely important debate. It has been really interesting and, with many people contributing, it has been quite rounded. The hon. Gentleman spoke passionately and knowledgeably about the issue, as did other Members. We have probably done the issue a disservice by having only an hour and a half to debate it. I look forward to further debates.
It is time to shift the centre of gravity of the health system from treating disease to building good health. To do that, we have to focus on the people and places who face the worst health outcomes. That is why on 1 October 2021, we launched the Office for Health Improvement and Disparities. The mission of OHID is to improve the health of our country so that everyone can expect to live longer in good health, and to break the link between people’s background and their prospects for a healthy life.
OHID is doing that by working with the rest of Government, the healthcare system, local government and industry, to bring together expert advice, analysis and evidence in policy development and implementation. As a number of hon. Members mentioned, covid has shone a light on the poor underlying health of certain groups in the population, the depth of health disparities and the implications for our health, economy and society.
Health disparities across the UK are stark. As the hon. Member for Bootle highlighted, in the borough of Sefton, where his constituency is located, the life expectancy deprivation gap is 11.8 years for women and 12.5 years for men. Health disparities can be driven by a range of factors, including education, income, employment and early years experiences. Therefore, OHID aims to systematically tackle the top preventable risk factors for poor health by looking actively at the evidence on health disparities and the ways in which we can go further to address them.
The new Health Promotion Taskforce, which was set up by the Prime Minister, will drive and support the whole of Government to go further in improving health and reducing disparities, because many of the factors most critical to good physical and mental health are the responsibility of partners beyond the health service. This new Cabinet Committee, now chaired by the Secretary of State for Health and Social Care, brings Departments together around the objective of reducing ill health and health disparities. It also provides a new opportunity to work together actively on the most important health issues and agree new ways to address them collectively. I hope that helps reassure colleagues that the new taskforce is at the top of Government, and is determined to bring all Departments together to tackle this agenda.
Jim Shannon
In my contribution, I referred to the contact that I have had with Crisis on homelessness. Will the contact that the Minister has referred to include those groups? They have the facts. She will have heard what I said about the disparities between those who, like us, live in a well-off area, and those who do not and have not got a home. Homelessness is deadly.
Maggie Throup
I reassure the hon. Gentleman that tackling homelessness is a high priority for this Government.
As hon. Members have mentioned, the Government will shortly publish a landmark levelling-up White Paper that will set out bold new policy interventions to improve livelihoods and opportunities in all parts of the UK, and to reduce the disparities between different parts of the UK. Poor health is stopping people accessing quality education and jobs with good career prospects, limiting their career progress, and undermining local prosperity and the general wellbeing of communities across the UK. Of course, it would be wrong of me to pre-announce the contents of that important White Paper.
Tackling health disparities promotes economic prosperity by increasing productivity and reducing strain on public services, including the economic cost of preventable ill health to the NHS and the welfare system. To address those issues, we are investing in tackling the key contributors, such as obesity and smoking. We are also investing £500 million to transform Start4Life and family health services.
Debbie Abrahams
I refer back to my point about not victim blaming, but in relation to the NHS resource allocation formula, can I ask the Minister whether the Government will be reinstating the health inequalities weighting that the previous Administration scrapped?
Maggie Throup
If I may, I will write to the hon. Lady on that so I can make sure that my facts are completely clear, rather than giving her an answer that may not be quite accurate.
In recognition of the strong relationship between work and health, the joint work and health unit was established in 2015. It has invested in a programme of trials and tests to identify effective models of health and employment support, and it is now using that learning to develop and/or roll out services to support disabled people and people with long-term health conditions to enter and stay in employment. The 2021 spending review confirmed that the public health grant will be maintained in real terms for the spending review period, so local councils can continue to invest in prevention and essential public health services. The distribution of that grant is heavily weighted towards the areas that face the greatest population health challenges, with per capita funding almost 2.5 times greater for the most deprived authorities than for the least deprived. The allocation at local authority level will be announced shortly.
The role that local authorities play in improving public health is far broader than simply the important services and interventions funded through the public health grant. That grant is part of a wider package of targeted investment in improving the public’s health over the spending review period, including £300 million to tackle obesity; £170 million to improve the “best start in life” offer available to families, including breastfeeding advice and parent-infant mental health support; and an additional £560 million to support improvements in the quality and capacity of drug and alcohol treatment, which was announced as part of the drugs strategy. In addition, we have made over £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19. Of this money, £6 billion was non-ringfenced, because we recognise that local authorities are best placed to decide how to manage the major covid-19 pressures in their local areas.
Stephanie Peacock
I made a point in my speech about an issue that affects my area, regarding covid death certificates and industrial disease. Would the Minister either respond to it now or write to me about it?
Maggie Throup
I was going to answer the hon. Lady’s point shortly, but I will answer it now. I will write to her on the important issue she raised about industrial disease. We need to ensure we have everything in place to enable families to access the different forms of support available to them.
I will come back to OHID for a moment. OHID has regional teams, which will have a vital role in working with integrated care systems at regional level. OHID will produce important data and information resources, which will be vital to ICS work in improving population health. Through ICSs, we will improve local working on population health and reduce health disparities.
One of the key objectives of these reforms is to give integrated care boards the responsibility and the ability to tackle health inequalities, as made clear in NHS England guidance. This will also reinforce the role of local authorities as champions of health in local communities and empower the NHS to improve poor health.
I will answer a few of the questions that have been asked. The hon. Member for North Tyneside (Mary Glindon) raised e-cigarettes. I commend her for the work that she does through the all-party parliamentary group for vaping, and I reassure her that OHID will continue to monitor and publish evidence and reviews on e-cigarettes. Our tobacco control plan will be published later this year, outlining our smokefree 2030 plans.
The hon. Member for Westmorland and Lonsdale (Tim Farron) highlighted disparities affecting rural communities. He raised a number of issues specific to his constituency, and I am sure that the relevant Health Minister will be happy to meet him to discuss them in more detail.
The hon. Members for Bootle and for Salford and Eccles (Rebecca Long Bailey) asked why we use the terms “disparities” and “inequalities”. I reassure them that the terms are used interchangeably, and it is important to understand that a term itself does not impact on our understanding of a problem or our response to it.
I thank the hon. Member for Bootle again for securing a debate on such an important issue. The pandemic has highlighted the impact of health disparities on people’s life outcomes and the pressures on the wider health and care system. The establishment of OHID, the creation of the new Health Promotion Taskforce Cabinet Committee and targeted investment in public health demonstrate that the Government are fully committed to tackling health disparities. I genuinely believe that by working together across Government, and with local authorities and the NHS, we can make a huge difference in improving health, life expectancy and life outcomes, particularly for the most vulnerable in our society.
Peter Dowd
I appreciate the fact that so many colleagues have come here to discuss this matter today, because it really goes to the heart of the needs of our communities.
We need a seismic shift—a paradigm shift—to tackle health inequalities and inequalities more generally. If we can guarantee £1.3 trillion to support a few institutions because of the banking crisis and £400 billion in relation to the pandemic, surely we can afford in the longer term to tackle health inequalities that affect the lives of millions of our constituents—many of whose lives are, to quote Thomas Hobbes’s “Leviathan”, “nasty, brutish, and short”.
Question put and agreed to.
Resolved,
That this House has considered the Office for Health Improvement and Disparities and health inequalities.
DWP Risk Review Team
(2 years, 10 months ago)
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Derek Twigg (in the Chair)
Before I call Kate Osamor to move the motion, I inform Members that this debate will conclude no later than 4.55 pm.
Kate Osamor (Edmonton) (Lab/Co-op)
I beg to move,
That this House has considered the Department for Work and Pensions’ Risk Review Team.
It is a pleasure to serve under your chairmanship, Mr Twigg. Today, I will talk about the Department for Work and Pensions risk review team, which was set up in May 2020. The DWP states that the team’s role is to
“review and take action on cases identified”
by the integrated risk and intelligence service as being “a high fraud risk.”
I was first alerted to the team’s existence in October 2021, when my constituency office began to receive contact from what would become a total of 29 constituents who had had their universal credit payments suspended indefinitely under almost identical circumstances. Those constituents are all Bulgarian nationals and tend to have either settled status or pre-settled status. Time and again, my office was told that the cases were under the management of the risk review team, with little to no further explanation of the reason, apart from some claims of suspicion of fraud. Constituents told me that their claims were suspended for months on end—as long as 11 months, in the worst case. Although that particular constituent’s claim has now been restored, they have received no compensation for the hardship caused.
The DWP provides no timeframe for the completion of the reviews, nor a right of appeal. A significant number of those constituents are single mothers who work part time. This situation has left them in a completely crippling financial position and pushed many into serious destitution—relying on food banks, facing eviction from their homes and racking up serious amounts of debt. One constituent, whom I will call Maria, is a constituent of mine only after she lost her home in Liverpool as a result of having her benefits suspended, and subsequently moved to Edmonton.
From the cases my office has been handling, a number of constituents have since had their universal credit payments restored and backdated, as there was no evidence of any wrongdoing.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Lady on securing this debate. I have constituents coming regularly into my office—you probably do as well, Mr Twigg—asking for help on this matter, although they may not be Bulgarian. Those constituents say that the DWP has asked them for information. I always ask, “Well, have you got that information?” to which they reply, “We are not quite sure.” Does the hon. Lady think that when an application is refused, whatever the reasons may be, the Department should make officers and staff available to help that person to get the right information and respond? The people she mentioned had their benefits restored, but they would not have had to wait had it been done right the first time around.
Kate Osamor
The hon. Gentleman makes a valuable point, which I will come to later. I back everything that he has said, because the claimants need much more support. For many claimants, English is their second language, so the more support the Department can give them, the better.
We have seen few claims disallowed for reasons of constituents failing a habitual residency test, and none that we have seen have had their claims closed for fraud. All that raises a series of questions for the Minister. How many fraudulent claims have been discovered by the risk review team? What justification is being used for the original investigation and suspension of claims? Has the Department undertaken an equality impact assessment to ensure that the process is not resulting in direct or indirect discrimination? I ask those questions because, sadly, there did not appear to be much information publicly available about the risk review team, and the Department appears reluctant to enlighten me further. I wrote to the Minister about these issues on 26 November 2021, and I received a response only yesterday evening. I am very grateful for that response, despite having to chase the Department nearly four times.
I have also asked a series of written questions. In response to one of them, the Minister for welfare delivery stated that as of 24 December last year, 149,000 cases—approximately 3.74% of universal credit claims—had been suspended under the risk review process. We have found out that 3% of claimants in those cases had their benefits reinstated. However, using the argument that to do so would mean incurring disproportionate costs, the Department has so far declined to confirm what has happened to the other 97% of cases.
Let me ask the Minister some more questions. How many claims have been deemed to be fraudulent and subsequently closed? How many claims remain suspended? How many people who we have not yet heard about are suffering in silence, not just in Edmonton but across the country? This issue is especially concerning because the cases I have seen predominantly concern claimants for whom English is a second language. Many face real difficulties accessing services, and that can create barriers to communicating with the Department directly and to accessing outside advice and assistance.
Some appear to have had their claims referred to the risk review team after being unable to answer security questions over the phone. I am unsure how much assistance they are given in the process if there are language barriers. In response to written questions, the Department has stated that there is a “high risk of fraud” in these cases, and that all claims are “suspended pending contact” with the claimant and them providing the requested information. It has also insinuated that the cases are related to organised crime, and yet in our experience the majority of those who are impacted appear to be vulnerable single mums who have done nothing wrong.
I can speak only for my constituency, but the brunt of the policy appears to have fallen overwhelming on Bulgarian nationals. Charities working in the local area, such as Citizens Advice Enfield and the Edmonton Community Partnership, concur with that assessment. From the many organisations I have spoken to that have similar cases, I have heard of Romanian and Polish nationals being affected, but no British citizens or those of other nationalities. Tellingly, those affected are all EU citizens.
Thus far, the Department has said that it does not keep demographic data on nationality, making it impossible to produce conclusive proof, but I understand that the Department does hold data on claimants’ nationality at the point of national insurance number registration. While we remain in the dark about how this opaque team conducts its business, and with the cases that I know about being so overwhelmingly concentrated among Bulgarian nationals and other EU nationals, it is impossible not to suspect that potentially discriminatory practices are being carried out.
Considering the issues that I have raised, I have a series of recommendations for the Minister. First, I urge the Department to change its “guilty until proven innocent” approach. The Department clearly does not have the resources to process the cases in a timely manner. I understand that there are roughly 165 full-time equivalent staff on the team. It seems likely that thousands of people are left languishing for many months, effectively under no recourse to public funds conditions, even if they are entitled to claim benefits and have committed no wrongdoing. Claims should be suspended only if evidence of fraud is found, with the review and an initial decision made prior to that course of action.
Secondly, the team must provide proper assistance to those whose cases are being investigated. It must appreciate the barriers that may exist to providing evidence. The whole process has appeared opaque and complex to my caseworkers and me, let alone someone for whom English is not their first language.
The DWP must also appreciate the barriers to providing documents—learning lessons, for example, from the Windrush scandal—as there may be deeper reasons why claimants are unable to provide certain pieces of evidence. The Independent reported on a Bulgarian national who was subject to the risk review process and was asked to provide every page of their old passport. However, that was impossible, as the Bulgarian embassy in London reportedly takes expired passports when citizens apply for a new one. That should be urgently be looked into, and an equalities impact assessment should be carried out.
Thirdly, the DWP should provide adequate compensation to those who have had their claims wrongly suspended. I know of constituents who have had their lives turned completely upside down, in some cases losing homes and acquiring significant debt, not to mention the stress and anxiety caused by the months of waiting.
Backdating payments does not make up for the impact of the process. Of all the cases my office has dealt with, only one constituent has received any compensation. They were granted a consolatory special payment of £200 because of delays in a mandatory reconsideration decision and the outcome of the risk review action. That sum is nowhere near enough to make amends for the seven months in which they waited for more than £10,000, which they were entitled to receive during that time. We need a proper compensation scheme for those who have been seriously affected by the way that the risk review team has conducted its business.
Lastly, and crucially, the DWP must be more transparent. More than 140,000 claimants have been affected by the risk review team. There must be greater awareness of the way in which it operates. Currently, it appears to be operating with impunity. Guidance should be published on how the team works in identifying and investigating cases. The DWP should also make public how many cases remain suspended, and what percentage of those have been closed after the Department came to the decision that it believed the claim was indeed fraudulent.
Transparency and scrutiny are essential for good governance. Any new policy that may cause negative consequences must be identified and then, ideally, addressed quickly. The hardship being caused to my constituents, which I have spoken about today, may not be an intentional effect of this policy but, for one reason or another, they are getting trapped in this net. It is imperative that we understand why. I urge the Minister to take on board the stories that I have relayed today and to urgently review the operations of the risk review team, with the seriousness that the situation deserves, before many more lives are torn apart.
The Parliamentary Under-Secretary of State for Work and Pensions (David Rutley)
It is a pleasure to serve under your chairmanship, Mr Twigg. I have had an opportunity to work with you in the House, but also on various hills—with mixed results, but it is always a pleasure to be in your company.
I congratulate the hon. Member for Edmonton (Kate Osamor) on securing this important debate. My Department faces a huge responsibility, day in and day out, to pay benefits to millions of households, ensuring they have the help and support they need and wherever possible helping them into sustainable employment. We do everything we can to make sure that happens in a timely way. That was proven when covid-19 hit. We paid out to over 3 million more households at a time of global crisis. Universal credit in particular is a very resilient system, because it has been stress-tested in such an environment. Our latest public statistics show that around 90% of new universal credit claims are paid in full and on time.
Alongside that, we have another responsibility: to ensure that we are using taxpayer money properly and that funding is going to those who need it. Unfortunately, there are those who think it is acceptable to commit fraud against the welfare system. Those people cost the taxpayer—in fact, stole from them—an estimated £6.3 billion last year. That is £6.3 billion of taxpayer’s money—an absolutely staggering sum. I can just imagine what any Member in this House would want to do with that money to help not only their constituents but thousands of others. It is money that could be going to fund other vital Government services. Those who fraudulently claim that money clearly have no right to it.
I believe it is right that my Department makes every effort to find and crack down on fraud, and to ensure that we have the fullest range of tools at our disposal to achieve that. Those committing fraud are clever, committed and constantly thinking of new ways to get around the systems that we have in place, and to turn new technological advances to their advantage. The job of the DWP is not just to keep up with that, but to try and get ahead of it. It is our job to keep innovating and finding new ways to identify fraud where it happens and to put a stop to it. It is our job to keep fraudsters guessing at how we might find them, so that they do not find new ways to evade us. The risk review team is one of those innovations, established as a direct response to new threats. Its role is to provide an operational response to threats that have been identified. It does this by suspending suspect cases, where specific intelligence provides evidence of fraud.
I would like to stress that we are talking about a relatively small number of claims. Of the 3.7 million claims made to universal credit since May 2020, less than 4%, approximately 149,000, have been suspended under the risk review process. Those are not run-of-the-mill cases, but ones where, based on our analysis, we believe there is a high level of risk. It is because of that level of risk that claims have been legitimately suspended. It is an approach that provides much needed capability to disrupt and respond to new and emerging threats at pace.
To give an example of one of the challenges that the DWP has faced, in May 2020 the cyber-resilience centre, working as part of the integrated risk and intelligence service—we are pretty good at coming up with snappy titles for teams—prevented an attack by organised criminals. That led to the suspension of thousands of universal credit claims and prevented £1.9 billion in benefits from being paid to people trying to scam the system in 2020 and 2021. That is just one example; those attacks continued and more cases had to be suspended to safeguard public funds.
Stephen Timms (East Ham) (Lab)
I am grateful to the Minister for giving way, and I congratulate my hon. Friend the Member for Edmonton (Kate Osamor) on securing this debate. I agree with the points that the Minister is making about the importance of tackling fraud, particularly as universal credit has the highest level of fraud of any DWP benefit in history. Does he agree that it is not acceptable to take somebody’s benefits away for 11 months, as in one of the cases that my hon. Friend mentioned, with no support available? That potentially completely ruins someone’s life.
David Rutley
I understand the point that the Chair of the Work and Pensions Committee makes, but the key thing is that claimants need to prove eligibility. We want to help them to prove eligibility for a benefit. The challenge, and the reason these cases take time, is often that claimants are not able or willing to provide that evidence. I will come on to that later.
Jim Shannon
I think the hon. Member for Edmonton (Kate Osamor) hinted at this, and I did in my intervention: there are occasions when people do not understand the process, and need a wee bit of help. I think the hon. Lady asked about that. Is there an opportunity to make extra officials available to pursue those necessary evidential bases when claimants may themselves not understand what has been asked for?
David Rutley
The hon. Member makes a good point. We stand ready to help and assist. One of the points made by the hon. Member for Edmonton was that, in some of the cases that she highlighted, there are challenges around the ability to speak English. Of course, interpreters are made available. In the Chamber today, we have three of the most well-recognised campaigners in the House, along with others who have not spoken yet. Hon. Members should bring cases about which they have concerns to my attention directly, with the usual information that they think is appropriate and that needs to be processed. If there are any outstanding concerns, I will take a personal interest in them and move cases forward. The issue is that often—I will talk about the statistics in due course—the information is not provided, and of course we cannot provide benefits without that evidence, because of all of the fraudulent cases we have spoken about. I will carry on with my speech, which I hope will answer more questions. We will take a close look at each and every one of those 29 cases if that information can be provided—I give hon. Members that undertaking.
First, I need to emphasise that the overwhelming majority of claims for universal credit are legitimate. We know that most people are not trying to defraud the Department. The hon. Member for Edmonton raised—I would not say “a couple”—a lot of pertinent issues via parliamentary questions. That was one of the reasons why we were delayed in providing full answers to all her questions: we wanted to make sure that they matched up with the parliamentary questions. In the letter that I sent her, I apologised for that. As I say, it was mainly because we wanted to ensure that we had all the right information in response to all the questions. I hope that underlines the approach that we want to take, which is all based on due process.
However, I take this opportunity to stress, as I already have, that we are trying to get the balance right between getting money to those who need it and tackling those who are actively seeking to commit fraud. I will follow up on those individual cases in due course once the information is provided. Benefit claims should be verified and paid as quickly as possible, which is why we always make it clear to claimants exactly what information they need to provide. We do that via the claimant’s universal credit journal, and the messages also let the claimant know exactly how they can contact the Department and speak to the staff members responsible for their case. That is an important dimension; in our casework, we can do better at highlighting that to constituents. I also take the feedback that maybe we can do a better job at communicating that to MPs and their offices—a point well made.
Where there is a problem in providing information, we always encourage the individual to get in touch, so that we can discuss and resolve the matter as quickly as possible. As the hon. Member for Edmonton would expect, when we suspend a claim, we do not do it lightly. Suspension is always a last resort, for the reasons that the Chair of the Work and Pensions Committee, the right hon. Member for East Ham (Stephen Timms), has highlighted. Suspension is based on an initial assessment that a person would not be entitled to the benefit that they have claimed—an assessment that is based on intelligence and not on the specific characteristics of claimants, such as nationality. I know that that was a concern of the hon. Member for Edmonton, but I can confirm that a person’s nationality is not a factor in determining whether a claim is referred to the risk review team.
In fact, because nationality is not a factor in that assessment process, an equality impact assessment is not needed. However, as part of the initial universal credit claim process—not the risk element, but the claims process itself—we do request information regarding a person’s nationality. That is necessary to assess the eligibility and entitlement of a claimant at the start of their claim, but it is not used as part of the risk review process.
We take good care to ensure that we understand a person’s personal circumstances, as the hon. Member for Strangford (Jim Shannon) highlighted, and any potential vulnerability before we suspend. That means that we can engage with individuals in the right way. We have processes in place such that any contact from a claimant will be dealt with by a dedicated team. That type of one-to-one conversation with a member of staff allows the claimant to discuss the claim in detail and means that the member of staff can provide the necessary support to help to ensure that individuals can give us the documentation we need.
Once the risk review team has its information and the decision has been made that there is an entitlement to benefit, we will of course lift the suspension immediately and pay any arrears due. However, we receive no contact from the majority of suspected fraud cases—approximately 65% of those that we suspend. That is a remarkable figure: 65% of people do not get in touch with us after a suspension notice.
If a claim is suspended, we are unable to make alternative payments. However, claimants are still able to get help from work coaches to find them work. We have a record more than 1.2 million job vacancies and our work coaches are supporting thousands of people into work. There is also continued support for the most vulnerable children, regardless of a parent’s universal credit suspension. Children in receipt of free school meals will continue to receive that support. There is also the free childcare provision for three and four-year-olds and disadvantaged two-year-olds, where eligible. An individual may also be entitled to claim child benefit, assuming they meet the qualification conditions.
More broadly, local authorities have responsibility for local welfare provision. Recognising that some households will require additional help this winter, we have provided £500 million to provide support with essential household costs such as heating and food bills. That is delivered through the household support fund in England. Other help may be available via healthy start payments and the holiday activities fund. Staff in local jobcentres will be able to help to direct those in need. I should also make it clear that, while in law there is no right of appeal against the decision to suspend payment of a benefit, a claimant does have the right to appeal any outcome decision where the Department has determined that there is no entitlement.
Hon. Members will appreciate that I cannot say too much about how the risk review team works in this area of activity. As I said, it is a constant challenge to stay ahead of fraudsters and we cannot provide any clues to those looking to evade our systems. However, while a focus on disruption is a primary tactic of the team, their activity does not stop at that point. The risk review team will also gather intelligence that can be used as the basis for a formal criminal investigation, should it be warranted. It is worth noting that although the number of suspicious claims processed by the risk review team is significant, it is believed that the numbers of people responsible for those claims are actually relatively small. Our focus is on pursuing those behind the attacks in intelligence-led investigations, which is the most effective use of our resources.
Last month I went on a raid with fraud colleagues as part of a joint crackdown on fraud with West Midlands police. The raid was part of Operation Goliath, a joint national operation with police nationwide that aims to combat fraud. Numerous arrests were made and we believe that we stopped an organised crime gang alleged to be stealing from the benefits purse. Thousands of false claims, based on thousands of hijacked identities, had netted the gang approximately £4 million already—a huge amount of money, and a figure that would have likely been far higher had we not been able to intervene at the pace that we did and had the approach taken by the risk review team not been in place.
As I have said, fraudsters are constantly thinking of new ways to attack us and to evade and circumvent our systems and safeguards. Some of the frauds are so engrained and deep-set that, remarkably, even after the arrest of major criminals, we are still being contacted by individuals pursuing claims linked to those investigations. It is extraordinary.
We are continuing to build and grow our capabilities, including investing to save. At the end of last year, we had announced a total investment of £630 million, which is a huge amount of money, over the next three years, to support the Department in this challenge and enable us to drive down fraud and recover debt. The money also enables further recruitment into our counter-fraud, compliance and debt so that we can continue to respond quickly and effectively to threats. It includes the funding of around 2,000 trained specialists to stop and identify scammers. I wish that we did not have to recruit those people, but we have a challenge, which is why we have to take those steps.
I hope that hon. Members agree that we must have a co-ordinated response to the attacks on the benefits system, and take action on as many fronts as possible to drive criminals out of it. These criminals will not let up and neither will we, on which note I commend the work of the risk review team, which is clearly playing a major part in helping to stop fraud getting a foothold.
At the same time, I reiterate the point that I made earlier: I know that it can be difficult, and that there are challenges for the people involved, but we always want to work with genuine claimants. In getting the balance right, I again extend the offer to hon. Members, particularly the hon. Member for Edmonton, who has been a doughty champion for her constituents, that if they write to us on those cases we will take them up and follow them through. I hope that she will do so, and that I have given her some satisfaction on the questions that she asked. Clearly, we will follow up on the outstanding parliamentary questions that she highlighted in due course.
Question put and agreed to.
Women’s Football
(2 years, 10 months ago)
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Derek Twigg (in the Chair)
I remind Members that they are expected to wear a face covering when they are not speaking in the debate, in line with current Government guidance and that of the House of Commons Commission, and that they are asked by the House to have a covid lateral flow test before coming on to the estate. Please also give one another and members of staff space when seated and when entering and leaving the room.
Julie Elliott (Sunderland Central) (Lab)
I beg to move,
That this House has considered the experience of women playing football in England.
As ever, it is a pleasure to serve under your chairmanship, Mr Twigg. I thank all Members in attendance. I can see that there is some incredible expertise on the subject in the Chamber, and I look forward to hearing others’ contributions. I am glad to have secured the debate, which has come at an important time for women’s football, not least because of the situation that Coventry United women players faced just before Christmas. The players and staff found out two days before Christmas that the club was in financial trouble and their contracts were to be terminated, only to be saved at the eleventh hour on 4 January by a new buyer for the club.
Women’s football has seen incredible growth in the last few years. That is down to increased opportunity and, importantly, visibility. The Football Association, under the leadership of Baroness Sue Campbell and Kelly Simmons, has done a great job in getting young girls and women playing football, as shown in the FA’s latest “Gameplan for Growth” report, published in 2020. Between 2017 and 2020, the FA doubled participation in grassroots football among women and girls, and doubled fans attending international and women’s super league matches. I thoroughly enjoyed, in spite of the cold, going to see the Lionesses as they played at the Stadium of Light last year in the World cup qualifiers. It is great to see them going around the country and playing to different audiences. The Lionesses will always be very welcome in Sunderland and I hope they return soon. That highlights the importance of visibility in the growth of the sport.
The BBC, for example, has done a great job in helping build the sport’s profile. It will provide live network TV and radio coverage of the women’s Euros, which take place in England this summer. It was the first to cover a whole Lionesses campaign, when it showed every game of their 2015 World cup run, and attracted 28 million people to watch the 2019 World cup campaign. Those are truly incredible numbers, showing the value of the BBC as a public service broadcaster, which I am sure the Minister recognises, while also showing that, when women’s football and women’s sport is on TV, it brings in viewers.
Do not let those stuck in the dark ages say that people are not interested in women’s sport. A report released by academics at Durham University last week exposed the levels of misogyny still present among male football supporters, with some respondents remarking how women should not participate in sport at all, or at least stick to perceived feminine sports, such as athletics, and that the media reporting of women’s sport is PC nonsense or positive discrimination.
Let me say on the record that they are wrong, and the numbers back that up. Visibility matters, and seeing women play sport on TV makes a difference. The importance of visibility cannot be overstated. Work by the Women’s Sport Trust shows that it is having an effect. Sky Sport’s new deal has already brought in almost 8 million new viewers in the early stages of the new women’s super league season. Around nine in 10 of those viewers had not watched women’s super league in the previous four seasons. The commitment that organisations, such as the BBC and now Sky, have shown to women’s football and women’s sport in general has given young girls across the country the opportunity to see good sporting role models. It is truly invaluable to see people who look like them do amazing things. It does wonders for the confidence of those just starting out on their playing journeys, no matter how far they decide to go.
I would like to ask the Minister where the Government are up to in considering adding the women’s equivalent of the men’s sports to the listed events regime. I understand that the Government are open to consultation on that. The Minister for Media wrote to me in November, saying that it takes time, but could the Minister today give me a more definitive timescale for when the consultation is likely to conclude? The case for equality is overwhelming. With the visibility of women’s sport and women’s football rocketing, there is even more reason to get the future of the sport right.
The situation at Coventry United women’s football club was so concerning, which it is why it is important to debate the issue. Coventry plays in the second tier of women’s football, turning professional only last summer, becoming the fourth fully professional team in the women’s championship. Many of the Coventry women had left good careers to achieve their dream of playing professional football. Many of them had supported the team for many years. Yet, on 23 December, two days before Christmas, the women were told that training was cancelled, and the players, who had not been paid in four weeks, were invited to a Zoom meeting at 10 am, in which they were told that their contracts were being terminated. That is a dreadful way to inform someone of that news.
One of the Coventry players, Anna Wilcox, told Radio Plus Coventry:
“It was just a feeling of emptiness, thinking that now I’ve lost the club that I played for for a long, long time…It hit a lot of players and a lot of staff so hard. I really don’t think we will be the last, unless something changes.”
There are many issues that emerge here. The first is governance. Women’s football has a range of different governance structures. Some teams are connected to men’s teams, such as in my own city of Sunderland, with some of those being rich premier league teams such as Manchester City and Arsenal. Other teams are independent of any men’s teams and operate on their own, such as Coventry United. Then there are fan-owned teams such as Lewes, who are doing extraordinary things under the leadership of Maggie Murphy. The range of governance structures means that there is an array of different financial arrangements, but the situation that arose at Coventry is one that could happen to any team at the will of their owner, especially as it is reported that Coventry were given FA money earlier than was planned, to help them through what they knew to be a difficult period. It is unclear where that money went.
The difference in the nature of ownership means that it is incredibly unhelpful to compare the situation in the women’s game with that in the men’s game. Therefore, I agree with the recommendation in the fan-led review led by the hon. Member for Chatham and Aylesford (Tracey Crouch), who is present, that the women’s game needs its own review to look into the issues and challenges that the game faces.
The second issue I wish to highlight is the working conditions of women players. The average wage in the men’s championship is around £35,000 a week. The average wage of the Coventry women’s team when they went into liquidation in December was just £16,000 a year, which equates to £308 a week. Although there are a multitude of reasons why the pay is different—not least the 50-year ban on women playing the sport—it is obvious that women’s experience of playing football is totally different from that of men. Although I am not saying that the women’s game is at the same stage as the men’s game, it is clear that the women’s game does not receive the respect it deserves. In women’s football, contracts are often shorter and the pay is low. Therefore, it is extremely hard for players and staff alike to plan for their future.
One of the most prominent examples of the working conditions of women footballers and their experience of playing is that of Birmingham City Women. When they were in ninth place in the top tier of the football pyramid in 2021, they came together to send a formal letter to their own club to bring to light their working conditions, because their previous request to meet the board about the issue was denied. This team are connected to a men’s team, but at the point of sending the letter, only three players were understood to be under contract for the following season. In reaction to the reports, the spokesperson for the club said:
“Both men and women’s first teams are yet to secure survival in their respective leagues. This makes it hard to start contract negotiations.”
I am afraid that I disagree with the spokesperson. Not being under contract also makes it hard for women to plan their futures.
The issue of maternity rights for players impacts on their lives hugely. In research conducted by Dr Alex Culvin last year, players were quoted as saying they
“need longer contracts so we feel more secure. I shouldn’t have to think I need to sign a four-year contract because I want to have a baby, so I know they’ll pay me.”
However, I understand that a new player contract has been agreed between the FA and the Professional Footballers Association that includes maternity cover and long-term sickness cover. I understand that this is a standardised contract that would cover players playing in both the women’s super league and the championship. If that is accurate and is to be implemented, it will be a massive step forward for the status of women footballers and, more importantly, for the terms and conditions and employment rights that they experience. I pay tribute to all those who have worked so hard in the game to get to this point.
That does not mean that we stop here, though. Although it is great news, there is still work to do. At the moment, only women who have played in the top tier of women’s football—the women’s super league—are eligible for PFA support. This needs to change, and the PFA needs to widen its remit to support all professional women players. Although the PFA runs workshops for male players on post-career options and life worries, it should offer the same services to women players. That issue is one of a package of issues in the women’s game that need to be looked at.
The investment put into the game by organisations such as Barclays has done so much to further the opportunities that are available, but we undoubtedly need a new formula that provides ample funding for the women’s game at the grassroots level and beyond, because the existing funding can only go so far. That is why it is so important that the Government listen to the fan-led review and bring forward an equivalent review into the women’s game.
I know that the Minister has said that we should expect a reply to the fan-led review in the spring, but a whole season—spring—is not a deadline and the women’s game is in need of review now.
While I talk about women’s football, it would be remiss of me not to pay tribute to the incredible work done by Khalida Popal in bringing the Afghan girls team over to the United Kingdom. This debate is focused on the experience of women playing football in England and I am extremely proud that these Afghan girls are now able to come and experience exactly that. There are tremendous opportunities in this country for young girls to advance in the sport and I am so happy that these Afghan girls were able to come here and continue to play the game they love, in safety and with support. Khalida’s work has been inspirational and I am sure that all Members here today will join me in thanking her.
In conclusion, I return to the fan-led review. The Government have said, in an answer to a written parliamentary question that I submitted earlier this year, that they
“welcome the Independent Fan Led Review of Football Governance and…endorsed in principle the primary recommendation of the review, that football requires a strong, independent regulator to secure the future of our national game.”
Can the Minister endorse in principle recommendation 45 of the report, which is that a wholesale review of women’s football should be conducted? Also, can he provide a more specific timeframe for when the Government will publish their full response to the fan-led review?
I look forward to hearing what other Members have to say in this debate and to hearing the Minister’s answers to the questions put by myself and others.
Derek Twigg (in the Chair)
This debate will finish no later than 5.55 pm. If hon. and right hon. Members can all keep their speeches to around five minutes, everyone should get in before we call the Front Benchers.
Tracey Crouch (Chatham and Aylesford) (Con)
It is a pleasure to serve under your chairmanship, Mr Twigg.
I begin by congratulating the hon. Member for Sunderland Central (Julie Elliott) on securing this important debate on women’s football. I hope that she will not consider this patronising, but I have to say that I thought her speech was one of the best speeches that I have heard in this Chamber. It was truly excellent. She is right to say that there has been enormous progress in women’s football but there is so much more to be done and I am sure that many of those who wish to speak today will do so on a very similar theme. I am also sure that the Minister will heed the points that are made, because I know that he is as passionate about women’s sport as I am and as many of us in this Chamber are.
Before I get into the nitty-gritty of my speech, I will just note that there are now many more colleagues across the House who are interested in women’s sport and women’s football than before. When I was first elected in 2010, I often felt like quite a lone voice in talking about women’s football. The hon. Member for Wirral South (Alison McGovern) and I are on the parliamentary football team, as is the hon. Member for Batley and Spen (Kim Leadbeater). Just by participating ourselves, we get to talk and think about women’s football much more than ever before. It feels like there has been a shift in attitude, not just outside this House but inside it, too.
Jim Shannon (Strangford) (DUP)
The hon. Member for Sunderland Central (Julie Elliott) referred in her contribution to people who inspire others. May I commend the hon. Member for Chatham and Aylesford (Tracey Crouch) on that very basis? Back in 2014, I had occasion to invite her to come and speak at my association dinner and I also then asked her if she would like to come round and visit some of the football teams in my area, and of course she said she would. On that occasion, she visited Comber women’s football club. As I say, that was back in 2014. Today, seven years after her visit, they still remember it. So I commend her. She is looking for role models. I tell you what: she is herself a role model.
Tracey Crouch
I do not often blush, but the hon. Gentleman is making me do so. It is very kind of him to say that. It is legendary that I ended up in his constituency because I did not understand what he was asking me. I just said, “Yes,” and then the email came through saying, “Thank you for accepting the invitation to come to my constituency.”
I do not want to hog the Chamber, Mr Twigg, as I have had enough airtime on football recently, but there are a few points I want to make that will build on what the hon. Member for Sunderland Central said. First, we should celebrate the remarkable growth in women and girls participating in football at grassroots level. In the five years since the FA published “Gameplan for Growth,” participation has doubled. That is fantastic and we should congratulate those involved, but we must ensure that no one is resting on any laurels. To be fair, the hon. Member for Wirral South and I met the FA last week and I do not believe they are.
There are still too many vulnerabilities in the system for anyone to take their foot off the gas. For example, there are real difficulties getting girls to transition from playing football in PE to playing it for a club outside school. That is a challenge that has existed for a long time. It requires joined-up thinking with the Department for Education and partners. It is not insurmountable but it is difficult and there is no easy answer, otherwise it would have been done by now.
Secondly, we should celebrate the incredible journey and success of the professional game. Its earliest origins date back to the 1890s. It saw record-breaking crowds during the first world war and was banned from the 1920s until 1971, before coming under the auspices of the FA in the early 1990s. With the emergence of the women’s super league in 2011 and the subsequent establishment of the women’s championship, we can now boast the leading league in women’s football, attracting players from across the world. However, the points the hon. Member for Sunderland Central made about contracts at Coventry—and I will throw Charlton into the mix as well—are valid. I hope they have been noted by Ministers and others outside this place, because we need to take the welfare and working conditions of professional female footballers very seriously.
Furthermore, during the fan-led review we heard evidence that women’s football continues to face many interconnected challenges. There were lengthy debates about the difficult questions of whether women’s football teams should be affiliated to men’s teams or be entirely independent. There were concerns about the long-standing disparity in the financing of women’s teams versus men’s teams.
There were also concerns about the overall infrastructure of the professional game and whether the gap between the top and the next level down is too big. That led us to recommend an independent review into the women’s game. While I respect that the Minister and his officials are still going through other recommendations in the report, I repeat the call that the hon. Member for Sunderland Central made: can the Minister can tell the House today whether he accepts the recommendation about a completely separate review into the women’s game?
Turning to broadcasting, we can celebrate greater visibility of the women’s game than ever before, as the hon. Member for Sunderland Central said. We have seen a 257% increase in domestic games broadcasts since 2016. Broadcasters have come a long way since the current Mayor of Manchester, then the Member for Leigh, and I ganged up on the BBC and persuaded it to show England in the 2011 women’s World cup quarter- final on BBC2. I am sure that at the time the BBC just thought, “We’ll show it to shush these pesky MPs,” but it was pleasantly surprised that it was well watched and well received. The director of sport at the BBC, Barbara Slater, deserves a lot of credit for persisting with an agenda to ensure that women’s sport is shown on domestic TV.
People should also thank Sky Sports for its continued commitment to women’s football. The current deal is definitely a landmark and an exceptionally welcome addition to its wider sports agenda. However, it would be game changing if the women’s football World cup and the women’s Euros were added to the A list of listed events. That would provide parity and equality with the men’s games. These events are themselves pre-eminent international events that command a large TV audience. Given that we are expecting FIFA to tender the rights to the 2023 World cup shortly, if these events are not listed there is a likelihood that at some point in the future they could end up behind a paywall, which would be a shame for all the budding girl footballers out there, who want to see their heroines in action. If the Minister could give an update on where the Government are at with the consultation on listed events, that would be extremely helpful.
There is more I could say, but I will not. However, I will briefly mention that the all-party parliamentary group on women’s football is still waiting for a response from the Minister to a letter sent before Christmas regarding the disparity in legislation that protects players from pitch invaders. I could also build on points made by the hon. Lady on the prevalence of misogyny towards women who play sport, but time is short, so I will end by thanking all those who are helping to grow the game and supporting women’s and girl’s football through broadcasting and sponsorship, and of course by wishing the Lionesses every success in their forthcoming Euros campaign.
Kim Leadbeater (Batley and Spen) (Lab)
I congratulate my hon. Friend the Member for Sunderland Central (Julie Elliott) on securing this important debate on the experiences of women in football. It is a real honour to follow the hon. Member for Chatham and Aylesford (Tracey Crouch). I start by declaring an interest as a proud new member of the cross-party parliamentary women’s football team.
Many of us in the team are not experienced footballers and, as someone who has played hockey for 30 years, I still spend most of my time trying to put my feet in the way rather than getting them out the way. The team brings together female MPs, peers, staff and journalists from across the parliamentary family and political spectrum. We are an excellent example of the power of sport, and specifically football, in bringing people together and bridging any differences we may have.
I have a background as a lecturer in sport and physical activity and as a group exercise instructor. Alongside my own adventures on the hockey pitch, I have worked with many female clients and students over the past 20 years to create and facilitate positive experiences of sport and physical activity for women, to enhance physical and mental health and wellbeing, to provide positive social interactions and to develop friendships and support networks for busy women who far too often put themselves at the bottom of their list of priorities and responsibilities.
However, I know that this positive experience is sadly not shared by many women across the country, who face a number of barriers to getting into sport, a lack of support once there or, worse still, totally unacceptable discrimination, sexism and abuse. I am keen to use my role in Parliament to be an advocate for all women who face such challenges, which is why I was keen to take part in the debate. I recently with Sport England to discuss women in sport, and just this week I spoke to Sam Keighley, strategic director of the Yorkshire Sport Foundation, who gave me a comprehensive overview of the issues faced by women when playing, spectating, refereeing and coaching football. Sadly, there are too many to mention, but I will share some of the highlights, or should I say lowlights, with hon. Members.
On playing, there is a lack of access to facilities for women’s teams. Poor pitches are often used for boys’ or men’s games prior to the female game taking place and they are left in a terrible state. Female footballers feel that sometimes they are treated as second-class citizens. Female football is always second to male football in funding, access to training, pitches and media coverage. Girls’ and women’s teams often get given second-hand equipment after the boys’ have finished with it.
There are fewer opportunities, with fewer teams, and there are fewer opportunities to progress. Often teams have to travel further distances, which is difficult for those girls without parental support or access to transport. There is still far too much, “Girls don’t play football,” with people not talking to girls about what they actually want to do. There is little use of female role models in football, and any prizes or match tickets given out tend to relate to the men’s teams, with no effort to link to the local women’s teams.
With regards to coaching, coaching courses are male dominated, and there are still only a handful of female coaches and managers. Sadly, research shows that few junior boys’ teams would welcome a female coach. There is abuse of coaches from parents and spectators during competitive matches, and there is a lack of opportunities for female coaches to develop. In terms of female referees, they sadly experience significant abuse. They experience sexist attitudes at clubs, such as, “Why have we got you refereeing?”, “Are you even qualified?”, and, “What do you know about football?”—some of the cleaner versions of comments made. The situation is improving, but it is a real issue and will continue to put females off officiating.
In terms of spectating, female spectators feel uncomfortable and are on constant edge when watching games with a female referee, waiting for the abuse to start once someone disagrees with a decision. Opinions and comments of female fans are often dismissed, to then be repeated by someone—a man—a minute later. This has happened to me on numerous occasions. There are even reports of a female physio in the professional game getting wolf-whistled every time she comes on to the pitch.
To conclude, I am sure we can all agree that football, and sport generally, play a crucial part in bringing people together, keeping us fit and healthy, both physically and mentally, and providing fun and entertainment for millions and sports clubs that are often at the heart of our communities. As has been said, women’s football is growing at an incredible speed, with the women’s World cup, the women’s super league and the women’s FA cup, and that should be celebrated. While there has been progress over the last 30 years, it is too slow. Before we can secure football as a sport that girls can play and get involved with as easily and comfortably as boys can, and before the women’s game is treated with the same level of respect, funding and resources as the men’s game, there is work to be done. We must get the grassroots and lower league stages firmly established. We must have a fully informed strategy to stamp out the abuse and sexism that are all too common.
I could talk about the broader issues around the importance of physical education in the curriculum and about many other subjects associated with women and girls in sport and physical activity, but I will conclude by saying what a pleasure it has been to take part in today’s debate with some well-respected colleagues.
Taiwo Owatemi (Coventry North West) (Lab)
Once again, it is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Sunderland Central (Julie Elliott) for her excellent and detailed speech and for securing this important debate. I also thank all those who continue to make women’s and girls’ football the fastest growing sport in the United Kingdom. Over the past decade, we have seen more and more clubs take on a women’s squad on a full-time basis, and grassroots football has made huge progress in ensuring that more women’s teams are able to thrive.
I grew up playing football, and as a teenager I absolutely loved the game. Many of my fellow female MPs are keen followers of the game, as we have heard today, and I am sure they will agree that it offers so much more than purely health-related benefits. Football taught me about communication, teamwork and competition. Had I not been given the opportunity to train at an academy, I doubt I would have had equal access to football and its many benefits. I am so grateful to have this opportunity to speak today on behalf of all the women and girls who simply do not have the same access to our national game as their male counterparts.
Progress in increasing participation has been made largely by the unsung heroes of the sport: the volunteer coaches, referees, administrators and community groups, without whose efforts women would not even have access to the game. Too many girls who love playing football constantly find themselves facing unnecessary barriers. For example, girls often cannot access teams because there are so few teams playing in organised leagues that it is not possible to get a proper fixture list together. That is why it is really important that we are here today looking at how we can best support new and existing women’s clubs so that women can have equal access to playing football, and that goes for all programmes, both amateur and professional.
As my hon. Friend the Member for Sunderland Central outlined, the professional women’s team in my own city of Coventry, Coventry United Ladies FC, was recently narrowly saved from liquidation. The club experienced significant financial pressures as a result of the pandemic, meaning it was forced to enter voluntary liquidation days before Christmas. Players and staff faced losing their job at the worst possible time. The club would have gone bankrupt, were it not for the 280 private donations from community members and an eleventh-hour takeover by a local midlands-based energy company that helped provide the necessary funds to keep the club afloat.
Even though the team has now survived this ordeal, the episode serves to highlight the systemic challenges still facing women’s football. The players were left in a precarious position after they were told that their contracts had been terminated. In a sport where women already have to contend with short contracts and low pay, these players also had to deal with the near collapse of their team with no safety net.
The barriers that women in professional football face are not only financial but cultural. We heard from my hon. Friend the Member for Sunderland Central about Durham University’s recently published report examining UK men’s football fans’ attitudes to women’s football. This study was, sadly but unsurprisingly, the first of its kind. Ridiculously, 68% of those polled thought women should not participate in sport at all, or if they did, that they would be better suited to more feminine pursuits than football. This attitude is appalling and is reflected in how unequally women’s football clubs are treated in this country.
The change in tone and in the perception of women’s football needs to be set from the top. If the Government truly want to create equality between men and women in football, they must do more to support women’s football clubs. As a proud sponsor of Coundon Court Ladies FC in my constituency, a former amateur player and a lover of the game, I urge the Government, mayors and local governments to do everything they can to support women’s football.
Chris Evans (Islwyn) (Lab/Co-op)
It is a pleasure to serve under your chairmanship again, Mr Twigg. I congratulate my hon. Friend the Member for Sunderland Central (Julie Elliott) on securing this important debate. I refer the House to my entry in the Register of Members’ Financial Interests. I am the author of “Don Revie: The Biography”, about the Leeds manager. I mention that because I want to mention him today. Don Revie was a victim of cancel culture. He resigned from a job he did not like, and the FA banned him for 10 years. I have asked the FA to apologise, but it has not. What is extremely important, and why it is so pertinent to mention him in the debate, is that women were the victims of cancel culture 100 years ago.
During world war one, women’s football was incredibly popular. Like in the men’s game, many teams grew from the factory workforce, with factories setting up their own teams. Games attracted thousands of spectators, with one Boxing day match watched by more than 53,000 people. Celebrity players came to exist, such as Lily Parr. Women’s football was thriving, with female players given offers to play all around the world. On 5 December 1921, that ended. The Football Association passed a resolution banning women from playing in its stadiums. Bolstered by sexist and selective medical opinions on the unsuitability of women for the sport, the FA delivered a death blow to women’s football. In all likelihood, the reasoning behind the ban was due not to the health concerns of female players but more to the popularity of women’s football, which was drawing spectators away from the men’s game.
Although that was not an outright ban on women playing football, it took away the big stadiums and the media attention. Women could no longer play in front of big crowds, and without media coverage and the ticket sales from larger stadiums, most clubs were forced to disband. It was not until 1971 that the FA lifted the ban on women’s football, and it was not until 1993 that the FA brought all women’s football under its direct control. Let me put that in context. When England won the World cup in 1966 and, it is said, modern football began, with football fever sweeping the country, women were still banned from playing football by the Football Association.
The season before women’s football was banned in 1921, there were only two professional men’s leagues in England. Since then, men’s football has grown to the point where it attracts the eye-watering salaries for the top footballers and can support four professional divisions. Women’s football was not given the same opportunity. The women’s game was cut off at the knees by the FA in 1921, just as it had become popular and mainstream.
I believe it is the duty of the Football Association to correct that. Given that a deliberate intervention by the Football Association caused the demise of women’s football in 1921, the FA ought to deliberately intervene to build up that sport and make up for the last 100 years. The hon. Member for Chatham and Aylesford (Tracey Crouch) will smile when I say this, but I have to mention Don Revie again. When I have written to the FA in the past to ask for apologies on behalf of the Revie family, it has dismissed that out of hand. That is an absolute disgrace. And I have no doubt that the FA will do the same if we try to do the same for women’s football.
Without the FA’s intervention by banning women’s football, who knows where it would be now? The FA has a debt to repay. Investing in women’s football clubs and academies, increasing media coverage of matches and encouraging spectators is not “positive discrimination”; it is something that is needed in the game now. It is necessary and should be brought about.
John Williams from the University of Leicester has said:
“The increase in media coverage of women’s sport…was openly supported by some men. But it also clearly represents, for others, a visible threat”.
That perception that the popularity of women’s football could be a threat to the men’s game is not new. It was the reason why women’s football was originally banned, 100 years ago. There are those who criticise women’s football as being less in some way—less skilful, less popular or less commercially viable. However, that is not intrinsic to the sport. In fact, women’s football in the UK was once more popular than the men’s. It was the actions of the FA that changed that.
Unfortunately, we have long heard male football fans—I congratulate my hon. Friend the Member for Batley and Spen (Kim Leadbeater) on bringing this issue up—criticising and belittling the women’s game. In fact, an academic study by Durham University reported that openly misogynistic views of women in sport were far too common among male football fans, irrespective of age. Lead author Dr Stacey Pope said of the study:
“Our research showed that attitudes towards women in sport are, to some extent, changing, with more progressive attitudes. However, the findings are also reflective of a patriarchal society in which misogyny is rife. There were numerous examples of men from across all generations exhibiting highly sexist and misogynistic attitudes.”
Participants described media coverage of women’s sports as “positive discrimination” or “PC nonsense”. That needs to change.
The number of women and girls playing football in England hit 3.4 million in 2020. The desire to play and the desire of fans to see more women’s football are evident. We saw that in the 2015 World cup: the Lionesses’ games were extremely popular. When women’s football is given the coverage that it deserves, people will watch. We simply need to give them the choice by showing more games on mainstream channels. That will only bring more young girls into the sport and strengthen the game’s future—something that we would all welcome.
Derek Twigg (in the Chair)
I will start calling the Front Benchers at 5.38 pm.
Alison McGovern (Wirral South) (Lab)
I will be brief, Mr Twigg. I pay tribute to my hon. Friend the Member for Sunderland Central (Julie Elliott) for obtaining this debate. She is an incredible champion for women’s sport in general and football in particular; and, Mr Twigg, nobody could be more perfect to chair the debate than your good self, a supporter of women’s sport, including women’s football, and the finest football team on the planet—that is the women and the men, I should say.
This issue obviously has a long history. I was going to begin by saying that often we talk up women’s football and the position that it has got to because growth has been significant in recent years, but that often people do not talk about the cause of the demise of women’s football previously. However, my hon. Friend the Member for Islwyn (Chris Evans) has just done me a favour there. There is a tendency not to talk about the fact that women’s playing football professionally in this country was banned for 50 years. Many of the problems that we are trying to tackle today, and which have been covered already in this debate, stem from that ban. We have to accept the truth of that. It is not good enough to cheerlead for women from the sidelines; we have to accept the consequences of the ban, which affect every single part of the women’s game today, whether it is the professional game or the grassroots game.
In relation to the professional game, people who love women’s football and want to see it succeed are often told, “We can’t pay the players more, because of market forces being what they are. People want to watch the men’s game on the telly, and unless more people watch the women’s game, the pay for women is going to be lower.” Well, we have just heard that actually there is a root cause as to why more people watch the men’s game than the women’s game. That is why we need extra effort, to restore the women’s game to the place where it should be.
The situation is the same for the grassroots game. I do not just play for the women’s parliamentary football team; I occasionally manage to make it to Wirral Valkyries FC, in the Wirral, and you would not believe, Mr Twigg, how hard it is to get a pitch for a women’s grassroots team. That is because we really have only enough pitches for half the people who want to play football in this country. We are going to double the number of people playing football at grassroots level, so we need some more space for them to play in. That inequality causes tension the whole time. Map the level of abuse that we all receive from a patriarchal society—as rightly said by my hon. Friend the Member for Islwyn; I would not get away with such naked feminism!—and we can see we have a problem.
Rather than going over all that, I would simply ask colleagues one question. There are two professional football players in this country who play for the same team and who are brother and sister. Lauren James, who is 20 and has incredible talent, will probably never be a millionaire; her brother, Reece James, who is 22 and plays for Chelsea—the same team—almost certainly will. That is a level of wage inequality that we would consider absolutely unjust and intolerable in any other sphere of British life. How long are we, in this room, going to look the other way while women in this country face that kind of unjust pay gap? Women who play football professionally do so with a determination that is almost irrational, given the lack of fortune that might reward their talent. It is as simple and as stark as that.
Very briefly, I pay tribute to the fantastic Sue Campbell at the Football Association, who is an incredible woman, as well as Kelly Simmons, the director of the women’s professional game. They do not get enough credit and we should all thank them. I also thank Suzy Wrack at The Guardian, who has covered women’s football absolutely brilliantly, and younger journalists such as Katie Wyatt and Caoimhe O’Neill, who write for The Athletic and are just brilliant. They are changing the fortunes of women’s football.
I will finish with three very direct questions to the Minister—I could talk about this subject for about seven hours uninterrupted, but I will not. First, the Government could do a really helpful job that would not cost them any money, which is to benchmark the interventions that they are already making. Could they check that all the money they already spend on the grassroots game of football is being spent equally on men and women? That would make a big difference.
Secondly, could they ask the FA to look at the FA cup prize money? Nearly 2 million quid for the men’s FA cup prize money does not really make a difference to the winners, but the women only get about £25,000 in prize money. There is absolutely no objective justification for that incredible disparity in prize money. It is our flagship competition. Could the Government ask the FA to look at that?
We have heard my final question from everybody; the hon. Member for Chatham and Aylesford (Tracey Crouch), who has done an absolutely brilliant job for football in this country, recommended it in her review. We need a women’s review—please may we have one? Let us crack on and deal with these issues.
Jeff Smith (Manchester, Withington) (Lab)
It is a pleasure to serve under your chairmanship for the second day in a row, Mr Twigg. It is good to see you here. It is a pleasure to respond for the Opposition in this debate. I congratulate my hon. Friend the Member for Sunderland Central (Julie Elliott) on securing it and on her excellent opening speech, as well as all hon. Members who have spoken.
It was especially good to hear my hon. Friend the Member for Batley and Spen (Kim Leadbeater) speak about the power of sport to bring people together and her experience as a new member of the parliamentary football team, noting the issues around girls’ participation. It was eye-opening to hear about the experience of women fans and the anticipation of abuse or sexism relating to female officials, which is an angle that I had not really thought of before. It was very interesting.
I also pay tribute to my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who spoke about how women’s football taught her about communication and teamwork, which has stood her in good stead for her role in the Opposition Whips Office. I join her in thanking the unsung heroes who keep women’s football going—the volunteers. Importantly, she outlined the ordeal of Coventry United, which I will return to briefly.
As always in any debate on sport, my hon. Friend the Member for Islwyn (Chris Evans) gave us a lesson. The history of women’s football is a fascinating background to the issues in women’s football today.
I pay tribute to my hon. Friend the Member for Wirral South (Alison McGovern), my predecessor, for everything she did when she held this role before me. I agree with almost everything she said, although I am not sure about her team being the finest team on the planet—they are trailing in second place in the premier league at the moment. I agree with just about everything she said, including on the extra effort that we need to put in to support women’s football in this country.
In many ways, these are good times for women’s football in England. The successes of the Lionesses in recent years—notably, taking third place in the 2015 World cup and then again making the semi-finals in 2019—have helped to boost the game’s profile, and growth in interest, spectators and participation have followed. The Women’s Super League has attracted record crowds, and we had 40,000 people watching the FA cup final at Wembley in December. Driven by the FA’s efforts, the participation of women and girls in grassroots football doubled between 2017 and 2020.
The hon. Member for Chatham and Aylesford (Tracey Crouch) referred to the increasing interest in Parliament on this issue. I would put that down partly to the general increase in interest in women’s football, but also to her work as an absolutely fantastic champion not just of women’s football, but of football in this country. I thank her for her work on the review and for her wider work on football.
As the country looks forward to hosting the Women’s Euros this summer, enthusiasm for the women’s game will grow, attracting more fans and inspiring budding footballers. I would agree that coverage on the BBC and on Sky has raised the profile of the game, with more and more people watching women’s football on TV, driving participation. I would echo the question from my hon. Friend the Member for Sunderland Central to the Minister about listed events, and I hope that he will respond.
In general, the future looks bright for women’s football, but as we have heard today, there are challenges. To build a future that is fair and works for players, staff and fans at all levels, some issues need to be addressed. That is a job for the FA and for leaders in football, but also for the Government.
Today’s debate was partly brought about as a response to the recent situation at Coventry United women’s team. The team narrowly avoided disaster thanks to a last-minute buyer, and I am pleased that Coventry’s players are going to be able to continue to earn a living playing the sport they love, but it should not have come to that. This was a full-time, fully professional championship club, but to the shock—complete shock—of the players and staff, they found themselves hours away from ceasing to exist.
Coventry is not the only example of the precarious nature of the existence of some women’s clubs. Just as the Women’s Super League was due to start in 2017, Notts County folded. In 2019, Yeovil Town dropped two divisions from the WSL as a result of financial problems. Leyton Orient cast aside its women’s teams last year, forcing the creation of London Seaward to ensure that the players could continue to play. Fylde women’s team was disbanded in 2020, only for the decision to be reversed some time later, and Holwell Sports Women FC in the fourth tier of the football pyramid announced that it would have to fold just at the beginning of this month. So there are challenges, and it is not just problematic governance and job insecurity that need to be fixed. There is great growth in participation, as we have heard, but there needs to be more work on encouraging people to participate and on breaking down the barriers.
In the professional game, when things go wrong women’s players are only eligible for support from the Professional Footballers Association if they have played in the top league of women’s football, leaving most women players with nowhere to turn. As we have heard, levels of pay across women’s football are generally low, with players often needing to work on other jobs alongside football to make ends meet. Many players, as we have heard, have poor access not just to pitches, but to the medical and fitness facilities needed to play safely. Employment contracts are often poor, short term and ill-suited to the specific needs of women. Generally there has been poor maternity support for women who wish to have children, although we have had encouraging news from my hon. Friend the Member for Sunderland Central about the potential change to that—so, fingers crossed.
Our women footballers deserve better. There is, of course, the issue of the abuse and harassment faced by women in the sport. Women in Football reports that almost a third of their members have experienced gender-based social media abuse, and that is one aspect of what many players have to endure. So there is progress, but more needs to be done.
We have had the excellent fan-led review of football governance, led by the hon. Member for Chatham and Aylesford, which the Government are still dragging their heels on responding to in full or implementing. That review called for a separate dedicated review of the women’s game, and that is really the key ask I have of the Minister today. We have had a number of asks, but I think the encompassing action for the Minister—I note that you want me to finish, Mr Twigg, so I will be brief—would be on that key ask. Given the complexities of women’s sport and the crises that have cropped up, a full review of the future of women’s football is urgently needed. The Government have said they would respond in full to the review in spring, but why the delay? Will the Minister clarify whether there is any truth in the rumour that the Treasury are the block on progress? The issues raised in the debate mean that a separate women’s review is needed, so why not get on with it? The Government have accepted in principle the fan-led review’s recommendation for an independent regulator. I repeat the request of other Members that the Minister should now endorse its call for a review of women’s football. That is what we need. Let us get on with it.
Derek Twigg (in the Chair)
I call the Minister, but I remind him that the hon. Member for Sunderland Central (Julie Elliott) will want a couple of minutes at the end to wind up.
The Parliamentary Under-Secretary of State for Digital, Culture, Media and Sport (Nigel Huddleston)
It is a pleasure to serve under your chairmanship, Mr Twigg, for the second time this week. I thank the hon. Member for Sunderland Central (Julie Elliott) for securing this debate, and everyone who has participated so eloquently and knowledgably. I wish a happy birthday to my opposite number, the hon. Member for Manchester, Withington (Jeff Smith).
The debate is particularly timely, given that we are counting down to 6 July, when England will kick off their first match in the women’s Euros against Austria at Old Trafford. As many hon. Members mentioned, women’s football has made significant progress recently. I was fortunate to be at Wembley last December for the Vitality women’s FA cup final between Chelsea and Arsenal. It was a brilliant match, and it marked the 50th anniversary of the first women’s FA cup final—interestingly, it was only the 50th, for the reasons the hon. Member for Sunderland Central outlined. It achieved, my notes say, a record crowd of 40,000 people, but that is corrected by the hon. Member for Islwyn (Chris Evans), who mentioned there being a 53,000-person crowd in the past, so we still have a way to go. In addition, a record audience of 28.1 million viewers watched the BBC coverage of the 2019 FIFA women’s world cup on television and online. I praise the work done by the BBC and many of the public service broadcasters in their broadcasting.
We have seen other kinds of progress. There have been bespoke women’s sports deals, such as the Barclays’ sponsorship of the FA women’s super league, which the hon. Member for Sunderland Central mentioned. We need that sponsorship; it is really important that this money flows into the game. England’s men and women senior players are now being the paid the same match fee for representing their country, but there is still huge progress to be made in equality of players’ pay, as many hon. Members pointed out. I praise teams such as Lewes for the progress and leadership they have shown.
Despite the positive signs and progress, we cannot be complacent. Since becoming the Minister for sport, I have made it a personal priority to champion women’s sport, including women’s football, at every opportunity. That is why last year I established a working group to explore the challenges and opportunities in women’s sport. The group included Women in Football and the FA, and it discusses challenges, opportunities and how best to overcome obstacles. The work of that group has already shaped thinking in the Department considerably.
I think I can make a few people happy today by announcing that I have written to sports’ governing bodies and broadcasters outlining that the Secretary of State and I are minded to add the women’s World cup and the women’s Euros to the listed events regime. We will have a short re-consultation, which will end on 16 February. This is a huge opportunity for women’s football; it can bring those tournaments to an even larger audience. We are working on several other areas, including the refresh of sport.
Many hon. Members mentioned misogyny and the hatred spread online. I am looking closely at how the online harms Bill might tackle the persistent and utterly unacceptable misogyny that continues to blight women’s sport.
As many hon. Members have mentioned, there has been considerable growth of the sport at grassroots level. The FA published its “Gameplan for Growth” and highlighted that women’s and girls’ participation has doubled over the last few years. There are 12,000 registered teams, and there are 2.4 million women and 1 million girls under the age of 16 playing football.
Many hon. Members mentioned the importance of access to facilities, and I completely agree with them on that. That is precisely why we are investing hundreds of millions of pounds in pitches and multi-sport pitches, and why I am working with the Department for Education on how we can make further progress on schools’ access to sports.
Despite the momentum in recent years, women’s sport, including football, has been heavily impacted by the pandemic; there is the slow return of spectators, a lack of media coverage in some cases, and a loss of sponsorship deals—deals that women’s sport has historically found it difficult to attract. As several hon. Members mentioned, we saw that most recently in the near liquidation of Coventry United ladies football club.
I turn to the fan-led review. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch)—like the hon. Member for Sunderland Central, and indeed everybody here—is a passionate advocate of women’s and girls’ football. The review, which published its final recommendations in November, not only considered the issues affecting the men’s game in this country, but examined the complex future of women’s football, which has a growing number of participants and fans. As my hon. Friend the Member for Chatham and Aylesford set out, fans and advocates of women’s and girls’ football gave evidence to the review, and starkly set out the fact that the women’s game is at a crucial point. Many who gave evidence spoke passionately about the need for women’s football to be properly financed; that should include a consideration of sponsorship and many other areas.
As many hon. Members have acknowledged, the review concluded:
“Women’s football should be treated with parity and given its own dedicated review.”
I am afraid that I cannot promise to give the Government’s response today, but I can tell hon. Members that we are working on it every day; many people are working on it. I will ensure that I give a full response in the spring. There is no dragging of feet here. I thank the many people who have done work on this, and particularly my hon. Friend the Member for Chatham and Aylesford. It is because that work was so comprehensive that we want to do it justice and give it a comprehensive response. My hon. Friend mentioned the letter that she and others wrote to me. I will reply to her letter regarding the designation of women’s football matches under the Football (Offences) (Designation of Football Matches) Order 2004.
It is worth pointing out that football banning orders are a Home Office policy, although we at the Department for Digital, Culture, Media and Sport do work very closely with the Home Office on that. I can confirm, however, that the football banning order legislation covers both women’s and men’s designated matches where there is a high risk of disorder. However, there may well need to be consideration of whether the scope of the order needs to be widened. I will happily raise that with my Home Office colleagues. Members mentioned several other requests.
Tracey Crouch
The Minister will be aware that the Home Office has tabled an amendment to the Police, Crime, Sentencing and Courts Bill, which is in the House of Lords, to extend the scope of football banning orders in order to tackle online racist abuse. Is this not an opportunity to ensure that football-related matters are covered?
Nigel Huddleston
I will happily raise that with the Home Office, though I cannot make promises about legislation on behalf of another Department.
I hope I leave hon. Members in no doubt that I am personally committed to continuing to help women’s sport, including football, to come out of the pandemic stronger than ever. I will continue to work with the sector, and with all stakeholders across the House, to make that happen.
Julie Elliott
I thank all colleagues for their contributions. There is general consensus on the broad issues that women’s football faces. I thank the shadow Minister, my hon. Friend the Member for Manchester, Withington (Jeff Smith), for his contribution and the Minister for his response. I am pleased about what he said about listed events. I am disappointed that he has not gone further on the fan-led review, and that he has not committed in principle to starting the women’s review, which was recommendation 45 of that review. We do not need to wait for the entire Government response to the incredibly thorough fan-led review before agreeing to that in principle. I ask him to look at that again, and to see whether the Government can respond sooner. They need only say, “Yes, in principle we agree.” That does not merit our waiting for the response to the whole review. I thank everyone for attending; it has been a very worthwhile debate.
Written Statements
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Special Health Authority for Independent Maternity Investigations
(2 years, 10 months ago)
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The Secretary of State for Health and Social Care (Sajid Javid)
I wish to inform the House of the Government’s plans to establish a special health authority under secondary legislation to continue the maternity investigation programme, which is currently a function of the Healthcare Safety Investigation Branch.
Plans to establish the Health Services Safety Investigations Body as a non-departmental public body are contained in the Health and Care Bill 2021. The Health Services Safety Investigations Body will take forward the work of the current Healthcare Safety Investigation Branch’s national programme once fully operational—expected to be 1 April 2023. The scope of the Health Services Safety Investigations Body’s investigations in the Bill does not include the current Healthcare Safety Investigation Branch’s maternity investigations programme. This is because conducting investigations under “safe space” is a key element of the new Health Services Safety Investigations Body. The maternity investigation programme investigations do not follow “safe space” principles.
The Healthcare Safety Investigation Branch became responsible for conducting independent investigations relating to intrapartum stillbirth, early neonatal death, or severe brain injury diagnosed in the first seven days of life and also maternal deaths—approximately 1,000 every year—on 1 April 2018. In 2020-21, the maternity investigation programme completed 1,024 reports and made more than 1,500 safety recommendations to individual NHS trusts addressing a wide array of issues.
The Government consider that independent, standardised, family-centred investigations should continue beyond April 2023 once the new Health Services Safety Investigations Body is established. The new special health authority will:
provide independent, standardised, and family-focused investigations of maternity cases that provide families with answers to their questions about why their loved ones died or were seriously injured;
provide learning to the health system at local, regional and national level via reports for the purpose of improving clinical and safety practices in trusts to prevent similar incidents and deaths occurring;
analyse the incoming data from investigations to identify key trends and provide system-wide learning in these areas including identifying where improvements are being made or there is lack of improvement;
be a system expert in standards for maternity investigations and support trusts to improve local investigations; and
collaborate with system partners to escalate safety concerns and share intelligence.
The special health authority will be established for up to five years from 2022-23 to enable maximum learning to be achieved and to equip NHS trusts with the expertise, resources, and capacity to take on maternity safety incident investigations in the future.
Learning from these investigations is key for meeting the Government’s commitment to “make the NHS the best place in the world to give birth through personalised, high-quality support”; and our national maternity safety ambition to halve the 2010 rates of stillbirths, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025.
[HCWS560]
United Kingdom-European Union Parliamentary Partnership Assembly: UK Delegation Appointments
(2 years, 10 months ago)
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The Prime Minister (Boris Johnson)
Article 11 of the UK-EU trade and co-operation agreement states: “The European Parliament and the Parliament of the United Kingdom may establish a Parliamentary Partnership Assembly”—consisting of Members of both Parliaments —“as a forum to exchange views on the partnership.” In December, the House of Commons and House of Lords endorsed the establishment of the assembly. Both Houses agreed that the procedures currently applying to the nomination, support and funding of delegations to other treaty-based parliamentary assemblies will apply.
This statement sets out the United Kingdom delegation to the UK-EU Parliamentary Partnership Assembly. The Government also take this opportunity to congratulate Roberta Metsola on her election as the new President of the European Parliament.
The UK delegation is:
Full representatives
Stuart Anderson MP; Lord Bach; Simon Baynes MP; Hilary Benn MP (Vice Chair); Andrew Bowie MP; Baroness Crawley; Sir Jeffrey Donaldson MP; Lord Gilbert of Panteg; Lord Godson; Sir Robert Goodwill MP; Lord Hannan of Kingsclere; Baroness Hayter of Kentish Town; Sir Oliver Heald MP (Leader and Co-Chair); Sir Mark Hendrick MP; Rupa Huq MP; Darren Jones MP; The Earl of Kinnoull (Vice Chair); Lord Kirkhope of Harrogate; Andrea Leadsom MP; Lord Liddle; Sir Tony Lloyd MP; Baroness Ludford; Baroness Mobarik; David Morris MP; David Mundell MP; Baroness Nicholson of Winterbourne; Neil Parish MP; Lord Ricketts; Chris Skidmore MP; Karin Smyth MP; Lord Teverson; Kelly Tolhurst MP; Valerie Vaz MP; Phillipa Whitford MP and Mike Wood MP.
Substitutes
Baroness Bull; James Daly MP; Marsha De Cordova MP; Dame Angela Eagle MP; Baroness Foster of Oxton; Kate Griffiths MP; Luke Hall MP; Sally-Ann Hart MP; Robin Millar MP; Baroness Ritchie of Downpatrick; Alyn Smith MP and Baroness Suttie.
[HCWS560]
Help To Claim
(2 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Work and Pensions (David Rutley)
The Department for Work and Pensions has announced today, on gov.uk, the outcome of the future support offer grant competition. The link to the announcement can be found at:
https://www.gov.uk/government/news/funding-boost-to-citizens-advice-to-deliver-help-to-claim-universal-credit-support
Citizens Advice, in partnership with Citizens Advice Scotland, were successful and will deliver independent support from April 2022 following a further £21.3 million investment. The provision will continue to cover England, Scotland and Wales for 12 months, and ensures that free confidential and impartial support is available to help people make a new universal credit claim and manage their claim, up to receiving their first correct payment.
The future support offer name, used during the competition to indicate that DWP was looking for future provision, will revert to Help to Claim. The decision to retain the name reflects the fact that Help to Claim is a recognisable brand, both to people who will be using the support and to the staff who will be providing that support.
Since April 2019, Help to Claim has supported over half a million people, with nine in 10 people rating their overall experience as good or very good and would recommend it to friends and family.
From April 2022, the support will be provided through telephony and digital channels. For those individuals who are unable to access support via these channels, they will be able to go to their local jobcentre, where jobcentre staff will identify the right support to meet their needs. This support is already in place and available to those individuals who choose to seek support from the Department directly in making a claim to universal credit.
The Department is committed to providing the best possible support for all our claimants, including the most vulnerable in society, in both making and maintaining their claim.
[HCWS561]
House of Lords
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Arrangement of Business
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Lord Ashton of Hyde (Con)
My Lords, before we begin proceedings on the Bill, I thought it would be helpful if I outlined the arrangements for today. We will sit until 2 pm in Committee on the Bill. We will then break until 3 pm. At 3 pm, the House will return for Oral Questions. After Oral Questions, we will resume proceedings on the Bill. The House will break again at 6.45 pm for questions on a Statement on Ukraine. After the Statement, we will continue proceedings on the Health and Care Bill.
We have so far spent over 30 hours in Committee on this important Bill across five days. We have three days remaining to complete Committee. I am sure I speak for the whole House when I say that none of us wishes to debate important issues in the early hours of the morning, but without further progress on the Bill we might be left with no choice but to do this. We therefore need to ensure that the Bill receives proper scrutiny effectively, but succinctly.
I know, because I have had very helpful discussions with the Opposition Chief Whips and the Convenor, that the Front Benches will seek to ensure that all their contributions are brief and focused. I urge—indeed, beg—all noble Lords with an interest in this Bill to do the same, to be as concise as they feel able to be in their contributions, to speak briefly to the amendments before the Committee, and not to rehearse arguments that would be more suited to a Second Reading. In this way, we can ensure that all the amendments to this important Bill receive the attention they deserve.
Health and Care Bill
Wednesday 26th January 2022
(2 years, 10 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-VI(a) Amendments for Committee (Supplementary to the Sixth Marshalled List) - (26 Jan 2022)
Lord Sharkey
Lord Sharkey (LD)
My Lords, Amendment 106 is in my name and those of my noble friend Lady Walmsley and the noble Baroness, Lady Thornton. I am very grateful for their support.
Two months ago, two of our Select Committees, the DPRRC and the SLSC, published simultaneous and collaborative reports. The DPRRC report is entitled Democracy Denied? The urgent need to rebalance power between Parliament and the Executive, and the SLSC report is called Government by Diktat: A call to return power to Parliament. It would be very hard to exaggerate the importance of these reports, and I congratulate both committees on a very timely and disturbing reminder of the Government’s habit of trying to bypass Parliament and avoid effective scrutiny, as they do again in this Bill.
Both the reports focused on the long-standing abuse of the use of delegated powers legislation, and the DPRRC concluded:
“The abuse of delegated powers is in effect an abuse of Parliament and an abuse of democracy, and this report will, we hope, be a prompt to strengthen Parliament in the coming years.”
We can make a start on that hope with this Bill.
The DPRRC noted in its report of 15 December that the Bill contains 155 substantive provisions and 156 delegated powers. It concluded:
“The Health and Care Bill is a clear and disturbing illustration of how much disguised legislation a Bill can contain and offends against the democratic principles of parliamentary scrutiny.”
The report examines some of the Bill’s clauses in some detail, including the insertion via Clause 20 of a new Section 14Z48 into the National Health Service Act 2006. Essentially, the new section gives a Minister the power to make law by simply publishing “a document”. The department tries to justify the lack of any parliamentary procedure associated with the publication of a document on the grounds that the power is concerned with operational and administrative matters. However, the DPRRC goes on to say:
“Such a power is very unusual. If used in a context other than one involving public sector health bodies, it might give grave cause for concern and set an extraordinary precedent. Statutory liabilities should be imposed transparently, subject to clear legal conditions and parliamentary scrutiny.”
I should point out here the force of the word “unusual” in the committee’s comments. This is the highest form of disapprobation used by committees, and for good reason. This proposed new section is a blatant, transparent and disgraceful attempt to avoid any parliamentary scrutiny whatever.
The DPRRC’s conclusion is damning. It says:
“The power to impose a legal liability by merely publishing a document, without any parliamentary scrutiny, is a striking example of disguised legislation. We regard it as an inappropriate delegation of power, which should be removed from the Bill.”
In its report on the Bill of 7 January, the Constitution Committee agreed with the DPRRC’s recommendation to remove the new section from the Bill. I agree strongly, and that is what our amendment would do. I suggest to the Minister that if he wants to retain the powers set out in proposed new Section 14Z48, he rework them between now and Report so that they at least involve scrutiny by the affirmative procedure. If not, he can certainly expect us to return to this serious abuse of delegated powers on Report. I beg to move.
The Lord Speaker (Lord McFall of Alcluith)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I invite her to speak.
Baroness Brinton (LD) [V]
My Lords, we have just heard a very powerful contribution from my noble friend Lord Sharkey, reminding Ministers and your Lordships’ House of the importance of the problem of Ministers taking delegated powers, stopping Parliament doing its job properly. I support his amendments.
Amendments 133, 139 and 161 in this group, from the noble Baroness, Lady Greengross, are on continuing healthcare and I can think of no better person in your Lordships’ House to speak about the importance of that. I look forward to her speech. I am pleased to support her amendments and will speak to them now. The NHS definition says:
“Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.”
The full continuing healthcare assessment and the toolkit for updating assessments are absolutely vital for any multidisciplinary team and, at least in theory, these amendments put them on a formal footing as part of the smooth package of care that individuals need. The amendments establish a duty to fund and assess continuing healthcare, which needs to be visible, not least because of the abuses in the current system.
The principles of continuing healthcare in current legislation are fine, but unfortunately, as money has got tighter, there are problems with how they work in practice. There are many reports of CCG assessors and social workers having disruptive and degrading discussions, sometimes with family members present, about whether a particular issue is a continuing healthcare or a personal care need, which would be funded by the patient or their local authority, or the NHS. I personally witnessed a debate about the percentage split of continuing care versus personal care concerning the incontinence of a family member. It was not about the patient; it was solely about money and who would pay.
Baroness Greengross (CB)
My Lords, I will speak to Amendments 133, 139 and 161 in my name, and to Amendments 143 and 144 in the name of the noble Baroness, Lady Finlay, to which I have added my name.
Amendments 133, 139 and 161 are intended to clarify the role that continuing healthcare—CHC—will play, along with other commissioned services. The Continuing Healthcare Alliance has raised concerns about the provision of NHS continuing healthcare. The package of care is there to support people with ongoing and substantial needs in England. Examples of conditions for which someone may qualify for CHC include Parkinson’s, motor neurone disease and dementia, but there are many others as well.
Amendments 143 and 144 would strengthen the power of NHS England to give directions to integrated care boards. They would help to ensure national consistency of CHC services, which, sadly, is not always the case at present. When the Bill was debated in the other place, the Minister, Edward Argar, responded to a similar amendment as follows:
“It is right that clinical commissioning groups, as they are currently called, are held accountable for NHS continuing healthcare within their local health and social care economy. That will also be the case with the national move to integrated care boards, where the board will discharge those duties and be accountable for NHS continuing healthcare as part of its NHS commissioning responsibilities.”—[Official Report, Commons, Health and Care Bill Committee, 28/10/21; col. 825.]
Given this earlier response, I believe that it is the intention of the Government to improve the national delivery of continuing healthcare and to ensure more consistent delivery throughout England. The intention of this group of amendments is to clarify that in the Bill, so I commend Amendments 133, 139 and 161.
Baroness Finlay of Llandaff (CB)
My Lords, I added my name to Amendments 133, 139 and 161, which were so ably introduced by the noble Baroness, Lady Greengross, and others. I also have Amendments 143 and 144 in my name. All the amendments aim to tackle the accountability gap: the inconsistency of provision of continuing healthcare across different parts of England.
The noble Baroness, Lady Greengross, alluded to some diseases, but this goes much wider. There are people with spinal injuries and long-term multiple sclerosis and there are people who have had strokes. They all need ongoing long-term healthcare at a high level—way above the level that can be provided by social care.
The problem is that the accountability gap exists and there is inconsistency in the quality of provision, with eligibility criteria being interpreted differently in different areas. Amendments 143 and 144 aim to strengthen the powers of NHS England in the Bill to give direction to integrated care boards, with the particular aim of closing this accountability gap. Within the existing system, NHS England is responsible for holding clinical commissioning groups accountable for their discharge of continuing healthcare and functions.
In the reformed system proposed by the Bill, NHS England will hold these boards accountable in a similar way, but I question whether it has adequate authority both in the current system and the proposed system and whether the levers available to it to act meaningfully are adequate. While the intention prior to the Lansley reforms was to give NHS England powers to intervene to create meaningful change in practice, the powers were restricted to high-level interventions where there was a failure of governance at the highest level, rather than interventions where a CCG was failing to implement good practice or to adhere to national policy.
The 2018 report by the Public Accounts Committee in the other place supported these concerns and stated:
“NHS England is not adequately carrying out its responsibility to ensure CCGs are complying with the legal requirement to provide continuing healthcare to those that are eligible.”
There are limited accountability mechanisms and there is inadequate data collection at present. These amendments seek clarification and would drive long-overdue improvements in the quality and, importantly, the consistency of the way that continuing healthcare decisions are made and the process is administered, with the aim of improving outcomes and reducing the strain of applying for continuing healthcare for people who live with complex health needs and for their loved ones, in particular their family and carers.
Baroness Pitkeathley (Lab)
My Lords, I very much support the noble Baroness, Lady Greengross, in her amendments. We should be clear that continuing health needs are ignored by assessors because of the issue of who will pay. I have experienced this twice with neighbours and friends. It was clear to me that both patients had complex needs, mentioned by the noble Baroness, Lady Finlay, and had undeniable continuing care needs, so I was puzzled as to why the families were working out how to fund places for their relatives. They had never been told of the possibility of continuing NHS funding. I suggested that they quote the legislation back to the assessors and of course when they did so they found that funding would be provided—and some years later it is still being provided. Without this chance encounter with me, and asking the right questions, those families would have been denied the funding that is their right.
Baroness Barker (LD)
My Lords, as ever, it is a great pleasure to row in behind my former boss at Age Concern—the inspirational leader of Age Concern for so many years—to return to an issue that Age Concern and its successor body Age UK have for decades raised with successive Governments during successive NHS reorganisations.
It is important, at the outset of this debate, that we understand the true importance of NHS continuing care. On one level, an individual level, it is about enabling people who have long-term conditions to live dignified lives in the community. At a strategic level, in terms of healthcare planning, it is about keeping people out of acute hospitals, which is the most expensive form of care.
The reason why it is right, again, that we seek to put these amendments on to the face of the Bill is that, at an organisational level within the NHS, there has never been a full accountability path for NHS continuing care. That means that, when it comes to individual decision-making on the part of members of staff in relation to individual patients, the decisions fall down. We have not just wide variation between different organisations but wide variation between particular practitioners, who sometimes resort to using non-standard checklists to make decisions, with inconsistent decision-making.
As a result of that, it is hardly surprising, but a real condemnation of a long-term failure of the NHS, that there is a need for an organisation such as Beacon to exist. It is a social enterprise set up by the main charities that gives information to older people and their carers. It should not have to exist. The fact that it does, and that it is a profitable social enterprise business, is testimony to the extent to which older people and their relatives are being badly let down on this.
I hope that in raising this yet again we have shone a light on a part of the NHS system that goes to the heart of what this Bill is supposed to be about. If we do not make this an express responsibility of the NHS in the Bill, yet again it is just not going to happen.
Baroness Walmsley (LD)
My Lords, I, too, support the noble Baronesses, Lady Greengross and Lady Finlay. It is right that people should have the cost-effective continuing care to which they have a right. I have my name on the amendment tabled by the noble Lord, Lord Sharkey, and I intend to make some very brief comments about that, although I make the point that the need for us to be brief is the Government’s own fault, because they have not given us enough days in Committee—fewer in fact that in another place.
On the amendment, we refer to the 15th report of the Delegated Powers and Regulatory Reform Committee. I have rarely read such a hard-hitting report by this highly respected committee. One of the worst of the Henry VIII measures that it mentions is allowing zero scrutiny on allowing NHS England, merely by the publication of a document, to impose a financial liability on an ICB. It specifies the circumstances in which an ICB is legally liable to make payments to a provider under arrangements commissioned by another ICB. The Government claim that this is an operational matter. However, if you believe that an ICB should be in total control of deciding how its funds are spent in its area in order to fulfil its duties, you might think that this is an important thing—a legal liability to pay for something that another organisation has decided to commission is quite a serious matter. The DPRRC thinks so and so does the Constitution Committee.
In their response to the DPRRC, as quoted in Appendix 1 of the committee’s 16th report, the Government said that they
“recognise that the Bill contains a significant number of guidance making powers, powers to publish documents and powers of direction.”
They suggest that
“these are appropriate because they reflect the often complex operational details, which are better illustrated by examples and guidance rather than legislation.”
The Government go on to say that there is currently a precedent in the powers of the clinical commissioning groups.
Baroness Wheeler (Lab)
My Lords, I thank the noble Lord, Lord Sharkey, for opening this important group and moving Amendment 106, to which my noble friend Lady Thornton added her name. As he explained, the substance of this amendment was singled out by the Constitution Committee and highlighted by the Delegated Powers and Regulatory Reform Committee. I reinforce the Constitution Committee’s endorsement of the DPRRC’s recommending the removal from Clause 20 of the imposition of legal liability merely by publishing a document. We agree with the two committees that this is a necessary amendment, and I look forward to hearing from the Minister how these concerns will be addressed.
Somewhat paradoxically, Amendments 143 and 144 strengthen the powers of NHS England in its quest for top-down management and imposition. However, they sit within the wider context of describing how NHS England would be able to give directions to integrated care boards under Clause 20 and improve these provisions, so we support them.
The remaining amendments on NHS Continuing Healthcare underline how vital it is to address this urgent issue, although it is not central to the intentions of the Bill. I thank the noble Baroness, Lady Greengross, for ensuring this focus in the debate and for Amendments 133 and 139, which ensure that this crucial issue is specified under the ICB’s duties and included in its annual report and performance review accountabilities.
Today, we heard in detail about the widespread concern about and scale of the problems with the way in which the NHS Continuing Healthcare scheme works and is funded, and the arguments it leads to about who pays for what, as a shared responsibility between the NHS and local government. Patients and their carers feel they are the sideshow, not the central focus of concern, and are deeply traumatised and upset by the whole experience.
As a carer of a disabled adult myself, like my noble friend Lady Pitkeathley, I know, from meeting many other carers and their loved ones, their deep concern about this. The three things that cause most concern and upset, which one hears time and again, are, first, the huge problems with inadequately funded social care packages—or their absence—to meet basic care needs, and deep worries and anxieties about how the care cap will operate; secondly, the trauma of the discharge-from-hospital process for carers and their loved ones, which we will discuss later; and thirdly, NHS Continuing Healthcare, the postcode lottery of whether your loved one receives it or not, the huge bureaucracy around the application and allocation process, the long wait for a response and being stuck in the middle of an NHS local authority fight over funding. As the noble Baroness, Lady Finlay, stressed, there is an urgent need to tackle the accountability gap in this process.
NHS Continuing Healthcare is the absolute manifestation of what our Economic Affairs Committee report on the “national scandal” of social care funding called the “condition lottery”—in other words, the wide disparity between health conditions for which people receive healthcare that is free at the point of use and those for which users usually have to make a substantial contribution with “catastrophic costs”, in the committee’s words. As we heard today, dementia is the condition most cited in this regard, but many of us know of cases where people with motor neurone, Parkinson’s and other degenerative diseases have struggled to get NHS Continuing Healthcare funding, either for home care or support in residential homes.
We support Amendment 161, which ensures that the Care Quality Commission reviews must include this issue. However, I am unclear—and may well learn in a minute from the Minister—what role the CQC currently has in looking into all continuing care matters which traverse NHS and local authority boundaries. However, we support its involvement.
The amendment would also ensure that the CQC reviews include looking in depth at how NHS Continuing Healthcare is working under each ICB. That will mean that at last we can begin to develop the much needed strategic overview of this crucial area for thousands of people in desperate need of care and support.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I thank the noble Lord, Lord Sharkey, and the noble Baronesses, Lady Finlay and Lady Greengross, for bringing this group of amendments.
I understand the intention behind Amendment 106, on payment to providers, which is to remove new Section 14Z48 in its entirety, but the section will allow NHS England to specify the circumstances in which an ICB is liable to make payments to a provider for services commissioned by another ICB.
The Government are committed to ensuring that delegated powers in the Bill use the most appropriate procedure, so that Parliament has due oversight of their use. We recognise that the Bill contains a significant number of guidance-making powers and powers to publish documents. However, we believe that they are appropriate because, as the noble Baroness, Lady Walmsley, said, they reflect the often complex operational details and the importance of ensuring that the guidance keeps up with best practice, especially as the system flexes and evolves. I understand the noble Baroness’s point about Parliament, but the issue here is whether, every time the system flexes, Parliament has to have another debate. The ICBs will be reading the guidance, not Hansard, and the guidance should reflect that.
Nor is it our intention to interfere unduly in the financial affairs of ICBs. Instead, the intention is to resolve specific circumstances, such as emergency services. The legislation makes it clear that each ICB has to arrange for urgent care services to be available for all people physically present in the area, not just for the people who are its core responsibility by virtue of their GP registration. I am sure noble Lords will agree that it would be neither fair nor in the best interests of promoting an efficient health service for the ICB to both arrange and cover the cost of all additional emergency treatment brought by visitors to the area, particularly in areas with high visitor numbers. A number of noble Lords referred to that principle in debates last week.
Instead, this provision allows NHS England to mandate a different payment rule for those services, ensuring that, where necessary, the ICB where a patient is registered will pay, rather than the ICB where they receive treatment. This ensures that the financial impact is felt in the right commissioning organisation and eliminates the risk of some ICBs having unreasonable financial demands placed on them—for example, during the holiday season.
The wording of this provision replicates almost exactly the National Health Service Act 2006 as amended in 2012, but it is updated to reflect the new ICB structure. As my noble friend Lord Howe mentioned to me, we had a massive debate about this 10 years ago, but the provision seems to have worked effectively in the CCGs, and we wish to continue that with the ICBs.
Amendments 143 and 144, in the name of the noble Baroness, Lady Finlay, are about NHS England directing ICBs. I understand the interest in ensuring that NHS England has the necessary tools to intervene in ICBs where necessary. However, we believe that NHS England already has sufficient powers to direct ICBs. NHS England already has certain powers to direct an ICB under Section 14Z59(2), and powers to intervene over ICBs in order to prevent failure and to ensure that the lines of accountability from ICBs through NHS England to Parliament are strong.
However, this power has a threshold in that it can be used only if NHS England deems an ICB to be failing to discharge a function or at risk of failing to do so. The threshold removes the possibility of NHS England overdirecting the system while retaining the power for use if necessary. This balances the need to prevent failure and to support accountability with allowing ICBs the autonomy they need to operate effectively.
Amendments 133, 139 and 161 expressly require that ICB annual reports and NHS England performance assessments of ICBs include specific consideration of commissioned services, including NHS Continuing Healthcare, which noble Lords have spoken about, and that the CQC reviews of ICSs include specific consideration of that. We agree with the principle, but we believe that it is already covered in the Bill. NHS England already has a key role in overseeing ICBs. For example, the Bill requires NHS England to assess the performance of each ICB every year, and ICBs are required to provide NHS England with their annual report. These reports will include an assessment of ICB commissioning duties, which would encompass any arrangements for NHS Continuing Healthcare.
In addition, as noble Lords are aware, Clause 26 gives the CQC a duty to assess integrated care systems, including the provision of relevant healthcare and adult social care within the area of each ICB. This would include the provision of NHS Continuing Healthcare. We intend the CQC to pilot and develop its approach to these reviews in collaboration with NHS England, but also with other partners in the system. This should ensure that the methodology does not duplicate or conflict with any existing system oversight roles.
With this in mind, we believe that these amendments are not necessary, because commissioned services, which we would expect to encompass NHS Continuing Healthcare, are already included in these clauses. I hope that I have been able to somewhat reassure your Lordships. For these reasons, I ask noble Lords not to press their amendments.
Lord Sharkey (LD)
My Lords, it is clear that new Section 14Z48 is an unambiguous abuse of delegated powers. It provides for a law to be created by the simple issuing of a paper. There is no real possibility of a coherent defence of this procedure and the Minister did not provide one, relying as he did on special pleading and the extraordinary notion that Parliament cannot handle complexity.
As the Bill stands, Parliament is bypassed and scrutiny is avoided. I remind the Committee that the DPRRC and the Constitution Committee have recommended the removal of this section. I again suggest to the Minister that if he wants to retain the powers set out in Section 14Z48, he should rework them between now and Report at least to involve scrutiny by Parliament via the affirmative procedure. If he does not, we will return to this issue on Report. In the meantime, I beg leave to withdraw the amendment.
Lord Hunt of Kings Heath
“(3) Subsections (1) and (2) do not have effect if the information involves the personal data of patients.”Member’s explanatory statement
The amendment is aimed at ensuring that the power to disclose information should exclude personal data on patients and is a probing amendment to see what purpose the Government thinks the power in the clause may be used for.
Lord Hunt of Kings Heath (Lab)
My Lords, my amendment concerns patient data. I want to probe the meaning of new Clause 14Z61, proposed by Clause 20(2), which relates to the permitted disclosure of information by integrated care boards. It sets out, on page 27 of the Bill, a number of conditions under which disclosure can be made. They include when
“the information has previously been … disclosed to the public”
or
“the disclosure is made in accordance with any enactment or court order”.
That seems perfectly sensible. However, proposed new subsection (1)(f) contains a catch-all condition under which a disclosure can also be
“made for the purpose of facilitating the exercise of any of the integrated care board’s functions”.
That seems remarkably open-ended. My amendment seeks an assurance that this power excludes the personal data of patients.
We have already had one go at the issue of data and digital transformation, and I have told the House that I am right behind the efforts of the NHS and the Minister’s department to encourage the digital transformation of the NHS. The potential is clearly enormous. However, public confidence depends on the integrity of the system and having embedded in it a guarantee that every use of data will be consensual, safe and transparent.
The recent Laura Wade-Gery review, on which a number of noble Lords have commented, acknowledged some of those concerns. As she said:
“The field of data science is undergoing a revolution as new tools such as machine learning transform our ability to gain insights and improve outcomes. These advances, combined with the explosion of new data driven commercial business models, have caused citizens to be concerned about the privacy of their individual health data and the controls in place over its dissemination and use.”
There may be situations where a patient does not want a doctor—by the way, just for the Chief Whip’s reassurance, I have not spoken for 37 minutes as the clock says—to tell another doctor something about them, yet this can be ignored by those who want to copy records across a lifetime. Modern communications have created the capacity to copy medical records on a scale that can shatter medical confidentiality.
The experience of Care.data is surely a lesson for us. The decision to axe the scheme followed the publication of two reports that supported far greater transparency over what happens to the information, and opt-outs for patients who want their data seen only by those directly caring for them. A review by the late Dame Fiona Caldicott, and a second by the Care Quality Commission, recommended tougher measures to keep people’s medical information confidential. The Caldicott review said that there needs to be much more extensive dialogue with the public as to how their information can be used. As she said:
“Citizens have a right to know how their data is safeguarded. They should be included in conversations about the potential benefits that responsible use of their information can bring. They must be offered a clear choice about whether they want to allow their information to be part of this.”
This was brought home to me recently by NHS England’s announcement that it is to give trusts, as employers, access to the Covid and flu NHS vaccination records of their staff. I am fully behind the vaccination drive and sympathetic to the Government’s mandating of vaccines, but the announcement said:
“To assist Trusts with understanding the vaccination status of their workforce, we are providing a solution for Trusts to view the vaccination status of staff who are on the Electronic Staff Record … system. To do this, we are undertaking an exercise on Trusts’ behalf, to match ESR data, using NHS numbers, with vaccination data held in the National Immunisations Management System … which includes data drawn from all point of care vaccination systems. Following a successful import of ESR data into NIMS, a dashboard will be provided to each Trust detailing their workforce Covid and Flu vaccination uptake, drilled down to employee-level.”
Let me be clear: I support the vaccination drive, as I said, but am I the only one to worry about the access to confidential data that is being given? I recognise that we are talking here about electronic staff records as opposed to electronic patient records, but the principle of releasing patient data is the same.
I would like to hear some assurance from the Minister about the use of this clause and the open-ended nature of new Section 14Z61(1)(f), because, as I think we will shortly hear from the noble Baroness, Lady Brinton, such an open-ended disclosure provision in other legislation would be looked at with very great concern. Having said that, and having taken up 44 seconds, according to the Clock, I beg to move.
The Deputy Chairman of Committees (Lord Lexden) (Con)
My Lords, I have failed in my duty, and not for the first time. I should have stated before calling Amendment 145 that the noble Baronesses, Lady Brinton and Lady Harris of Richmond, will be taking part remotely. May I apologise, and invite the noble Baroness, Lady Brinton, to speak?
Baroness Brinton (LD) [V]
My Lords, this probing amendment from the noble Lord, Lord Hunt, is essential, because it protects confidential patient data from being given out by an ICB in contravention of the ethics rules of the General Medical Council and other regulatory bodies.
When the Police, Crime, Sentencing and Courts Bill arrived in your Lordships’ House in the autumn, it had clauses in it that gave the police, probation and prison services access to a patient’s confidential medical data as part of their role to reduce and prevent serious violence. As originally drafted, that Bill would have required GPs, CCGs and their staff to hand over that data. This was not just about those under suspicion; it could have been anybody involved in serious violence.
I had extreme concerns about this, and I tabled an amendment not dissimilar to Amendment 145. I was grateful for the support of the noble Lords, Lord Patel and Lord Ribeiro, the General Medical Council, the BMA and others in Committee on that Bill. We had meetings between Committee and Report with officials from the Department of Health and the Home Office, meaning that by the time we got to Report the Government had laid amendments to ensure that a patient’s personal data could not be demanded by the police, probation and prison services. It is now recognised that the medical regulators—the GMC, the Nursing and Midwifery Council and other bodies—actually have the responsibility and the excellent ethical standards by which their members are expected to judge what they should do if they are asked for personal data.
The amendment from the noble Lord, Lord Hunt, would address what data an ICB may disclose by adding a subsection to protect the Government in the same way as happened in the police Bill, so that the personal data of patients should not be disclosed. This is a vital amendment. The Government have already accepted in this Parliament that a patient’s personal data must not be accessible by those other than clinical and clerical staff dealing with it, who must abide by the confidentiality rules of their regulatory body or by their employment contract.
This is even more necessary, because the Bill says in new Section 14Z61(1)(g), on permitted disclosures of information, that
“the disclosure is made in connection with the investigation of a criminal offence”.
That is even broader than in the original police Bill. Patient confidentiality is a fundamental ethical duty. It is crucial to upholding the trust that lies at the heart of the doctor-patient relationship. The new section will give the ICB the right to override that.
New paragraph (e) is also more far-reaching than the investigation of any crime. It says that
“the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person under any enactment”.
So it is not the doctor or the ICB that has the choice about disclosing that information; they must take the word of the person making that request. That is total free access for anyone who says that it is necessary or expedient for them to have that information. Where is the protection of a patient’s individual and confidential data?
It also removes the decision from GPs, despite GPs having very clear and effective guidance from the GMC on when, in exceptional circumstances, they can give out data. I will not quote the whole of the guidance, because we do not have time, but there are two vital points that a GP must consider: the patient must consent, whether implicitly or explicitly; and disclosure must be permitted or must have been approved under a statutory process that sets aside the common-law duty of confidentiality. The doctor also has a duty, even when they have made their decision, to use anonymised information if practicable, and they must be satisfied that the patient has ready access to information explaining how their personal information will be used. It goes on, but I will not quote the rest.
One might hope that Ministers assumed when drafting the clause that confidential patient data would never be included, other than for the treatment of the patient. However, paragraphs (e), (g), (h) and (f), as the noble Lord, Lord Hunt, outlined, put paid to that. If the argument is that the clause is needed because the ICB might have to share data with, for example, care providers or social workers carrying out assessments, that needs to be made clear, and it would be permissible. But, as drawn, it is far too brief.
The amendment from the noble Lord, Lord Hunt, at least protects the personal data of patients. It is very straightforward and provides the protection that every doctor, nurse and patient would expect. So I hope the Minister will say today that he is happy to accept the amendment. If he is not, please will he agree to a meeting with those who have spoken in this debate, and invite the GMC and the BMA? If progress is not made on this, I will lay an amendment on Report and am likely to press it to a Division.
The Deputy Chairman of Committees (Lord Lexden) (Con)
My Lords, the noble Baroness, Lady Harris of Richmond, is also taking part remotely and I invite her to speak.
Baroness Harris of Richmond (LD) [V]
My Lords, having spoken on just about every police Bill in this House for the past 23 years, I am afraid that I could not let this amendment pass without comment. I refer your Lordships to my policing interests in the register.
As my noble friend Lady Brinton has just said, the Police, Crime, Sentencing and Courts Bill, which has just gone through this House, had provisions that gave the police and other criminal justice bodies investigating possible serious violence, or plans to produce serious violence, the power to demand the confidential medical data of individuals. As drafted, unspecified police officers —that means any police officer, not just a senior ranking officer—could make requests to a GP’s surgery or a CCG, or their staff, to hand over the data.
What I found chilling was that the police would not be required to explain to the patient’s GP why they wanted the information, or whether the patient concerned was a potential criminal or possible victim—or even someone associated with the investigation, for example a possible witness or family member. After discussions with Peers, the General Medical Council, Ministers and the British Medical Association, the Government made their own amendments, making it clear that the police would not have this universal access to patient data. Instead, they would have to use the current, traditional method of approaching a patient’s GP directly and asking for the data, with the decision being made by the GP under the GMC code of ethics, as my noble friend Lady Brinton explained.
New Section 14Z61 gives the new integrated commissioning boards a duty to hand over personal medical data to a wide range of bodies that request them. However, I will focus on paragraphs (g) and (h), which are about police requests for data when they are undertaking criminal investigations. It is even more extraordinary that a health Bill is proposing to give the police even wider powers than in the recent police Bill. At least that Bill originally limited access to cases of serious violence. I will quote my noble friend from 25 October 2021, in debate on the Police, Crime, Sentencing and Courts Bill:
“It is quite extraordinary that this Bill proposes that any Home Secretary can, at will, demand that doctors and other healthcare professionals breach patient confidentiality, over and above their responsibilities of confidentiality to their patients and their commitments to their regulatory body.”—[Official Report, 25/10/21; col. 551.]
Lord Clement-Jones (LD)
My Lords, I support the amendment in the name of the noble Lord, Lord Hunt, to which I have added my name. He is not the only one to be concerned about this part of the Bill. My noble friends Lady Brinton and Lady Harris have delivered powerful support and a demonstration of why we have to be absolutely vigilant about access to, and sharing of, personal data, as they were so successfully on the police Bill. We must not repeat those experiences.
We will talk further and more comprehensively about data later in Committee. In the meantime, Amendment 145, as the noble Lord, Lord Hunt, explained, tries to illicit from Government their intention behind these disclosure powers for ICBs in new Section 14Z61 in Clause 20 with regard to information, whether personal data is involved and what the safeguards are. New Section 14Z61 sets out the provisions whereby
“An integrated care board may disclose information obtained by it”
in the exercise of its power. As the noble Lord, Lord Hunt, said, the catch-all condition in new Section 14Z61(1)(f) under which disclosure can be made
“for the purposes of facilitating the exercise of any of the integrated board’s functions”
seems remarkably open-ended. My noble friends have also pointed out the sheer width of paragraphs (e), (g) and (h), which go even further than those originally proposed in the police Bill and raise crucial questions for the Minister to answer.
Amendment 145 aims to ensure that an ICB cannot disclose information where this is patients’ personal data. In my last intervention on the group headed by Amendment 26, I, like the noble Lord, Lord Hunt, expressed my support for the NHS’s digital transformation programme. It is clear, as the noble Lord says, that there is great potential growth in new technologies using data such as AI and machine learning. However, there is an absolute imperative to have the right safeguards in place in relation to duties and data. This is very much aligned with transparency in public information and engagement, particularly in this context. Transparency, choice and consent are crucial, as the noble Lord, Lord Hunt, says.
We have all looked forward to the Goldacre review, but I am not convinced that it will range wide enough and cover the governance arrangements needed to preserve and enhance public trust in the sharing and use of health data, but we will see. I look forward to the debate towards the end of Committee when we discuss the wider aspects of the Bill, when we will produce further illustrations of the rather cavalier way in which the Government, the department and the NHS have treated personal data. Not least of these is what has been called the attempted GP data grab of last year. In the meantime, I hope the Minister will be able to give assurances that the powers in Section 14Z61 will be very limited.
Baroness Finlay of Llandaff (CB)
My Lords, from the perspective of a clinician, I support this amendment very strongly. If it is not adopted, I can see it being imperative, in any doctor’s consultation, to warn the patient that their data could be accessible and to be very careful about what is recorded in the clinical record. Very often, patients come to see a doctor, possibly at a very early stage of slightly disordered thinking or because they have undertaken a potentially high-risk activity, often in the sexual domain, and are worried that they may have contracted some condition or other. If you inhibit that ability to see a doctor early, you will further drive people into whatever condition is beginning to emerge, so it will not be known about until later. That applies particularly in mental health, where early intervention might prevent a condition from escalating.
I can see that, without an amendment such as the one proposed by the noble Lord, Lord Hunt of Kings Heath, every clinical consultation will have to be conducted with extreme caution, because of potential access to data.
Lord Bethell (Con)
My Lords, I an enormously grateful for this debate, because this clause and related clauses are critical both to achieving the digital transformation aims of the NHS, referred to by the noble Lord, Lord Clement-Jones, and to getting the healthcare system to work better together.
I am also grateful for the humanity and testimony of several noble Lords, exemplified by the noble Baroness, Lady Finlay, who spoke movingly about the practicalities of patients going to see their doctors. I know from my own life and from my family how important it is to protect those relationships.
That is why I would like to hear a little from the Minister about what protections there are, because health data is and should be treated as a special category of data. What additional protections are there in the use of health data, including in the common law duty of confidentiality, the role of the National Data Guardian, the way the Caldicott principles will be used and the national data opt-out? What reassurances do we have that those special considerations will apply to this clause and its related components?
Baroness Thornton (Lab)
My Lords, I agree with my noble friend Lord Hunt and those speakers who expressed their concern about the open-endedness of what is in the Bill at the moment and the lack of protection for patient data. I look forward to the Minister’s reply on this.
Baroness Chisholm of Owlpen (Con)
My Lords, I am grateful to the noble Lord, Lord Hunt, particularly for his brief and, as always when he speaks, his clear understanding of the amendment. It makes it so much easier for us to know where the noble Lord is coming from.
I am grateful to all other noble Lords who spoke on this issue, and I understand the interest in the integrated care boards’ power to disclose information that is personal data. As the noble Lord, Lord Hunt, mentioned, public trust is essential in this and individuals’ data will be used lawfully and with respect, and held securely with the right safeguards in place. It will need to be proportionate, transparent and subject to individuals’ rights to access and correct information in use.
Let me further explain how we will make sure this happens. I assure noble Lords that the clause already restricts integrated care boards’ powers to disclose information by limiting these to the specific circumstances set out in the clause. Further, all use of personal data is subject to data protection legislation, including the UK general data protection regulation and the Data Protection Act 2018. This legislation provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data-protection principles for the sharing of personal data.
Under the UK GDPR, health data has to be treated as a special category. This data requires additional protections due to its obvious sensitivity. For this type of data to be lawfully processed, a further condition must be met, in addition to identifying a lawful basis, as set out in the GDPR and the Data Protection Act.
This data protection legislation applies to the use of all personal data and provides robust safeguards in relation to information and disclosure. Importantly, there are additional protections on the use of health data, including the common-law duty of confidentiality, along with the role of the National Data Guardian, who advises and challenges the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly. As the noble Lord, Lord Hunt, mentioned, there are also the Caldicott principles; there are seven of these, which I am sure noble Lords are aware of, so I will not go through them all now. They provide guidance to health and care organisations on the use of confidential information. Along with this, there is also the national data opt-out.
I remind the Committee that new Section 14Z61 will apply, which provides when an ICB may disclose information obtained by it in the exercising of its functions. I emphasise that maintaining trust that healthcare data is being used properly is paramount. Individuals’ data will be used lawfully and with respect, held securely and have the right safeguards in place. None of the changes we are making will remove the duties of organisations to comply with the requirement of data protection legislation. Along with that, we are working with the Home Office to ensure that the protection and confidentiality of patient information is upheld within the Police, Crime, Sentencing and Courts Bill. Appropriate safeguards are in place and the Bill makes it clear that information can be shared only in accordance with data protection laws.
I am concerned that this amendment could cut across the different pieces of relevant legislation, preventing the ICB from effectively discharging its functions where it may be necessary to disclose information, which may include personal patient data. This would include investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system, with different rules applying to different organisations.
I know that my noble friend the Minister, the noble Lord, Lord Kamall, has agreed to talk about this further with the noble Lords, Lord Hunt and Lord Clement-Jones. He wants to meet civil liberties organisations, along with them, to discuss this subject further. However, I regret that the Government cannot accept this amendment. I hope that I have given the noble Lord some reassurance and that he will feel able to withdraw the amendment.
Lord Hunt of Kings Heath (Lab)
My Lords, I am of course grateful to the noble Baroness but I am not sure that she has entirely dealt with the concerns expressed. Because the noble Baroness, Lady Brinton, referred a lot to the GMC, I should just say that, although I am a member of its board, I am not acting here on behalf of the GMC at all.
The noble Lord, Lord Clement-Jones, and I signed the amendment and we both start from the basis of supporting digital transformation in the NHS, but we have always seen that it has to go hand in hand with the safeguards. That is why this debate is so important. We have heard powerful interventions from the noble Baronesses, Lady Brinton and Lady Harris, about why the police Bill had to be amended in relation to police access to patient information. The noble Baroness, Lady Finlay, referred to the issues for clinicians if they did not feel that the integrity of the patient confidentiality system was sufficiently safeguarded.
The Minister has basically said that we need not worry, because the NHS will only deal with information lawfully, and she went through some of the protections, including the fact that in the Bill there are conditions before the integrated care board can release the information. She referred to the data protection legislation, the GDPR, the special category given to health data about patients and the Caldicott principles. She went on to say essentially that my amendment would cause problems, because it would get in the way of legitimate information being given by the ICB, which might have an impact on patient care quality.
Lord Hunt of Kings Heath
“(ba) members appointed by each of the local medical, dental, pharmaceutical and optical Committees, and”Member’s explanatory statement
This amendment would ensure that primary care professions would have mandated roles within Integrated Care Partnerships with a member appointed by each of the practitioner committees.
Lord Hunt of Kings Heath (Lab)
My Lords, Amendment 147 concerns the establishment of integrated care partnerships. Although the amendment is specifically about the membership of ICPs, I think that it is appropriate that I comment more generally on ICPs and their role. As I see it, the proposals on integrated care partnerships can be seen as an attempt to try to bind the NHS more closely into a wider system that delivers much wider services contributing to care and well-being.
Particularly at issue is the relationship between the NHS and its partner local authorities. If there is to be a genuine generational shift in thinking that moves the NHS from being a sickness service to one that contributes to the overall well-being of the public, that must be welcomed. Of course, there is a lot to do. At the heart of the issue must be who decides how the money is spent. Who sets the priorities and allocates funding down to place or to service line? If it is just the NHS itself through integrated care boards, that will not work. We have to widen the decision-making to ensure that other voices are heard.
What is missing is some assurance that integrated care partnerships are to have some focus not just on wider well-being but on the need to reduce inequalities and to leverage maximum social value for the area covered. Here, the skeletal nature of the Bill once again gives rise to many more questions than it answers. How are integrated care partnerships to be performance-managed? Will there be an executive? Where will the funding come from? Can the ICP actually deliver any services? Could ICPs be the hub for shared services across the NHS and local authorities?
We have so far heard very little about ICPs; there has been much more emphasis on integrated care boards. Many noble Lords have remarked that the Bill is too focused on the NHS. It is clear that, so far, much energy has been put into the establishment of ICBs and much less into the establishment of integrated care partnerships, which are due to be set up jointly between the NHS and the relevant local authority or authorities. That shows that the building blocks are flawed, because essentially local authorities should have been equal partners in the establishment of integrated care boards. If this was really an integrated Bill about the NHS and adult social care, surely local authorities would be equal partners with the integrated care partnerships on the integrated care boards.
I do not want to go over old ground, but the very fact that NHS England is excluding local authority councillors from the integrated care boards means that it does not want a serious NHS contribution on ICBs from local authorities. I can only take that as the reason for wanting to exclude local authority councillors.
Finally, I will make a general comment about ICPs. The noble Lord, Lord Lansley, raised this earlier. I fail to understand why health and well-being boards are continuing in parallel with the integrated care partnerships. I hope that we might at some stage get an explanation.
That brings me to my amendment. I have concerns about the neglect of primary care and I think that local representative committees have been an important part of the NHS since its foundation. I see no reason why they cannot be assured of some kind of presence on the new integrated care partnerships.
We had a very good debate last week, led by the noble Lord, Lord Crisp, on the role of primary care generally in these arrangements. The Minister said that it was important to consult the relevant primary care local representative committees, and that was why there was a provision under new Section 14Z52 to introduce a duty to consult anyone the ICB and its partner trusts considered appropriate when preparing the forward plan. But underlying my amendment is a concern expressed by the noble Lord, Lord Warner, who on Thursday asked whether the Minister was aware that the influence on key decision-making in the NHS was diminishing for primary care in general and GPs in particular.
In response, the Minister was clearly sympathetic to making sure that primary care was better represented and not dominated by acute trusts. He said that he was open to further discussions in this area and I hope that he will extend those discussions to the membership of ICPs as much as integrated care boards.
The Minister may say that ICP membership is best left to the local level, but I do not think that that is sufficient. We are fully entitled to agree the framework of the new arrangements. Primary care is at risk of being marginalised and that cannot be left to local discretion. I beg to move.
Baroness Walmsley (LD)
My Lords, as the noble Lord, Lord Hunt, said, Clause 21 is about representation on the integrated care partnerships, and new Section 116ZA specifies who should be on the committee of the partnership. The Bill currently specifies that one member of the ICP should be appointed by the ICB and one by each of the local authorities. The partnership is also free to appoint others. My Amendment 148 requires that one of these additional members must have responsibility for public health—and in that I include public mental health—and one must demonstrate that he or she can represent local voluntary organisations.
It is tempting in a Bill such as this to assume that all the members of these very influential committees should be from the major health organisations or local authorities in the area. However, there are many small community organisations run by charities or not-for-profit groups that play a very valuable role in providing services to local communities in a very cost-effective manner. Unless they are represented at ICP level, it is quite possible that their survival will be threatened by the new arrangements—and we heard in previous debates that they already do feel threatened. I am sure that the Government do not want that.
Similarly, public health has a major role to play in addressing many of the preventable diseases that contribute to health inequalities—and it looks after the tracing of communicative diseases. We saw the value of that recently when it was a great deal more effective than the national test and trace service at tracing the contacts of Covid-positive patients.
So, the work of both groups is very cost effective. If the ICB and the ICP are to use their resources efficiently and fulfil their duties to level up health inequalities, it is important that both groups are represented on the integrated care partnership. I echo the comments from the noble Lord, Lord Hunt: the Bill is quiet on the structure of and representation on the integrated health partnership. Given the duties that it is being asked to perform, it is perfectly reasonable for us to suggest that some of those important duties are properly covered in representation.
Lord Davies of Brixton (Lab)
My Lords, in speaking in support of my Amendment 150, the issue is simple. We have much to learn about ICPs; I associate myself with the remarks of my noble friend Lord Hunt.
My proposal is that the rules determining the membership of ICPs should be consistent with the rules for membership of ICBs. As the Committee will be aware, it has been agreed, with the amendment made in the House of Commons, that ICBs will not and cannot be controlled by the private sector, in any way. I believe that the Health Minister, Edward Argar, made the point of principle clear when speaking during the Commons Report stage. He said that
“ICBs will not and cannot be controlled in any way by the private sector, as NHS-accountable bodies guided by the NHS constitution and with NHS values at their heart.”
Let us just remind ourselves that the requirement added by the Government to Schedule 2 is that an ICB’s constitution “must prohibit” a candidate being appointed to it if the person making the appointment considers, in the Government’s words in the amendment,
“that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”—[Official Report, Commons, 22/11/21; cols. 119-61.]
We might not agree with the wording adopted by the Government, as previously discussed, but the principle is accepted on all sides.
So, as with ICBs, we should have a parallel provision for ICPs. In this, I am simply following what the Minister said in relation to ICBs: he wanted
“to put the matter even further beyond doubt.”—[Official Report, Commons, 22/11/21; col. 116.]
I emphasise “even further”. The debate here is not really about the precise wording of any amendment; it is about the principle of extending to ICPs the same protection that, as has already been agreed, should be extended to ICBs.
I look forward to the Minister’s reply. It is possible that, given the way in which ICPs are appointed—on the one hand, by ICBs, which are already protected by the Government’s amendment to Schedule 2, and on the other hand, by local authorities—it might be suggested that the issue simply does not arise and that protection is already there. However, if only to put the matter even further beyond doubt, why not accept my amendment?
Baroness Thornton (Lab)
My Lords, my noble friend Lord Hunt and the noble Baroness, Lady Walmsley, started what I hoped was going to be a discussion about ICPs.
My first question is this: who was consulted on the structure, membership and role of ICPs? This question has hung over all our debates from the beginning. The Minister has said several times that this is what the NHS wants—well, which bit of the NHS? Who was consulted? As far as we can see, in the role proposed in the Bill, it is not at all clear who was consulted on how ICPs should operate. Indeed, in a previous debate, we asked how this will work with the role of health and well-being boards. That has still not been answered. It is not at all clear why both things are needed; that is the first point. My noble friend Lord Hunt is right that, at the moment, the Bill raises more questions than it answers.
In particular, the idea that local councillors cannot be members is ridiculous and slightly offensive, because the role of the ICPs is to discuss strategy and local health infrastructure and delivery. Their role is absolutely vital.
Lord Hunt of Kings Heath (Lab)
My noble friend raises a very important point, because councillors can presumably go on integrated care partnerships and health and well-being boards but cannot go on the integrated care boards—but one of their officers can. What is the logic? Can my noble friend help me? So far the Government have given no answer whatever as to why. I know I am going on about this, but it is a fundamental issue: why are local authority councillors not seen as core partners on integrated care? It makes a mockery of the integration. There is no integration: they are setting up two separate boards. I do not know why they are not setting up one integrated board to cover the NHS and the partnership. It defies understanding. Why have they come up with this complicated arrangement and are continuing with health and well-being boards? Can my noble friend help me?
Baroness Thornton (Lab)
I certainly cannot help my noble friend, but I live in hope that the Minister can. It smacks of a fix. The Minister might not be prepared to say on the Floor of the House what exactly the fix was between the various bits of NHS England and various bits and other parts of the machinery. I suspect that the noble Lord, Lord Lansley, might know better than the rest of us what that fix was.
I will comment on my noble friend Lord Davies’s amendment. The problem with it is that, as the ICPs are proposed in the Bill at the moment, they will not be spending any money or commissioning services. It is also important that they include the various important parts of our local health delivery systems, including pharmacists, dentists, GPs, social enterprises and the voluntary sector. As I read it, this amendment would exclude hospices, for example—which would be a ridiculous thing to do. So my noble friend might want to rethink that amendment, because it does not necessarily serve the intended interests of the ICPs.
Lord Kamall (Con)
I thank all noble Lords, especially the noble Lord, Lord Hunt, for the points they have raised. ICPs will play an important role in co-ordinating services, planning in a way that improves population health and reduces inequalities between different groups. It is right that we consider the best conditions for their success. I was asked where the idea for ICPs came from. It originated from the Local Government Association. We have had extensive consultation with both the LGA and NHS England. To be clear, councillors can sit on ICPs.
Baroness Thornton (Lab)
Is that the fix: that councillors are not allowed to sit on the ICBs, where the money is spent, but they are allowed to sit on the ICPs? That is not acceptable to me.
Lord Kamall (Con)
I do not see it as a fix. The consultation was much wider than just NHS England. In November 2020, NHS England ran a public consultation on the structure of ICSs, including NHS staff, patients and members of the public.
Baroness Walmsley (LD)
May I ask the Minister whether councillors were consulted?
Lord Kamall (Con)
I do not know for certain, but I am sure their views would have been heard via the Local Government Association.
Lord Kamall (Con)
They were. Good. I got the answer just in time.
I will turn to Amendment 147, which would mandate a role for a member drawn from each area of primary care. With all amendments relating to the ICP membership, we want to be careful to give space for local areas to find a model of membership that works best for them. As the noble Lord, Lord Stevens of Birmingham, raised at Second Reading, it is right that in a country as large and diverse as ours, one size will not fit all. Therefore, it is right that local areas should be able to determine the model and membership that best represent their area.
We fully expect primary care professionals to be involved in the work of ICPs. Each partnership will need to involve a wide range of organisations and representatives from across the system, including professionals from primary medical, dental, pharmaceutical and optical backgrounds as they prepare their strategy. The department has published a draft list of representatives for ICPs to consider involving, which includes clinical and professional experts, including those from medical, dental, pharmaceutical and ophthalmic settings. The mechanism of how this is done will be down to local discretion. For example, one ICP may wish to formally appoint certain members, whereas a neighbouring ICP may wish to have an extensive range of consultees, and a third may decide to invite primary care representatives to join a subcommittee instead. We believe it is right that local areas are able to determine the model of partnership that best works for them, and this amendment would prevent that from happening.
A similar argument applies to Amendment 148. While we welcome the contribution of directors of public health and the voluntary, charity and social enterprise sector, I do think that we risk limiting the flexibility of ICPs. We expect public health experts to play a significant role, especially given their role in developing the joint strategic needs assessments that are crucial to guiding all planning, and their role in supporting, informing and guiding approaches to population health management.
Similarly, we expect appropriate representation from the voluntary, charity and social enterprise sectors, which will be able to contribute in respect of a number of different interests and perspectives. A number of noble Lords have spoken very eloquently about the reasons we should involve these sectors. We believe it would not be prudent, for example, to suggest that it may be appropriate for only one person to represent the local voluntary sector on a partnership, given the diversity of their involvement in health and social care.
I turn to Amendment 150, tabled by the noble Lord, Lord Davies of Brixton, and I also thank the noble Baroness, Lady Thornton, for her advice on that. I appreciate that the noble Lord might want to prevent anyone who works for, represents, or has a financial interest in a private health and care company, from being a member of an ICP. However, I would draw the noble Lord’s attention specifically to the recent experience of coronavirus, which showed that independent and voluntary providers were a vital part of the health and care picture. This amendment could exclude a significant part of the health and care sector, as the noble Baroness, Lady Thornton, rightly said. Given their scale and the central role they play, adult social care providers in particular would be potentially useful members of an ICP. It also risks leaving out, for example, dentists, pharmacists, opticians and many others working in primary care, and doctors other than GPs who work both in the NHS and privately.
We expect every ICP to have robust measures to ensure that formal conflicts of interest are managed carefully and transparently. It is also important to note that ICPs, as the noble Baroness, Lady Thornton, says, are not commissioners, and so will not be making decisions on the allocation of funds. Fundamentally, the ICP is working solely for the interests of people in the area. The experience of the health and well-being boards is helpful here, as they have similar flexibility in membership, and there have not been significant issues with conflicts of interest as they have developed their plans. We really expect the ICP strategy to be rooted in the people and communities they serve, and to be directly informed by the health and well-being boards and the joint strategic needs assessments. We are refreshing the health and well-being boards’ guidance to ensure that there are strong foundations in place at neighbourhood levels that the ICP can consult and build on.
Having said this, I thank noble Lords for their contributions on this important matter. However, as I have explained, we believe that these amendments run contrary to the principles of flexibility and subsidiarity that the Bill is based on, and therefore I hope that noble Lords will not press them.
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister. First, I thank my noble friend Lord Davies for his amendment. I think, notwithstanding what the Minister said about some of the technical details, the principle that he put forward is absolutely right: clearly, the consistency with ICBs that he mentioned is really important. I am also very sympathetic with the noble Baroness, Lady Walmsley, and her amendment on the importance of public health and voluntary organisations.
We come here to the principle that some of us continue to be puzzled by the architecture we see before us. The Minister says that this was consulted on and the Local Government Association is fine and dandy about it but, with respect, that is not sufficient in terms of your Lordships and the rigour and scrutiny that we need to put into this legislation. Frankly, as my noble friend Lady Thornton suggests, it looks much more like a fix between representative institutions to preserve the current arrangements as much as possible.
I remain somewhat confused about the structure. The Minister said that health and well-being boards will feed into ICPs, but why? Think about what he said about the role of integrated care partnerships; it sounded to me like the role of the health and well-being boards. I just do not understand the differences. I understand that, in some parts of the country where the ICP will cover a lot of local authorities, there is an argument that you should continue with health and well-being boards at the local level, but I do not see why they cannot be sub-committees of the integrated care partnerships; the Minister referred to that. Why on earth do we in Birmingham need a health and well-being board as well as an ICP? I simply do not understand it.
If the Minister believes that this should all be set out at the local level, why can people decide locally not to have a health and well-being board? He may say, “Ah no, you need a framework”. Our argument is that you need a framework in relation to membership as well. The compromise here might be to set out in legislation, as we will want to do, certain conditions around local governance and then leave it up to the local level. In relation to ICPs, however, we cannot leave it as it is. Having said that, I beg leave to withdraw my amendment.
Lord Farmer
Member’s explanatory statement
This amendment and others to Clause 21 and Schedule 4 in the name of Lord Farmer would specify that integrated care partnerships consider how to integrate family help services into the provision of health and social care services, as relationships are recognised by research as a 'health asset'. ‘Family help’ is defined in accordance with the Independent Care Review’s starting definition. ‘Family hubs’ are named as key potential sites for delivering integrated paediatric health and family help.
Lord Farmer (Con)
My Lords, I will speak to all four amendments in this group in my name. I remind the Committee that I have already declared my interests, especially as regards integrated care and family hubs.
In Committee in the other place, the Minister, my honourable friend Edward Argar, recognised
“that the system has been calling for two different and important types of integration: integration within and across the NHS to deliver healthcare services within a defined locality, and integration between the NHS and local government and wider partners.”
He went on to say:
“The ICP is intended to bring together health, social care and public health to develop a strategy to address the needs of the area also covered by the integrated care board. If”—
I emphasise “if”—
“the ICP wants to go further, it can also involve representatives from the wider system, where appropriate, such as voluntary and community groups, and social care or housing providers. That will be up to the ICP, and we will welcome locally driven innovation to reflect local circumstances.”—[Official Report, Commons, Health and Care Bill Committee, 16/9/21; col. 332.]
I, too, welcome locally driven innovation to reflect local circumstances, as I will emphasise shortly. However, I am genuinely mystified as to why integration between the NHS and local government and wider partners is voluntaristic in the Bill. My Amendment 154 would exchange “may” for “must” and require integrated care partnerships to include in their strategy a statement of how health-related services could be more closely integrated with health and social care.
Baroness Tyler of Enfield (LD)
My Lords, I lend my voice to this important group of amendments. I will explain very briefly why family hubs are so important to many of the big themes that we have been discussing in the Bill so far: prevention, early help and integration in particular.
Family hubs have a very important role to play in improving early intervention services and helping with integration and data sharing, as we discussed earlier, among public services and the voluntary sector. Importantly, as the noble Lord, Lord Farmer, explained, the range of services available in family hubs often includes important services such as children’s health services, which are better delivered in a community setting and integrated with other family health services, rather than delivered in a hospital or somewhere that has a much greater focus on acute care.
The Public Services Committee, on which I served until very recently, produced what I thought was a very important report on vulnerable children recently. It put a national rollout of family hubs at the very core of a national strategy for child vulnerability, proposing that the most deprived communities be prioritised in the early stages of any such expansion. In our report, we set out what fundamental characteristics we thought should be at the heart of every family hub, including employing full-time family co-ordinators, offering addiction and domestic violence services, providing support for parents with poor mental health and organising parenting classes. I say that, because I hope that it illustrates the point I made about integration between health services and broader family support services.
I had the privilege as a committee member—I think the noble Lord, Lord Hunt, was with me—to visit Westminster family hub. I sat down and talked to a young mother with two young children who had a lot of very difficult issues that they were dealing with. The mother explained how the help and support she was getting through the family hub, both with her health issues and those of her children, as well as a wider range of issues, were helping her to keep her head above water. I was so impressed with that family hub and the help and support it was giving, and the way it was integrating statutory services and the voluntary sector.
I will make two other brief but important points. First, family hubs will be working with children from birth to 19. I see that as important, because families face challenges at any time, not just when children are very young, and focusing solely on early years and not helping families with older children does not have the same sort of holistic approach. So it is extremely helpful if, during early years, families build up these trusted relationships with people they meet in family support hubs of the type I have described, rather than sever that relationship when the child reaches the age of five. Parents can continue to contact a familiar team and access that trusted source of information and advice.
My final point to emphasise is the importance of family relationships and relationship support. One key thing about family hubs that is very important is the work they do to prioritise help with relationships—it might be couple relationships, parent-child relationships or even sibling relationships. By being able to deliver counselling and various other programmes to address some of the conflict and breakdown that often affects families in these difficult situations, they often help avoid the whole family reaching crisis point, particularly to the extent that parents have to access the courts to resolve disputes. For all these reasons, I very much support the amendments.
Baroness Wyld (Con)
My Lords, I support my noble friend Lord Farmer. I declare my interest as a non-executive member of the board of Ofsted. I apologise for not being able to speak at Second Reading for my own family reasons. I echo everything that the noble Baroness, Lady Tyler, said. It was a real pleasure to serve with her on the Public Services Committee.
I will praise the Government first, which is always wise. They are showing great commitment to family hubs and I believe that they are committed to the rollout. What concerned me when the committee took evidence from certain members of the Government was a sense of a lack of urgency. Everybody agreed that this was a brilliant idea, but different people from different departments had different ideas about how they should work.
We also took evidence from families, in private and in public. The stories we heard over and again were, as others have alluded to, that, “This could have been prevented if it had been addressed in a joined-up way”. We particularly heard from young children, “I had to tell my story over and again.” Imagine the trauma. This could have been prevented under a different model. These situations did not have to happen.
We have the building blocks to make sure that these situations do not happen, but I do not think the legislative framework is in place to help us to address that. For that reason, I am persuaded by my noble friend Lord Farmer and I am happy to support his amendment.
Lord Mawson (CB)
My Lords, I am very supportive of what the noble Lord, Lord Farmer, said. My colleagues and I have been in this space for 37 years and we have built rather a lot of things in it. It has been very interesting to watch what happened in east London, when this new scheme from a new Government arrived in the middle of a group of communities that already had well-established relationships with very vulnerable families, with a whole range of opportunities emerging. I am sure it was unintentional—it is part of the danger of being overinfluenced by the idea that local authorities will sort this stuff out in the same old usual way that they have tried to before—but it was very disruptive for the social enterprise sector, which was already doing this stuff very effectively, with all the numbers to show it. I will not go into the detail now, but when you look at the detail of what actually happened, the present facilities cost £100,000 more than those being delivered by the social enterprise sector.
These ideas are really important. I am happy to take the noble Lord into this in a lot more detail. I encourage him to spend more time in the detail in some real places to look at the unintended consequences of what happens when new government programmes arrive in communities, with the best will in the world, with an overconfidence in what they think the state can deliver. I am very happy to have a further conversation with the noble Lord, but the detail of the long-term relationships with these families really matters.
Lord Warner (CB)
My Lords, briefly, I support these amendments, partly from my own experience as a director of social services and Children’s Commissioner, but also because of the points that the noble Lord, Lord Mawson, raised.
I have three key points from history. As a director of social services in the 1980s and 1990s, I offloaded my local authority family centres to the voluntary sector because a survey of parents suggested that they would not come to a service run by the organisation that was likely to take away their children. That was a perfectly rational position and we should listen to what people say about that.
Fast forward to 1999 and parenting orders under the Crime and Disorder Act. We find that compulsion brought parents to the party but, when they actually attended, they found—not so much men but women—that they were being treated and given skills that enabled them to manage children, largely teenage children, much better than they had been. It was a great shame that we used the criminal justice system to bring people to a parenting tuition experience that they should have been given many years before.
This is a final point from history. Michael Gove made me—this was madness on my part, as well as his—children’s commissioner for the failing Birmingham City Council children’s services. Ofsted report after Ofsted report had been telling them of their deficiencies. We found that the group they could not handle, for which they had no effective responses, was teenagers. If we are to make any progress in helping people to help the family unit, we need to address the support given to parents during the teenage years, because they are really struggling, particularly mums.
Lord Bethell (Con)
My Lords, I will briefly say that I am extremely optimistic about family hubs. They answer the challenge to solve the complexity around integration incredibly well. My noble friend Lord Farmer made the point that one cannot think of a better example of what integration looks like than family hubs. The noble Baroness, Lady Tyler, talked clearly and persuasively about the journey they have been on.
My noble friend has made the case for these amendments. Other noble Lords have made the case for updating the legislative framework. I ask the Minister to look carefully at what can be done to bring these laws up to date so that family hubs can thrive, as I believe they will.
Baroness Merron (Lab)
My Lords, I am grateful to the noble Lord, Lord Farmer, for introducing this important debate and to other noble Lords who have supported the amendments before us and spoken about how we can improve the support that families will receive through this Bill. As the Family Hubs Network rightly observes,
“prevention is simply listed in the Bill as one of several commissioning requirements of ICBs with no broad mention of children’s health”.
This group of amendments gives us the opportunity to sharpen this.
As we have heard, the issues that families face, in whatever form or shape, do not exist in isolation. In addition to the impact of financial, housing, social and other pressures, the physical and mental health of a child or young person affects the physical and mental health of not just their parents, but their wider family, and vice versa. It makes common sense to facilitate a healthcare system that is designed and resourced to actively take a holistic approach to the many issues that face children and those who care for them.
I cannot help but feel that the points raised today are not new. We have the experience of Sure Start to show us how effective properly integrated family services can be. As the Institute for Fiscal Studies confirmed:
“By bringing together a wide range of early years services for children under 5, Sure Start centres dramatically improved children’s health even through their teenage years.”
Early investment is crucial.
I hope the Minister will be keen to embed change in this Bill to replicate the success that we saw through Sure Start. The first step towards doing this is to make sure that integrated care partnerships are properly required to consider how family help services can be thoroughly integrated into our health and care system, so that family members—no matter what form those families take—are seen as both individuals and groups who have an effect on each other.
Lord Kamall (Con)
I thank my noble friend Lord Farmer and all noble Lords who spoke about their experiences. The creation of integrated care boards represents a huge opportunity to support and improve the planning and provision of services to make sure that they are more joined up and better meet the needs of infants, children and young people.
Before I go into the specific amendments, I make it quite clear, as my noble friend said, that the Government set out in their manifesto a commitment to championing family hubs. We want to see them across the country, but at the same time we must give democratically elected councils the choice to shape how services are delivered, bearing in mind some of the points made by the noble Lords, Lord Mawson and Lord Warner, whom I thank for their experience on this.
The Government agree that it is vital to ensure that ICPs work closely with a range of organisations and services to consider the whole needs of a family when providing health and care support. In preparing the integrated care strategy, the integrated care partnership must involve local Healthwatch and the people who live or work in the area. We are working with NHS England and NHS Improvement on bespoke draft guidance, which will set out the measures that ICBs and ICPs should take to ensure they deliver for babies, children and young people. This will cover services that my noble friend considers part of family help.
In addition, the independent review of children’s social care is still considering its definition of “family help”, and the definition published in The Case for Change may well be further refined as a result of ongoing consultation. It would be inappropriate to define the term in legislation at this stage, pre-empting the full findings of the review and the Government’s response to it. Also, it is important that there should be a degree of local determination as to what should be included in the strategies of ICBs and ICPs. In order for them to deliver for their local populations, a permissive approach is critical.
On Amendment 167, we agree that family hubs are a wonderful innovation in service organisation and delivery for families. The great thing about them is how they emerged organically from local councils over the last decade. I pay tribute to my noble friend for the key role he has played in advocating family hubs and bringing this innovation to the heart of government. The Government strongly support and champion the move but we are clear that they have to be effective and successful—they need to be able to adapt to local needs and circumstances. They also need to be able to operate affordably, making use of a diverse range of local and central funding streams.
In both these regards, local democratically elected councils should hold the ultimate decision-making power over whether to adopt a family hub model and how it should function. As such, I regret that we cannot support the amendment, which would place too much prescription on the decisions and actions of local authorities and risk imposing significant new financial burdens. For this reason, I ask my noble friend to consider withdrawing his amendment.
Lord Farmer (Con)
My Lords, I thank the Minister for his rather disappointing reply and those who supported these amendments, particularly the noble Baroness, Lady Tyler, and my noble friend Lady Wyld, for giving such clear definition to the services and the advantages of family hubs. I take to heart the advice from the noble Lord, Lord Mawson, about unintended consequences. I would quite happily talk to him about this. I also take the point from the noble Lord, Lord Warner, that it is nought to 19, not nought to five. Families have so many problems with teenagers, as we see on the streets today, and family hubs can be a non-stigmatising place where help can be got.
I agree with the noble Baroness, Lady Merron, about Sure Start. In a way, I have always said that family hubs are building on Labour’s Sure Start centres. However, it is not nought to five but nought to 19—in fact, nought to 25 for children who come out of the care system, et cetera, with special needs.
There might be concern that my amendments attempt inappropriately to set in concrete the policy of family hubs when it is constantly progressing. However, the changes I have described are not just about bringing the latest policy idea into the Bill. Absent of these references to places where families know that they can access help and be connected to the full gamut of local services and support, the Bill will not reflect the overarching direction of travel. Their inclusion requires health to be fully on board, which has not happened in the past, to the detriment of the success of previous policies.
Lord Mawson
“223CZA Financial duties of NHS England: the principle of subsidiarity(1) NHS England must exercise its functions in accordance with the principle of subsidiarity, and must promote the principle throughout the integrated care system in particular by ensuring that integrated care boards observe the principle.(2) The principle of subsidiarity is that responsibility for deciding how and where to use resources is as far as possible to be delegated to local areas in order to meet local needs and to promote local groups working collaboratively.(3) In doing so, the process and timing of procurement should take account of the benefits of long-term relationships and stable partnerships in delivering sustainable integrated solutions to local health issues.”
Lord Mawson (CB)
My Lords, I have listened carefully to the debate taking place in Committee over the last few weeks with great interest and noted the growing consensus that now exists across this Chamber for transformation and change. These debates have shown the House at its best. It is clear that the Government now have before them an opportunity to transform not only the NHS, its culture and its ways of working but the public sector, much of which is not fit for purpose in this century. People inside and outside these systems know this—listen to those who are leaving for early retirement.
As well as listening, I have been talking to colleagues around the country: those inside the NHS systems; those responsible for the development of the ICSs; and those outside who seek to transform the health and care world and who wish to partner with these systems. I will share a few concerns that I have heard, because they relate to my two amendments, Amendment 159A and 210A.
First, colleagues both inside and outside NHS systems have heard fine words from Governments before about change and transformation in health and care, but they are sceptical. They know that the Civil Service and government systems and mindsets are not fully fit for purpose. The Civil Service’s culture and mindset need to transform; it needs to get interested in what is happening among young entrepreneurs in Bradford, for example. The voluntary and social enterprise sectors need the Government to go beyond fine words and deal with, for example, the situation that my colleagues at the Bromley by Bow Centre have to deal with every day as they navigate—as the noble Baroness, Lady Cumberlege, mentioned last week—41 different funding streams coming up the silos from the Treasury, at enormous cost and wastage of time, as they try to deliver integrated services. If we are to build a more integrated health and care programme, these practical issues are going to get worse—not just in east London but across the country—unless we address this now.
Many years ago, we had a secondee from the Treasury in Bromley who told us how all tax revenue was paid into one bank account. How much does it cost to then spread this out across 41 government departments and programmes, only for it all to be brought back together to address the multiple, complex and interlocking issues that somewhere like Bromley by Bow faces? How much cost does all this add? No one knows. Is it 20%, 30% or more? No wonder we have a productivity crises.
The Single Regeneration Budget programme was an early attempt, some years ago now, by the Civil Service and the Government to bring funding streams together. What lessons have been learned in government and the Treasury from it? I suspect there is no memory of this programme in the system.
There is also a danger of the NHS and public sector culture imposing itself on the voluntary and social enterprise sectors, as they try to innovate and generate new ways of working—what I call putting old men in new clothes. I have seen this in the housing association movement, which I was involved with in the very early days, and in what happened to children’s centres, which were launched in Bromley-by-Bow by a Labour Government, which then unwittingly undermined our integrated model and ways of working with local families.
My colleagues in parts of the country can already see the NHS centrally trying to impose its old processes on them as they innovate, at the very moment there needs to be a two-way street and real learning taking place. The centre needs to learn from the micro, from the innovation platforms we have created, not impose its outdated systems on them. Government needs now to show a clear resolve to transform the culture of the NHS or people will become even more cynical. The whole system and culture desperately needs change, and the way into this is via the micro and practical details.
Yes, it will take time, but first we must be clear about why we are taking these initial early steps and where we are trying to get to. There is a real danger of our Civil Service systems unwittingly deepening poor-quality outcomes and a dependency culture. The centre should see these innovation platforms as a place that can teach the centre, not the other way around. I declare my interests here. We need new behaviours from NHS England, not last-minute processes that want everything tomorrow. The macro needs to learn from the micro; the whole system needs to return to first principles and create an environment which encourages healthy communities.
Levelling up is surely about addressing the UK’s productivity gap, especially in marginalised communities, and one way of doing that is via a healthy and thriving population. It is also the only way to stop the NHS taking an ever-greater percentage of the UK’s GDP. I suggest health is now everybody’s business.
My two amendments fit within this mindset and suggest some first steps that could be taken along this road. Let me now deal with my first amendment, Amendment 159A. True subsidiarity cannot be achieved without delegation of resources and the authority to allocate in a way which will achieve the intended and agreed objectives. For example, systems may wish to ensure that discretionary local services such as community centres, community transport, struggling family support and meals on wheels should be prioritised and sustained ahead of further spend on health capacity, given their key role in supporting ongoing independence and social cohesion and preventing the need for health services.
Place systems may choose to pool delegated resources in order to commission collaborative services at scale, where they jointly agree that they are not best placed to provide such services, and such discussions are already taking place in mature systems. For example, in north-west Surrey we have agreed to jointly commission dermatology services across two place systems. The point is that delegation to place does not work against the development of services at a wider scale where that is appropriate, but the recognition of this needs to come from the place level.
True transformation—true to the spirit of the Bill and the long-term plan and to achieving the intended benefits of integration—cannot be achieved without the freedom to invest those resources in a way which can unlock long-term benefits. This may require speculative investment in some cases, as well as investment in preventive services which do not offer rapid returns but are essential to maintaining the ongoing sustainability of services. We would not expect any of this to be done without due diligence on the capability of place-based partnerships and appropriate levels of holding to account for achievement of improvements and results. The ICS will have a key role in not only ensuring that funds are delegated appropriately but supporting place-based systems to build the capability to manage delegated funds effectively.
We need to make leaps in how health services are now delivered through integrated services and offers to populations, by thinking radically about who can support people best, and in what way, to keep them healthy, look after them at home where possible and provide services which understand people as individuals and meet their needs holistically.
This degree of change in public health, prevention and provision of services needs innovative and broad-based collaborations and partnerships between organisations—health organisations, local authority organisations, VCSE and business—tailored to fit the needs of the place. These relationships are not quick to build; they take time and effort. The work takes years and the impact can be seen only through long-term relationships and stable partnerships. For this to succeed, the ICS will need to embrace the principle of subsidiarity, delegating meaningful responsibilities and accompanying budgetary responsibility to place level. This may mean that standard procurement cycles and processes do not immediately bring the outcomes that the Bill envisages. More innovative processes and timings may be needed to ensure that the benefits brought through long-term relationships and stable partnerships are given time to be achieved.
Let me now deal with Amendment 210A. In general, NHS bodies do not currently make best use of their local voluntary community, social enterprise and faith sectors when procuring services to achieve key health outcomes, especially in prevention and early intervention services. This is all well understood but, somehow, we never seem to get beyond one-off experiments or short-term, time-limited initiatives. By contrast, the best local authorities have been procuring and partnering with their VCFS for many years, though this has become more difficult with recent funding pressures. There is an opportunity, therefore, for health colleagues to learn from their local authority colleagues in the ICS on best practice in this regard.
With NHS vacancy rates at their highest levels, together with waiting lists for treatment, now is the time to take a whole-system approach and look more collaboratively across the local community. There is also a strong value-for-money argument. Simply waiting for people to become seriously ill, which is what is happening in practice at the moment with regard to many mental health services—but not by design—and could equally be applied to services for struggling families, leads to very poor outcomes and is very expensive. Using VCFS organisations and others, with a combination of staff and local volunteers to create a coherent health-oriented rather than illness-oriented approach, will pay dividends, but only if there is real intention and focus over a sustained period of time. This is a long-term play, not a quick win, but vital none the less.
Traditional models are not working for the groups which can offer most value. Local charities and social enterprises tend to be funded on a hand-to-mouth basis using grants, so most cannot permanently invest in their services. This is despite a huge growth in charitable giving from the public, directed in the main at the NHS.
In north-west Surrey, we are looking at how we can give similar prominence to local charities supporting areas of deprivation and communities in need, but more needs to be done to enable charities and voluntary sector groups to be assured of ongoing funding to provide core services. Keeping such VCS groups active is essential to achieve insight into the needs of communities. There are innovative approaches such as Tribe, a platform developed by a technology business- person, Richard Howells, simply because he had become so frustrated by the inabilities of the NHS and care services to deal with his own mother’s care needs. Richard did not write a research paper; he created a practical solution, which is pretty impressive. When he shared this practical solution with the NHS centrally, there was a lot of interest and fine words but, in actual detail, no follow through.
We now need to allow these insights at the most granular level to inform the commissioning and targeting of services. Without this, we will not be able effectively to respond to specific areas of inequality or health risks, leading to ill health and pressure on services. The existing models of voluntary sector support need to be developed to enable and promote micro- enterprise creation on a far greater scale. This both protects the quality of services and enables individuals to gain training, support and income. It has the potential to open up a currently untapped resource of care support, which is critical in places such as north-west Surrey, where community care staff vacancies run at around 40%.
Employment and volunteering are themselves key determinants of well-being. Place-based systems will wish to use their spending power to leverage this benefit and invest directly in local employment, where it can be demonstrated to be the most effective use of resources. In north-west Surrey, we have achieved a virtuous cycle of supporting furloughed airline workers during lockdown through recruiting them into the hospital workforce, supporting the delivery of services and well-being of clinical staff, and reducing the risk of those individuals developing physical or mental health problems through inactivity and stress.
The Deputy Chairman of Committees (Lord Duncan of Springbank) (Con)
I now call the noble Lord, Lord Howarth of Newport, who will be taking part remotely.
Lord Howarth of Newport (Lab) [V]
My Lords, I support the spirit of these amendments. The noble Lord, Lord Mawson, in his working life at Bromley-by-Bow and more recently in north-west Surrey, and in his very full speech, has demonstrated the significance to healthcare of the principle of subsidiarity, the freedom to innovate and the mobilisation of community resources. If ICSs are to mobilise the full power of place this must indeed be a governing principle.
Although there might be definitional issues to clarify, I particularly applaud the ambition expressed in Amendment 159A that resources should be used at local discretion to promote collaboration by local groups, and that the procurement processes should take account of the benefits of stable partnerships. How could anyone dissent from that? Yet, the experience of so many non-clinical and VCSE organisations is of chronic financial instability and of promising work being aborted because of policy discontinuity.
I will give one instance of damaging discontinuity of funding. The Alchemy Project used dance as a form of early intervention in psychosis. The project was developed jointly by Dance United, South London and Maudsley, and King’s College London. Two cohorts of participants were drawn from young people in south London boroughs where the rate of psychosis is very high. With no previous experience of dance, after four weeks they performed a specially commissioned piece at the Shaw Theatre and Sadler’s Wells. Academic evaluation demonstrated clinically significant improvements in well-being, communication, concentration and focus, trust in others and team working. The project helped participants to develop relationships with their peers and restore relationships with their families. The Alchemy Project had to be abandoned, however, when a fragile consortium of funders did not renew its funding. ICBs and ICPs will need to be less fickle and less prodigal, bolder in supporting innovation, and more consistent and farsighted in their relationships with their providers and communities.
Baroness Cumberlege (Con)
My Lords, I also support these amendments. Earlier in Committee, I described the noble Lord, Lord Mawson, as
“a man of infinite resource and sagacity, an entrepreneur and … a great achiever”.—[Official Report, 18/1/22; col. 1575.]
I am sure that, if noble Lords are not convinced, these amendments will further endorse my description.
I now add that the noble Lord is a very determined reformer. He has told us how the present systems serving the public are not fit for purpose. The Government are trying through this Bill to remedy that through greater integration and other measures. It was Edmund Burke who said that, if you want to preserve something important, you need to be prepared to reform it. Our systems are important and need reforming.
Amendment 159A is about the financial duties of the NHS in England and solidarity. In the previous debate, I mentioned Bromley by Bow, as the noble Lords, Lord Mawson and Lord Howarth, said. Bromley by Bow was the forerunner of other imaginative, ground-breaking and huge entrepreneurial schemes in the north of England, London and Surrey. The examples are breathtaking but they cost energy, hard work, original thinking and money. It is sad that these scarce resources are dissipated by the convoluted systems that we, the nation and the Government impose on burgeoning and, at the beginning, fragile schemes. However, Bromley by Bow is not one of these. It is well established but not secure due to having to navigate 41 different funding schemes, as the noble Lord, Lord Mawson, said. Huge effort and wasted time are spent trying to integrate these schemes for the use of a single neighbourhood centre.
I strongly support Amendment 210A. The noble Lord is right: he paints a compelling picture of the future, which will be realised only if our public health, prevention and provision of services collaborate in partnership with local organisations. They understand the history, dynamics and strengths that permeate their local place—their neighbourhood. The noble Lord is also right that, to thrive, ICSs will have to embrace the principle of solidarity, which is the essence of a successful project; that includes the financial duties of NHS England.
I have lived in my community from the age of five. In another debate, I said that my father, a GP, knew his patients inside and out. I, too, know my villagers inside and out in a different way. I treasure the relationships I have made with local organisations. We fight for every shop and organisation that is threatened. We welcome newcomers. We have produced a pocket list of 45 organisations with a mantra on the front saying, “Newick”—my village—“is here for you”. It goes on to say that there is so much going on in our village and there is something for everyone, whether you would like a new hobby, to make new friends or just give something back to the community. Get active, get involved and get happy.
I strongly support Amendment 210A, which urges local providers in particular to be prioritised. I certainly support that. This is not about get-rich-quick developers, who have no regard for the nature of the community in which they are going to build, building bricks and mortar. In our village, we fight for employment, which is absolutely critical in local communities. It reduces traffic problems and helps to mitigate global warming. Above all, it goes some way to generating happy communities. It generates the Government’s intention to make place an important component of a stable community. Surely that is what we all want.
Baroness Thornton (Lab)
My Lords, we on these Benches said everything we needed to say on this matter in support of the noble Lord, Lord Mawson, when we had the substantial debate. I do not know when it was—last week, I think. These two amendments flow from that. We probably could have taken them then, but I am sure that the Minister will have useful things to say.
Earl Howe (Con)
My Lords, we return to the very important theme of subsidiarity, to which the noble Lord, Lord Mawson, has brought us in both his amendments and his powerful speech, born of his immense experience in the real world.
I will begin with Amendment 159A, if I may. One of the main reasons for introducing this Bill was to ensure that existing collaboration and partnership working across the NHS, local authorities and other partners was built on and strengthened. This relates especially to the framing and monitoring of assessments and strategies. We intend for these assessments and strategies to be a central part of the decision-making of ICBs and local authorities. That is why we are extending an existing duty to ICBs and local authorities to have regard to the relevant local assessments and strategies. Furthermore, the integrated care board and local authorities will both be directly involved in the production of these strategies and assessments through their involvement with both the integrated care partnership and the health and well-being boards. As a result, they have a clear interest in the smooth working of the ICP.
More widely, there are already several mechanisms to ensure that ICBs and local authorities will have regard to the assessments and strategies being developed in their areas. First, health and well-being boards have the right to be consulted by ICBs and give NHS England and ICBs their opinion on whether the joint forward plans take account of the joint local health and well-being strategy. Likewise, as part of its annual assessment of ICBs, NHS England must consult each health and well-being board on how well the ICBs have implemented the relevant joint local health and well-being strategies.
There are what one might call insurance policies embedded in these arrangements. Each ICB must also include in its annual report a review of the steps it has taken to implement any relevant joint local health and well-being strategy. It must also consult the health and well-being board when undertaking that review. Finally, NHS England has formal powers of intervention if an ICB is not complying with its duties in any regard. Putting all this together, we think that it is sufficient to ensure that ICBs will have regard to both ICP and health and well-being board plans.
The emphasis is on collaboration. Implicit in that concept is the two-way street on the sharing of ideas and exemplars that the noble Lord, Lord Mawson, called for and illustrated in his examples. Given the strong collaborative measures in the Bill and the strong foundations of collaborative and partnership working across the NHS, local authorities and other partners on which this Bill is built, we do not think that further provision is required. We would expect an ICP to resolve disagreements through discussion and joint working rather than additional, potentially burdensome procedures.
Amendment 210A brings us once again to the role of non-statutory organisations in helping to create and sustain healthy communities. I want to stress straightaway that the Government hugely value the contributions of the voluntary, community and social enterprise sectors to the health and well-being of the nation. We recognise their important role in supporting the health and care system.
The Government fully expect that commissioners will also recognise this contribution and role going forward. This role will be particularly important in efforts to recover performance and move beyond a purely reactive service to building a sustainable and personalised health and care system, something the non-statutory sector is uniquely placed to offer. I think the lessons learned, so well described by the noble Lord, Lord Warner, in the previous set of amendments, are widely accepted nowadays.
Lord Mawson (CB)
My Lords, I thank the Minister for those helpful thoughts and reflections. First, on NHS England, we need to be very sure that a two-way street is established, because I worry that systems such as this are not learning organisations—we know this from experience—and they now need to become such if they are really to embrace an environment that is about innovation and more entrepreneurial activity. I put that on the record. We will watch what happens; I am sharing with noble Lords what is actually happening now, live, in some of these services around the country as they try to establish new ways of working.
I pass on apologies from the noble Baroness, Lady Andrews, and the noble Lord, Lord Clement-Jones. They have supported these amendments but, because of the change in the timetable, were not able to be with us today. This debate is being watched around the country, and I am aware of a very interesting dialogue going on with people both inside and outside the system. We should all be encouraged by that and should build on it.
With regard to the Report stage and to these two amendments and my earlier amendment, my colleagues and I, with others in the system, will reflect on these discussions. We will, I hope, talk further with the Minister and other colleagues and think about what the next steps might be. For now, I beg leave to withdraw my amendment.
Baroness Chisholm of Owlpen (Con)
My Lords, if my noble friend Lord Lansley agrees, this might be a good moment to stop for lunch, rather than him having to start and stop perhaps mid-speech on his amendment.
UEFA Euro 2020 Final
(2 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Bassam of Brighton
To ask Her Majesty’s Government what progress they have made with football authorities towards addressing the (1) safety, and (2) security, implications of the report by Baroness Casey of Blackstone An independent Review of events surrounding the UEFA Euro 2020 Final ‘Euro Sunday’ at Wembley, published on 3 December 2021.
The Parliamentary Under-Secretary of State, Department for Digital, Culture, Media and Sport (Lord Parkinson of Whitley Bay) (Con)
My Lords, I begin by putting on record again our appreciation of the sterling work of the noble Baroness, Lady Casey of Blackstock, on this review. The Government recognise the critical importance of the safety and security implications of her report. We are now working with relevant parties, including the police and the football authorities, to consider not only those implications but the report’s recommendations in full. We are committed to ensuring that the UK continues its world-leading reputation for holding safe and successful major international sporting events.
Lord Bassam of Brighton (Lab)
My Lords, the noble Baroness, Lady Casey, described the crowd events at Wembley’s Euro final as a “near miss” for fatalities and life-changing injuries and said that we need a national conversation about kicking racism and hooliganism out of football. Can the Minister tell us what plans the Government have for taking forward her six recommendations in full to improve safety, security and behaviour at football matches? Why did the Government not use the recent opportunity of a police Bill to incorporate new tailgating and drug-disorderly football banning orders, and to create a new offence of endangering public safety, as the report recommended?
Lord Parkinson of Whitley Bay (Con)
My Lords, we acknowledge that the review shows that these events were foreseeable, but they were unprecedented. As in the previous exchange we had on this, it is important to underline that the blame lies squarely with the minority of supporters who caused the disorder and aimed to spoil the day for everybody else. It is clear that in future, we must ensure that the safety and security arrangements for an event such as this are in line with its national significance. The review was commissioned by the FA, so the Government do not intend to respond formally as the Government; the key thing is taking action. We are working with partners to ensure that we learn from it and that the recommendations are appropriately implemented. I pay tribute to the noble Lord for his recommendations on the online abuse of footballers, which were taken forward in the police Bill.
Lord Addington (LD)
My Lords, will the Government go a little further on their attitude to some of the recommendations in the report, predominantly that the stewards—the people inside provided by football to look after its own—were insufficient in number and not properly trained for this event? Could not the Government take this forward with the police to ensure that we have security at such events and do not overload our police forces?
Lord Parkinson of Whitley Bay (Con)
As I said, we are working with the police on the implications of the noble Baroness’s report. Work is also being undertaken by the Sports Grounds Safety Authority to gather evidence on stewarding. Once that is concluded, the Government will work with it and other relevant parties to see how the findings are applicable not just to football but across the events industry.
Lord Cunningham of Felling (Lab)
My Lords, this event brought shame and disgrace on our country as a whole, as well interfering with the championship game. The Minister mentioned the involvement of the police. How close have the police so far got to identifying who was behind this event? You do not produce 6,000 people storming a national football stadium very easily, so someone must have organised it. Are the police pursuing that line of interest?
Lord Parkinson of Whitley Bay (Con)
My Lords, the noble Lord is right that some of the actions that we saw on 11 July were shameful. The report is clear that the responsibility for the reckless and criminal behaviour lies with the shameful individuals who perpetrated it. The police have made 39 arrests and the investigations are continuing. I am afraid I cannot give more of an update on those police inquiries beyond that, but action is being taken by the police in this matter.
Lord McLoughlin (Con)
My Lords, in the discussions that the Government are having with the football authorities, could they also have one with the EFL about the appalling way it seems to be communicating its attitude towards the future of Derby County Football Club, which was one of the founding members of the Football League? The EFL seems to be deliberately withholding information. Perhaps one way out of this would be to make it subject to the Freedom of Information Act.
Lord Parkinson of Whitley Bay (Con)
My Lords, the Government continue to engage closely with the EFL about Derby County. Ultimately it is for the EFL, the administrator and the club to resolve the issues that remain in order to ensure the survival of the club, but the Government have urged pragmatism from all parties to find a solution. Everyone wants to see one of the founding members of the Football League continue this season and beyond under appropriate ownership, and openness and transparency are a key part of that.
Lord Faulkner of Worcester (Lab)
My Lords, the Minister will recall that on 6 December he answered a Private Notice Question on the excellent report by the noble Baroness, Lady Casey, when I declared my interest as vice-president of the charity Level Playing Field. Particular recommendations were made in respect of disabled supporters, disabled access to the stadium and the disgraceful way in which thugs effectively overran them. Would he be willing to meet representatives of Level Playing Field—the chairman, the chief executive and perhaps me—to discuss what the next steps should be?
Lord Parkinson of Whitley Bay (Con)
The noble Lord is right that the way in which football fans with disabilities, their friends and those accompanying them were tailgated and exploited by people intent on doing disorder was shameful. I think a meeting with my honourable friend the Sports Minister would be more appropriate. I am sure he would be very happy to do that, and I will follow that up with the noble Lord.
Lord Laming (CB)
My Lords, I am sure the Minister agrees that the noble Baroness, Lady Casey, deserves great credit for the speed with which she produced her thorough report, which is very practical and is to be taken seriously. But, my goodness, since then it seems to those of us who have been following this that very little action has been taken on her recommendations, yet incidents continue to happen at football grounds, as has been reported in recent games. Could the Minister use his good offices to encourage the Football Association and others to address the report, not just thoroughly but with some speed?
Lord Parkinson of Whitley Bay (Con)
I am happy to echo what the noble Lord says about not only the speed but the thoroughness with which the noble Baroness undertook this work. The report’s recommendations are extremely valuable and are being taken forward by the relevant parties. The Football Association has apologised for its role in what happened on 11 July, as is right. The Government are working with the FA, the Sports Grounds Safety Authority, the police and others to make sure that they are taking the appropriate action on the recommendations that relate to each of them.
Lord Clark of Windermere (Lab)
My Lords, I declare my interest as a director of Carlisle United Football Club. When the Minister refers to working with the football authorities, will he bear in mind that on an average weekend more people attend Football League matches than attend Premier League matches? When the Government are working with the football authorities, will they constantly remind them of that fact?
Lord Parkinson of Whitley Bay (Con)
The noble Lord is right and he makes an important point. The vast majority of people who enjoy playing and watching football do so peacefully and bring great enjoyment and health benefits to themselves and those around them. It was a minority of people on 11 July who marred what should have been a very special day for football fans, not just in this country but around the world, and it is right that the blame for what happened lies squarely on them.
Lord Kennedy of Southwark (Lab Co-op)
My Lords, the noble Lord, Lord McLoughlin, talked about how important it is to make sure that we save Derby County Football Club. My club is Millwall, but I have been to Derby County many times, both to the old Baseball Ground and to Pride Park. It is a fabulous club; it needs our support, and the Government need to press the Football League to save it.
Lord Parkinson of Whitley Bay (Con)
As I said, the Government continue to engage closely with the English Football League and have urged pragmatism so that a resolution can be found and that they can continue to play against Millwall and other football clubs.
Lord Londesborough (CB)
My Lords, we are seeing increasing pressure being put on match day stewards, who are paid as little as £9 per hour to control football crowds, while police presence in many grounds is decreasing. Is this the way to face off the increasing challenge of rising violence across all four divisions? Surely we need an increase in police presence. Does the Minister agree?
Lord Parkinson of Whitley Bay (Con)
The noble Baroness’s review clearly stated that many stewards showed huge bravery and courage that day. The action taken by them and by the police in difficult and unprecedented circumstances may have saved lives, so we should be grateful to them all. An unprecedented number of police were deployed to the stadium, but the noble Baroness’s report makes some important recommendations for the police, for stewards, for the FA and for others, and we are making sure that they are all taken forward, as they should be.
Electric Vehicle Charge Points
(2 years, 10 months ago)
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Lord Berkeley
To ask Her Majesty’s Government why they have removed the requirement for there to be an electric vehicle charge point in all existing non-residential properties with more than 20 parking spaces; and what assessment they have made of the implications of this change for their net zero target.
The Parliamentary Under-Secretary of State, Department for Transport (Baroness Vere of Norbiton) (Con)
My Lords, we believe that a more ambitious and tailored approach is needed for existing non-residential car parks. We have already progressed this policy and are currently analysing feedback from a further consultation on the future of transport regulatory review. The noble Lord asks why proposals have been removed. I am unclear as to where he feels they have been removed from.
Lord Berkeley (Lab)
My Lords, I got this information from the Government’s Consultation Response: EV Charge Points in Residential and Non-residential Buildings, dated November 2021. The executive summary says:
“The Government will not introduce the proposed requirement for one charge point in all existing non-residential properties with more than 20 parking spaces.”
To me, that means that they have cancelled the need to put charging points in existing car parks. Maybe they do not think charging points are necessary; maybe we do not need electric cars. It is a bit of a confusing policy.
Baroness Vere of Norbiton (Con)
I understand why the noble Lord might have been a little confused by that sentence. It is not the case that we are not going to do it at all; rather, we are not going to do that specific proposal. The feedback we received from our original consultation back in 2019 suggested that the proposals were not ambitious enough and that details on the implementation and the impact were unclear. We agreed that perhaps we could be more ambitious. That is why we consulted again on the future of transport regulatory review, which closed on 22 November. It sought further views on this topic. Proposals in this area are absolutely still under consideration; we just want them to be as ambitious as possible.
Lord Geddes (Con)
My Lords, sequentially over the past 10 years, I have been the owner of two hybrid cars but I am anxious to buy an all-electric car. I have yet to find one that can get to and from my home in Wiltshire without having to be recharged. What plans do the Government have for installing electric charge points within the Palace of Westminster and particularly Royal Court?
Baroness Vere of Norbiton (Con)
Oh, my Lords. I am well aware that several noble Lords have repeatedly requested EV charging facilities at your Lordships’ House. The Government clearly cannot direct the powers that be in your Lordships’ House to install a charging point, but this member of the Government is disappointed by the lack of leadership.
Lord Birt (CB)
My Lords, public charge points often do not work. There is a multiplicity of apps and payment methods; tariffs can be opaque. Does the Minister accept that EV charging needs to be as seamless as buying petrol? Will she accept that the Government must urgently bring much-needed order to our chaotic public charging system?
Baroness Vere of Norbiton (Con)
I do not quite accept that the system is chaotic. It is definitely growing and it is incredibly innovative, but that is why the Government consulted on things such as opening up public charge point data; improving the reliability about which the noble Lord speaks; streamlining payment methods, which is incredibly important; and increasing price transparency, so that people know how much they are going to be charged. We will publish the response to this consultation very soon, and we will lay legislation this year.
Baroness Randerson (LD)
My Lords, only last Saturday, I was standing in a car park trying to download yet another app, only to discover that the EV charger was not working—again. Achieving net zero requires all drivers to switch to EVs, not just those of us with space to install our own charging points. SMMT figures show that only one new public charger is being installed for every 52 new electric vehicles registered, and that ratio has been getting worse. What urgent plans do the Government have to improve this record and to ensure that charge points are properly maintained and accessible with an ordinary credit or debit card?
Baroness Vere of Norbiton (Con)
I will not repeat what I have said about the consultation. Certainly, payment and reliability will all be parts of our response to that. The noble Baroness will know that 80% of charging happens at home; the Government are therefore supporting people to put in their own chargers at home where they are able to. For those who are unable to, we are very much focused on on-street charging near homes and offices, and we are providing funding for that to happen.
Lord Flight (Con)
My Lords, I discovered to my surprise some time ago that Westminster did not charge for charging. Is there a system whereby all local authorities and providers can be organised to render appropriate charging?
Baroness Vere of Norbiton (Con)
I apologise to my noble friend—I was not aware that Westminster did not charge. That may be an anomaly and not something that can go on for ever.
Lord Watts (Lab)
How difficult would it be to adapt street lights to be charging points?
Baroness Vere of Norbiton (Con)
The noble Lord is stretching my technical knowledge at this point. I am sure that those things are being considered. Obviously, the Government are working closely with the industry on the design of charging points, because we want to make sure that they are accessible and do not obstruct the pavement—and we have seen much innovation in the area.
Lord Walney (CB)
It is good that the Minister acknowledges the problem of reliability, which is a particular issue on the motorway network. Does the suite of her responses include increasing fines for companies when their charge points are out, which is all too common? They need a greater incentive to comply.
Baroness Vere of Norbiton (Con)
That, of course, is a very serious consideration: we need to make sure that companies do not just stick up a charge point and then leave it there unmaintained and, therefore, unreliable. We will be considering all options as we respond to the consultation.
Baroness Jones of Moulsecoomb (GP)
The Minister has mentioned on-street parking and not on-pavement parking. Is any advice given to councils, because an awful lot of them put the chargers on pavements, which obviously makes life harder for pedestrians?
Baroness Vere of Norbiton (Con)
The noble Baroness raises a very important point. I do not know what guidance exists on the siting of EV chargers. I shall take that back to the department and write to the noble Baroness.
Lord Kirkhope of Harrogate (Con)
My Lords, further to the question from my noble friend Lord Geddes about these premises being non-residential and having at least 20 car parking spaces, I realise the difficulties, but I wonder—particularly given that, as the Minister will know, we are a little hard up at this end—whether in her beneficence she might be able to ask her department to assist with the financing of the necessary chargers for their Lordships.
Baroness Vere of Norbiton (Con)
I would be a little cautious about that. It may look as though the Government were feathering the nest of Parliament, and I do not think that would be a good idea.
Lord Rosser (Lab)
The Competition and Markets Authority reported last July and urged the Government to intervene in the electric car charger market to prevent what it described as “charging deserts” and increase availability in locations outside London that remain underserved. As I understand it, across the UK there are huge regional inequalities in the number of available charging points. In London, there are 80 charging devices per 100,000 people, but in Yorkshire, for example, there are fewer than 20 per 100,000. What steps are the Government taking to support new charging points in areas that are currently lacking? If the answer is “not very much”, it just shows that the Government’s levelling-up slogan is just that—a slogan—and no more.
Baroness Vere of Norbiton (Con)
The Government encourage every local authority to look at its local needs. We have a fund of £20 million per year to which 135 local authorities have already applied. That fund is there to put chargers in local areas where there are fewer publicly available chargers and there will be a local EV infrastructure fund launching soon.
Lord Bird (CB)
Will the Minister return to the argument of the noble Lord, Lord Berkeley, that this is a retrograde step? If we are talking about levelling up, we need to level up the relationship between the electric motor and the petrol engine. Will she tell us again why what the noble Lord, Lord Berkeley, says is happening and why she is saying it is not happening?
Baroness Vere of Norbiton (Con)
It is happening; it is just not happening yet, because the original proposal—
Baroness Vere of Norbiton
It will be happening! The original proposal, we felt, was not good enough; indeed, stakeholders agreed it was not good enough, so there will be proposals for existing non-residential car parks. We will consider carefully how we can make those as ambitious as possible and make sure they have the impact we want to see.
Racism in English Cricket
(2 years, 10 months ago)
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Lord Addington (LD)
My Lords, on behalf of the noble Lord, Lord Mann, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.
The Parliamentary Under-Secretary of State, Department for Digital, Culture, Media and Sport (Lord Parkinson of Whitley Bay) (Con)
My Lords, the Government are clear that racism has no place in cricket, just as it has no place in any sport or in our society at large. We welcome the steps taken so far by the England and Wales Cricket Board and the new chairman of Yorkshire County Cricket Club, the noble Lord, Lord Patel of Bradford. These steps are only the beginning. We now expect to see clear and sustained evidence of cultural change across the sport resulting from them. We will continue to hold the ECB to account directly on this and reserve the right to take further measures if necessary.
Lord Addington (LD)
I thank the noble Lord for that reply. I join him in saying that the noble Lord, Lord Patel of Bradford, is really doing us all a service here in taking this on. Will the Government give us an assurance that this will not be something that sticks with cricket, but that they will look wider and make sure that all sport learns from what is found out, and also that cricket will have to learn the lessons learned in other sports? Otherwise, we are in danger of having small reports and struggles repeating themselves over and over again.
Lord Parkinson of Whitley Bay (Con)
I certainly agree with the noble Lord about the important role being played by the noble Lord, Lord Patel of Bradford. Just as in the previous Question about football, it is a commendation of your Lordships’ House that it is from this House that work to deal with these important issues is coming. I was very glad that the noble Lord, Lord Patel, held a briefing with interested Peers on Monday, ahead of this Question, to update them on the work he is doing. He made very clear that, while his focus is on sorting out the problems in Yorkshire, he is drawing on the experiences of people from other sports, and the lessons that he is learning and the actions he is taking have implications for other sports and, indeed, other parts of society.
Lord Cunningham of Felling (Lab)
My Lords, does the noble Lord have an opinion about the abysmal performance of the Middlesex chairman in front of a House of Commons committee in the last few days when he displayed all the racism that too many white people at senior levels in cricket in this country seem to adhere to?
Lord Parkinson of Whitley Bay (Con)
I agreed with Ebony Rainford-Brent who called Mr O’Farrell’s comments at the Select Committee “painful” and “outdated.” I am glad to see he has apologised for them, but I share the dismay of many in hearing them. I think it also underlines the important point that racism takes many forms: it can be a sin of commission as well as of omission. It is good if people are focusing on the barriers that might be holding people back from participating in society, but it is completely wrong to stereotype people on the basis of their race or ethnicity, and that is why it was so dismaying to hear what he said yesterday.
Lord Haselhurst (Con)
My Lords, I declare my interest as a member of Yorkshire County Cricket Club, and Middlesex, and others. Does my noble friend acknowledge that the sweeping changes that have been made at Yorkshire County Cricket Club under the direction of the noble Lord, Lord Patel, indicate the sort of measures that may have to be taken more widely in sport to ensure that potential players, spectators and lovers of sports can find a real welcome when they are involved, either as players or as members?
Lord Parkinson of Whitley Bay (Con)
Like my noble friend, I was impressed by the summary given by the noble Lord, Lord Patel of Bradford, of the work that he has undertaken since he became the chairman of Yorkshire County Cricket Club nine weeks ago. He outlined the many actions that are being taken, and I agree that these will have a wider application for other cricket clubs and other sports.
Lord Hunt of Kings Heath (Lab)
My Lords, has the Minister seen the reports that many county cricket clubs charge huge amounts of money for young players who have been identified as having particular skills to go into training programmes? He will know that there is a concern at the higher reaches of cricket that there is a dominance by pupils from public schools. Does he not think that the ECB needs to take action to make sure that these training programmes are open to everyone?
Lord Parkinson of Whitley Bay (Con)
The noble Lord, Lord Hunt, is right: there are many barriers which hold people back, and the Government are working with Sport England and other agencies to dismantle those barriers and make sure that everybody has the opportunity to participate in sport, whoever they are and wherever they come from. There is obviously work for the ECB to do, and lessons are being learnt in Yorkshire at the moment, but the noble Lord is right that these barriers go beyond matters of race.
Lord Dholakia (LD)
My Lords, Yorkshire has shown clearly how racism had affected cricket in the past and, thanks to the effort of the noble Lord, Lord Patel, that things are now improving. I would like to know what is being done in youth clubs and schools to ensure that people from diverse communities are aware that racism should not be a bar in pursuing a career in cricket?
Lord Parkinson of Whitley Bay (Con)
Over the last four years, Sport England’s investment in the ECB has focused on equality and diversity, with a commitment to fund, for instance, its south Asian action plan and its south Asian female activators project, to give just two examples of how it is encouraging people from different backgrounds to take their rightful places and reach their full potential in this sport.
Lord Faulkner of Worcester (Lab)
My Lords, I declare an interest as a member of Worcestershire County Cricket Club, which has a proud record of inclusion and cultural and ethnic diversity going back over 60 years, starting with the great Basil D’Oliveira, followed by his son and this grandson, all of whom have been associated with the club. The chairman is from an ethnic minority background and his insistence on good governance and diversity is a model that other counties should follow, and the club is certainly well ahead of the ECB guidelines. Could the Government have some conversations with Mr Hira to see what Worcestershire is doing right and how others can learn from it?
Lord Parkinson of Whitley Bay (Con)
The noble Lord is right that we should point to the many happy examples of people who are getting it right and who are working very earnestly and very hard to make sure that people from all backgrounds are able to enjoy cricket, whether as players or spectators. In his capacity as president of Northamptonshire County Cricket Club, my noble friend Lord Naseby came to the briefing with the noble Lord, Lord Patel, and we are always happy to point to examples of clubs that are getting it right, and from which others can learn.
Lord Bassam of Brighton (Lab)
My Lords, we have heard this afternoon a litany of responses which focus on racism, and rightly so. For our part, it is very frustrating to see the responses of senior people in cricket, and others across the sport, who are determined to bury their heads in the sand on this issue. The announcement that Clare Connor will lead a review into dressing room culture in the men’s and women’s games is very welcome, but that must be only one part of the sport’s response. Yesterday the chair of Glamorgan County Cricket Club noted that his own club’s efforts to promote diversity were only possible after years of work to make the club financially sound. What work is the government department doing with the ECB and the clubs themselves to ensure that schemes such as those promoted by Glamorgan get off the ground and start to produce the results and make the fundamental changes that cricket needs?
Lord Parkinson of Whitley Bay (Con)
As I said, we are watching the ECB closely and reserve the right to take further action if we think that is needed. But since November, the ECB has made some structural developments for long-term cultural change, which is what we need to see, including publishing its plan for diversity and inclusion. It has also committed to forming a new anti-discrimination unit by June this year. The Independent Commission for Equity in Cricket, which was established in March 2021, has opened a call for evidence and will publish a report in the summer this year, examining all the issues relating to race and equity in cricket. We are glad to see that work is being done.
Baroness Blower (Lab)
My Lords, I am sure the Minister would like to congratulate Show Racism the Red Card on taking on Monty Panesar as a patron and a very active member of that charity, working in schools to ensure that the message of anti-racism gets through. However, I feel that the Government may very well have to do more, because those remarks made by the Middlesex chairman yesterday, to which my noble friend has already referred, were utterly appalling and speak of deep-seated bigotry and bias; he clearly thought that what he said was reasonable, while I am sure everyone in this House believes that it was not.
Lord Parkinson of Whitley Bay (Con)
I am very happy to extend my congratulations to Show Racism the Red Card. There are many organisations, individuals and role models who are doing sterling work in highlighting the issues that have been faced by so many people for far too long, pointing to the way forward and making sure that people are inspired to enjoy playing or watching their preferred sport to the best of their abilities.
Ukraine: Minsk II Protocol
(2 years, 10 months ago)
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Lord Truscott
To ask Her Majesty’s Government what steps they are taking (1) to ensure that all parties implement the Minsk II protocol, and (2) to defuse the tensions over Ukraine.
The Minister of State, Foreign, Commonwealth and Development Office (Lord Ahmad of Wimbledon) (Con)
My Lords, the Government support the Minsk protocols to deliver peaceful resolution to the conflict in full respect of Ukrainian sovereignty and territorial integrity. We have condemned Russia’s aggressive acts and are working closely with our allies and partners to hold Russia to the commitments it signed up to freely, including the Helsinki Final Act, the Minsk protocols and the Budapest memorandum.
Lord Truscott (Non-Afl)
I thank the Minister for that reply. The problem is that Russia does not see NATO as a defensive alliance—rather, it sees it as a group of countries, some of which are openly hostile to Russia, refusing to give any security guarantees while expanding eastwards to Russia’s borders. Unfortunately, the memories of NATO’s bombings of Tripoli and Belgrade are fresh. We are facing a very different series of global threats since the Atlantic alliance was formed in 1949. President Macron talked about a new security framework for Europe; perhaps this is something Her Majesty’s Government should think about to secure lasting peace for future generations.
Lord Ahmad of Wimbledon (Con)
My Lords, as the noble Lord will be aware, NATO is a defensive alliance. It was interesting to hear in the recent Statement of my right honourable friend the Defence Secretary—this is relevant to what we are discussing—that only 1/16th of the Russian border is actually shared with a NATO country. NATO is a defensive alliance, and it remains so. It is serving its purpose. We are working in unity, because what is required now is not just unity of words —it is unity of purpose and, indeed, unity of action.
Lord Robathan (Con)
My Lords, I have just been to a meeting with the Ukrainian ambassador, where we discussed the Budapest memorandum. These were assurances given by the Russian Federation in 1994 that it would respect the sovereignty of Ukraine, which, of course, included the borders with Crimea. Putin has reneged on this. Should the international community not come together and condemn this bad faith from Putin and now the Russian Federation, and do it both at the United Nations and elsewhere?
Lord Ahmad of Wimbledon (Con)
My Lords, I agree with my noble friend that what we have seen from Russia is pure aggression. We should not forget that it is an occupying power in Crimea. We have come together; we are acting together within the context of the NATO alliance. My noble friend importantly points to discussions at the UN, and I assure him that we are engaging directly with partners but also bilaterally with Russia.
Lord Purvis of Tweed (LD)
My Lords, the Normandy format is still of great importance. Are there any British officials taking part in the talks in Paris today under the Normandy process? The Minister knows that part of the Minsk II agreement is over the area of disputed territorial lines. The Prime Minister told the House of Commons yesterday:
“I think what we need to do, if I may say so, is build up an instant, automatic package of western sanctions that will come in automatically in the event of a single toecap of a Russian incursion into more of Ukraine.”—[Official Report, Commons, 25/1/22; col. 872.]
Is there agreement among all the western powers and our allies about what qualifies as incursion? We may well be asked to legislate in haste. Therefore, it is vital to know what an incursion is.
Lord Ahmad of Wimbledon (Con)
My Lords, on sanctions, let me assure the noble Lord—I know this is of interest to all noble Lords—that we are working very closely with all our allies and partners, particularly those who have such regimes. This is not an empty threat; this is a clear sanction against Russia for any incursion it makes in terms of territorial sovereignty. On noble Lord’s first question: that is not a group the UK directly participates in. We are aware of the meeting today; it is being held at political advisers’ level, and Russia is participating. I have seen some of the detail emerging, and I would not hold out too much hope as yet.
Lord Morris of Aberavon (Lab)
My Lords, as a young NATO soldier, I was occasionally in charge of the nightly train from Hanover to Berlin, to establish our rights of passage, despite Russian intransigence. Will the Government, while continuing to affirm our rights, use every diplomatic means to reduce fears of any expansion of NATO that may not have much practical importance?
Lord Ahmad of Wimbledon (Con)
My Lords, as the noble and learned Lord will know from his own experience, insight and expertise, it is for a country to make an application to NATO. NATO is a defensive alliance, and when an application is made, a procedure is followed for allowing entry to new members. On the wider point about engaging with Russia and ensuring that every diplomatic channel is open, we are doing exactly that: there is extensive diplomatic engagement at every level, including from my right honourable friend the Prime Minister, my right honourable friends the Foreign Secretary and the Defence Secretary, and other Ministers.
Baroness Stuart of Edgbaston (CB)
My Lords, if you follow on a daily basis the press reporting in both France and Germany, there is a narrative developing, that if only the United Kingdom and the US were less alarmist, the tensions could be reduced. That shows that reliable information is becoming increasingly important. I urge the Minister to look at two things: whether the BBC World Service is sufficiently covering the area; and whether those within the FCDO have the required language skills to ensure they are on top of any information that is coming out?
Lord Ahmad of Wimbledon (Con)
My Lords, on the noble Baroness’s second point, the FCDO has established language skills training for diplomats, and we engage directly, through those language skills, with countries around the world. Of course, there is always room to do more. I will follow up the matter that she raises about the BBC and see whether more can be done, but, of course, that is directly a decision for the BBC.
Lord Balfe (Con)
My Lords, does the Minister not accept that the Minsk II agreement has not been implemented on either side, and that what we need is to get negotiations going on an open basis between Russia and Ukraine, with the help of the French and the Germans, so that we can dial down the tensions and not keep on inching towards conflict, which is going to do no good to anyone and end up with body bags being sent back to Britain?
Lord Ahmad of Wimbledon (Con)
My Lords, no one wants to see body bags. But it is for Russia—Russia is the aggressor here. A key point is Crimea: Russia is occupying, under international law, sovereign territory of another country. We should not lose sight of that. We are seeking to work with our alliances, including NATO. We are working with key partners, and I have assured noble Lords that we continue to engage directly with the Russians as well.
Lord Collins of Highbury (Lab)
My Lords, the Minister refers to action required to stop Russia taking this aggressive act. On Tuesday, Boris Johnson told the House of Commons that the Government were bringing forward a register of beneficial ownership as part of their efforts to track down Russian money in this country. However, the noble Lord, Lord Agnew, who had oversight of counterfraud, revealed in his resignation letter to Boris Johnson on Monday that, in a decision apparently taken last week, the economic crime Bill has been rejected for consideration during the next parliamentary year. Who is correct? I know who I believe.
Lord Ahmad of Wimbledon (Con)
My Lords, first, I acknowledge from our side, and indeed from across the House, the valuable services of my noble friend Lord Agnew, who served this House well. I recognise the important role he has played. As someone who has great respect for my noble friend, I listened carefully to the statement he made. The issue of illicit finance is important and it is a key priority for this Government. My right honourable friend the Prime Minister has committed once again to ensuring that we weed out the fact that London is still used—I fully accept this—as a base for money laundering and illicit finance by some. We need to take further action. On the specific point about the Bill, I will refer to my colleagues at the Treasury and write to the noble Lord.
The Lord Bishop of St Albans
My Lords, it is right that we attend to the situation in Russia, but Ukraine is a deeply divided country. The situation is not helped by, for example, Ukraine’s decision three years ago to make Ukrainian the national language, precluding the involvement of some 50% of Russians in the south and east of the country, who speak only Russian. What are Her Majesty’s Government doing to bring economic development and social cohesion to try to strengthen and bolster the life of Ukraine, as it faces this threat?
Lord Ahmad of Wimbledon (Con)
The right reverend Prelate is of course correct that it is important to recognise the diversity of different communities, and indeed different people, within Ukraine. Ukraine is a partner and we are working in a very constructive way. While the focus right now is rightly on the security of Ukraine, I assure the right reverend Prelate that we have a full range of programmes, relating to both the economic empowerment of countries and communities and working with civil society. I visited Ukraine just before Christmas and saw directly, for example, how faith communities are working together. There is a lot of work still to be done, but we are working directly and constructively with Ukraine in various areas.
Arrangement of Business
(2 years, 10 months ago)
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Lord Ashton of Hyde (Con)
My Lords, for the benefit of noble Lords who were not in the Chamber at 11 am this morning, it may be helpful if I outline the arrangements for the remainder of today. We will shortly continue proceedings on the Health and Care Bill. The House will break again at 6.45 pm for questions on a Statement on Ukraine. After the Statement, we will continue proceedings on the Bill.
We have now spent over 33 hours in Committee on this important Bill. This morning, I urged—indeed, begged—all noble Lords with an interest in the Bill to be as concise as they felt able to be in their contributions, to speak to amendments that were before the Committee and not to rehearse arguments that would be more suited to Second Reading. I noted that the Front Benches would also seek to ensure that their contributions were brief and focused, and I am grateful for their co-operation this morning.
I am pleased that the House listened—a somewhat novel experience for this Government Chief Whip—and we made excellent progress this morning. However, we still have eight groups of amendments to get through today, and I once again implore Members to ensure that the debates remain as focused and succinct as they were before the break. In this way, we can ensure that all the amendments to this important Bill receive the attention they deserve. As I said this morning, I am sure I speak for the whole House when I say that none of us wishes to debate important issues in the early hours of the morning, so it is important that we continue in the way we started this morning.
Health and Care Bill
Wednesday 26th January 2022
(2 years, 10 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-VI(a) Amendments for Committee (Supplementary to the Sixth Marshalled List) - (26 Jan 2022)
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, will be speaking remotely in this debate. I should also alert the Committee that, should this amendment be agreed to, I will not be able to call Amendment 163 by reason of pre-emption.
Amendment 162A
Lord Lansley
Member’s explanatory statement
This amendment, along with another to this Clause, would remove the power of the Secretary of State to set, and from time to time revise, objectives and priorities for the CQC, but would require the CQC to consult the Secretary of State when it revises indicators of quality for the purposes of assessments under subsection (4).
Lord Lansley (Con)
My Lords, the purpose of Clause 26 is to introduce a process by which the Care Quality Commission inspects integrated care systems. The structure of this is the subject of my Amendments 162A and 164A. Those two amendments go together—they are not separate, but entirely linked. The purpose of Amendment 162A is to remove the process by which the Secretary of State sets objectives and priorities for the Care Quality Commission in undertaking such inspections of integrated care systems; Amendment 164A then seeks to insert a process by which the Secretary of State, and indeed others, are consulted by the Care Quality Commission over the quality indicators that it would use to assess the quality and performance of integrated care systems.
A bit of background would be helpful for noble Lords in this respect. Think back to what the Care Quality Commission’s existing statutory arrangements are in relation to reviews and performance assessments of existing bodies in the National Health Service. The structure is very straightforward. The commission is asked to set quality indicators, to consult on those and then to review against them and produce reports. I know from personal experience that the Secretary of State cannot direct the Care Quality Commission to undertake a particular review, but they can certainly make a request, and their role as steward of the whole healthcare system has certainly led Secretaries of State to do that from time to time. But the legislation does not permit the Secretary of State to direct the Care Quality Commission in how it does its job; it is an independent body corporate. There is intrinsic merit in the Care Quality Commission, as an inspectorate, operating independently. The structure of this clause in this Bill is at odds with the way in which the existing legislation is structured in the 2008 NHS Act as amended. The effect of these two amendments would be to restore the independence of the Care Quality Commission in undertaking its activities and in the way in which it goes about its job.
The Government’s drafting of the legislation is wrong anyway. There are references to objectives and priorities. The priorities are referred to in new subsection (3), inserted by Clause 26(2), which says that they
“must include priorities relating to leadership, the integration of services and the quality and safety of services.”
I have to say that this is teaching grandmothers to suck eggs. There is no way in which the Care Quality Commission is not going to incorporate such indicators of quality. We know that from the generic nature of the quality indicators that it uses generally for existing NHS bodies. The reference to setting objectives is not only novel but completely undefined. The Secretary of State can set whatever objectives they wish to; we do not know what they are and there is no indication of what they might be. Taking out references to objectives and priorities seems to me to be a very good thing.
As it happens—I declare my own role in this—in the 2012 legislation there was previously a process by which the Secretary of State set standards for the Care Quality Commission in determining what the quality indicators should look like. We actually took that out of the 2012 legislation, precisely on these grounds: that the Care Quality Commission is, and should be, as independent as possible.
I think this clause proceeds from the mistaken apprehension that the Care Quality Commission is a part of the management process of the NHS. It is not. If the Secretary of State wishes integrated care systems to proceed in any particular way, the Secretary of State has the means to do so available via the mandate; the Government plan to add specific powers of direction; and NHS England has duties that go in exactly the same direction. The Care Quality Commission is not part of the management process for integrated care systems; it is an inspectorate. If—and this is a risk we must avoid—the Secretary of State were directly intervening to set objectives for integrated care systems to be inspected subsequently by the Care Quality Commission, whereas NHS England is itself setting objectives for integrated care systems through its responsibilities and duties, those two may come into conflict.
For all those reasons, the Government would be well advised to accept these two amendments and put the Care Quality Commission into the independent role in relation to ICSs that it, and people working in the National Health Service, would recognise as being its role. I beg to move.
Baroness Brinton (LD) [V]
My Lords, the noble Lord, Lord Lansley, has set out the tensions underlying the Bill about returning to the Secretary of State powers over independent, arms-length bodies; specifically, in this amendment, the inspections carried out by the Care Quality Commission in its role as a regulatory body. He rightly reminded us of the current arrangements, which give the CQC the ability to set its indicators and which, frankly, work well. I will not repeat his arguments, except to say in a slightly wider context that almost every piece of legislation brought to Parliament by this Government has given Ministers more powers—including, as in Clause 26, the power to intervene and to change remits.
The noble Lord’s amendments maintain the independence that the CQC—and other regulatory bodies—need to be able to inspect and make rulings without fear of favour or influence from politicians, while ensuring that the CQC must consult the Secretary of State when it revises indicators of quality for the purposes of assessment. That seems to me to provide the requirement for the CQC and the Secretary of State to engage in dialogue, but without the political intervention outlined in Clause 26(2) and (5).
Can the Minister explain why the Government feel the need to remove the independence of the CQC—whether this is an issue of management, as the noble Lord, Lord Lansley, said—and how giving the Secretary of State these powers can maintain the independence of a regulatory body?
Baroness Merron (Lab)
My Lords, it is essential that we get the arrangements for the Care Quality Commission right throughout the Bill, and I am grateful to the noble Lord, Lord Lansley, for trying to do that through these amendments. If the health and social care provided is to be of the highest standards, we must ensure, through the powers of scrutiny and review in your Lordships’ House, that we enable the watchdog to have the proper tools and framework to achieve that, so I support the amendments.
As the noble Baroness, Lady Brinton, emphasised, this is about putting the responsibility in the right place to ensure that a key inspectorate can do an independent job and support proper integration and delivery. I hope the Minister will accept the good sense in these amendments.
Baroness Altmann (Con)
Can I briefly ask my noble friend whether part of the thinking behind the current wording might be that the remit of the CQC may need extending? For example, when it comes to private operators of social care, the CQC currently does not have the power to look at the financial stability of those operators. Is this provision perhaps based on the thought that the Secretary of State may need to widen the remit and powers of the CQC? If not, we will be returning to this at some point.
Earl Howe (Con)
My Lords, I thank my noble friend Lord Lansley for bringing this debate before the Committee. He has made some worthwhile points but I hope to be able to explain why I think his amendments should not be pressed.
My noble friend Lady Altmann is not quite right in what she suggested was the intention of Clause 26. Clause 26 will allow the CQC to look across the integrated care system to review how integrated care boards, local authorities and CQC-registered providers of health, public health and adult social care services are working together to deliver safe, high-quality and integrated care to the public. That will include the role of the integrated care partnership. These reviews serve several functions. They will provide valuable information to the public, help drive improvement, and review progress against our aspirations for delivering better, more joined-up care across the system.
These amendments would remove the requirements on the Secretary of State to set and approve the priorities for these reviews. They would also remove the Secretary of State’s ability to direct the CQC to revise the indicators of quality that it will determine for these reviews. Instead, the amendments would add a requirement on the CQC to consult on those indicators with the Secretary of State, prescribed persons and other persons considered appropriate.
I entirely see where my noble friend is coming from as regards the CQC’s independence, but I must tell him that we have thought about this issue very carefully and we think it is right that the Secretary of State, who is accountable to Parliament, should have the flexibility to set the overall strategic direction of these reviews, with priorities and objectives. That is not an open-ended facility. In the other place, we accepted an amendment to develop this further by making it clear that the priorities set by the Secretary of State must relate to leadership, integration, and quality and safety. The amendment would remove that certainty.
As I have already mentioned in previous debates, there will be quite a range of different forms of accountability and oversight within the system, including NHS England’s role in overseeing ICBs. As a result, we think that the Secretary of State should play a strategic role to ensure that the CQC reviews complement the other oversight and accountability mechanisms. This will be achieved, in part, through the Secretary of State’s approval of the quality indicators. To provide my noble friend with an analogy, we believe, as I am sure he does, that there is a proper role for the Secretary of State in setting the strategic direction of NHS England. He does this, of course, through the mandate.
Finally, the drafting of this clause is not an accident. It is drafted deliberately to protect the independence of the CQC in how it operates, while also encouraging consultation and collaboration. It will allow the CQC to develop its approach in collaboration with NHS England and other partners in the system. The CQC is already intending to develop its approach to these reviews co-operatively and is able to consider a wide range of views in doing so. We do not think it is necessary to require it to consult.
I hope this has given my noble friend some reassurance as to why we have taken the approach we have and, for these reasons, I ask him to withdraw his amendment.
Lord Lansley (Con)
I am grateful to my noble friend for that explanation, which, I am sorry to tell him, wholly fails to provide reassurance. First, he was wrong, in the sense that he maybe implied that my amendments would have removed the Secretary of State’s requirement to approve the indicators on which the commission chooses to base its reviews. That is left in at new Clause 46B(4)(b), so the approval of the Secretary of State for the indicators would remain. What is being taken out by my amendments is the requirement for the Secretary of State to set objectives and priorities. I am afraid that everything that my noble friend said went to support my view that there is an erroneous perception on the part of the Government that the CQC must be turned into an integral part of the management of the NHS and the integrated care system. That is simply not the case.
I am grateful to the noble Baroness, Lady Brinton, for her support. I quibble with her slightly in a pedantic way. We should not talk about the CQC as just another regulator; it is the inspectorate. In my experience, inspection should never be regarded as a substitute for management. Quality is integral to the management of the service. The CQC is there to determine and review whether that quality is being achieved, which is why I am perfectly happy for the Secretary of State, and indeed others, to be consulted and for the Secretary of State to approve the indicators of quality that the CQC arrives at. Frankly, however, for the Secretary of State to go further and start to prescribe the way the objectives of the CQC are set in this way is directly at odds with how the CQC reviews and reports on other NHS bodies. I can see the drift of this. If we accept it, we will end up with the CQC being told by the Secretary of State what its indicators of quality are for every NHS body and setting objectives and priorities for the CQC right across the board, which is completely at odds with the independence of the CQC.
I shall make one final point. I am grateful to my noble friend Lady Altmann. Exactly the same argument applies to Clause 137, although I have not tabled amendments to it. It creates the CQC’s additional scrutiny and performance assessment of social care functions. We should therefore come back to precisely the point that she is talking about, as she suggests.
I hope my noble friend the Minister will take my point and that we might have further conversations between now and Report. However, I have to tell him that it is not just me who raises these points; I have been asked by representative bodies within the NHS to do so. We should take them seriously and hope that between now and Report we might see whether there are better ways to structure Clause 26 to secure both the Government’s objectives and what the NHS would expect to happen. I beg leave to withdraw the amendment.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
We come to the group beginning Amendment 164. The noble Baronesses, Lady Brinton and Lady Masham, will be contributing remotely to this debate.
Amendment 164
Baroness Wheeler
“(4A) The indicators of quality set by the Commission under subsection (4) must include—(a) whether national standards in the care of people with rare and less common conditions are being met;(b) whether the views of patients with rare and less common conditions are being represented;(c) whether people with rare and less common conditions have access to a named clinical nurse specialist.”Member’s explanatory statement
This amendment would require integrated care boards to be assessed by the Care Quality Commission on the provision of care for people with rare and less common conditions, in particular.
Baroness Wheeler (Lab)
My Lords, Amendment 164 heads this wide-ranging group and probes how the proposed Care Quality Commission rating system for ICBs’ work in practice, with a particular focus on rare and less common conditions, although this debate is more broadly relevant to all aspects of the CQC’s role.
Amendments 178 and 240 from the noble Lord, Lord Sharkey, to which I have added my name, also relate to people with rare diseases and their access to innovative medicines and medicinal products, and the general need for awareness-raising about those conditions among health and social care staff. I remind the Committee of my role as vice-chair of the Specialised Healthcare Alliance. The noble Lord will speak to those amendments later.
The group also covers amendments on wider care and safety issues that impact on patients, including ensuring that liothyronine T3 is available to patients when it is prescribed by a doctor and the regulation of healthcare and associated professions. This includes safeguards to apply under the Secretary of State’s power to alter the professional regulatory framework; protecting the use of the title “nurse”; hospital food standards for patients and training for staff; reviewing the surgical consultants’ appointment process; and licensing aesthetic non-surgical cosmetic procedures in registering cosmetic surgery practitioners.
The noble Lords who have their names to these amendments will speak to them, so I will leave them to it and concentrate on my rare disease issues and the matters that our Front Bench team have added their names to. Returning to the CQC, and following on from the previous debate on Clause 26, on the amendment tabled by the noble Lord, Lord Lansley, regarding the role of the Secretary of State in setting objectives and priorities, overall, we welcome the extension of the CQC’s remit to ICBs but now need to understand how it will work in practice.
As it stands, the Bill establishes an overarching framework under which the CQC will need to determine for itself the quality indicators against which it will assess ICBs. My amendment raises the issues about the quality indicators relevant to those with rare and less common conditions. If the purpose of the rating system is to protect patients, it must help to ensure that national standards of patient care, where they exist, are being met. Under the NHS’s plans to jointly commission or delegate commissioning responsibility for specialised services to ICBs, set out in NHS England’s Integrating Care paper, an important assurance given is that specialised services will
“continue to be subject to consistent national service specifications and evidence-based policies determining treatment eligibility.”
Will the CQC ensure that services organised by ICBs are organised in line with these national specifications?
Moreover, people with rare diseases are concerned that if services are to be commissioned in some way by ICBs in future, rather than just NHS England, their voices may be lost. NHS England’s specialised commissioning team meets regularly with representatives of the rare disease community, including the SHCA, and it is important that ICBs can hear their views too. How will this happen and how will the CQC rating system act to ensure that this happens?
Finally, one of the key asks of patients with rare diseases to help deliver continuity in their care is that they have access to a named clinical nurse specialist, which is commonplace for patients with more common conditions. That continuity of care is an important marker of quality. Will the CQC rating system help to deliver it?
Beyond these questions are broader ones. If the bulk of the CQCs work will continue to focus on inspecting providers, can the Minister explain how it will ensure that its ICB ratings are not unnecessarily duplicative, given that providers will form part of ICBs? Also, the CQC looks at whether services are safe, effective, caring, responsive and well led. Given that the first three of these should continue to be the primary concern of those providing care, rather than of the ICBs organising it, how will the CQC ensure that the new rating system clarifies rather than dilutes this accountability? How will the CQC’s work align with the wider performance management of ICBs undertaken by NHS England? How specialised services will operate is a complex area and I am happy for the Minister to write to me on some of the specifics of my questions.
As I said, I will speak briefly to other amendments in this group, to which Labour Front-Benchers have added their names. Amendment 243, tabled by my noble friend Lady Merron, covers the important issue of the protection of the title “nurse”, and is supported by three respected medical and healthcare professionals whose contributions I look forward to. The recent Health Service Journal survey found hundreds of roles that do not require Nursing and Midwifery Council registration but use “nurse” in the job title. While “registered nurse” is a title protected by the NMC, “nurse” is not. The term may be used by anyone in the UK to offer professional advice and services, and people with no nursing qualifications or experience, or who have been struck off the professional register, may use it.
Obviously, this is worrying and even dangerous—a dangerous trend which potentially compromises patients’ health. What progress is being made on the Government’s review of healthcare professional regulation following their consultation last year? Surely we must follow the example of other countries, such as France and Australia, in giving the consistently most trusted profession in the UK the recognition and protection that it deserves.
My noble friend Lady Thornton has added her name to Amendment 258, from my noble friend Lord Hunt, to the welcome new Clause 145, on hospital food standards. It underlines the importance of investment in the food served to patients in hospital and other care and treatment settings. It is welcome because it specifies food quality and standards and stresses the importance of recognising staff skills, experience and training, as well as ensuring investment in NHS kitchens and catering equipment to ensure that the highest standards can be maintained.
On Amendment 266 from my noble friend Lady Merron, we seek to give the Secretary of State power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and to introduce an offence of practising without a licence. This area is crying out for regulation. The Department of Health’s own report has said that non-surgical interventions which can have major and irreversible adverse impacts on health and well-being are almost entirely unregulated. We fully recognise that this is also a highly complex policy area. However, I understand that noble Lords concerned about this issue had constructive and positive discussions yesterday with the Minister, and I look forward to the Minister updating the House on the scope and discussions of the Government’s ambition in this important area.
Finally, I offer my strong support for my noble friend Lord Hunt’s Amendment 176, which seeks to ensure that the general powers of the Secretary of State to direct the functions of NHS England include ensuring that when T3 is prescribed to patients with hyperthyroidism, the drug is made available to them. My noble friend rightly raises this issue at every opportunity, and I hope the Minister will have a bit of good news for him today and tell us that some real progress has been made. It is clear that many thyroid patients would benefit hugely from the declassification of T3 as a high-cost drug, back to a drug that is routinely prescribed in primary care. It is much cheaper now, and the many patients who were taken off the drug and continue to be denied it need to have it restored. The Government must ensure that the now updated NICE guidelines which reflect this new position are implemented consistently across the new NHS structures, rather than repeat the record of the nearly 50% of CCGs which failed to ensure that the drug is properly prescribed.
I will leave it at that, and I look forward to the debate.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
I remind the Committee that both the noble Baronesses, Lady Brinton and Lady Masham, will be contributing remotely. I call the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, I have signed two amendments in this very wide-ranging group. The first, in the name of the noble Lord, Lord Hunt, is Amendment 264 on the appointment of surgical consultants. As the noble Baroness, Lady Finlay of Llandaff, said in your Lordships’ House recently, 48% of advertised consultant posts last year went unfilled. Given our discussions about the workforce earlier this week, we need as many posts filled as possible and to remove any bureaucratic barriers to so doing.
Part of the problem at the moment is that trusts are having difficulties establishing appointment panels which can make these consultant appointments. Currently, the rules are too tightly drawn in the National Health Service (Appointment of Consultants) Regulations 1996 and the subsequent 2005 guidance. The members of all the royal colleges across the UK have a wealth of expertise, but the current legislation says that only members of English royal colleges can help trusts fill their appointment duties. In its helpful briefing, the Royal College of Surgeons says that the Royal College of Emergency Medicine, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh are excluded from being eligible to join these panels. This amendment would be a simple remedy and speed up the appointment of much-needed consultants, and I do hope that the Minister can agree to it.
I have also signed Amendment 266 in the name of the noble Baroness, Lady Merron, on the urgent need to ensure that practitioners undertaking non-surgical aesthetic procedures such as lip fillers, injectables, thread lifts, semi-permanent make-up, laser treatments, piercings and tattoos are properly trained and licensed. These treatments are easily available to members of the public, but without the safeguards required when being carried out in the health sector. I am afraid that we see daily in the press and media reports on the many problems when treatments go wrong, which can include infection, disfiguration and burns, among other serious issues. When treatments do go wrong, it is usually the NHS that has to pick up the pieces, so I believe it is very much in the interests of the Department of Health and Social Care to accept this amendment.
The signatories to this amendment have been working with the Chartered Institute of Environmental Health, alongside a coalition of public health organisations and industry representatives, so that we can make sure that a licensing scheme can be introduced for all non-surgical aesthetic procedures. This will enable the setting of appropriate standards, a level playing field for practitioners and, importantly, protect consumers in this sector.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
I call the noble Baroness, Lady Masham of Ilton.
Baroness Masham of Ilton (CB) [V]
My Lords, I shall speak to Amendments 178, 266 and 293. Amendment 178, which was tabled by the noble Lord, Lord Sharkey, is important for people with rare and less common diseases. The amendments could be a lifeline for people who have rare conditions who use products that may be the only substances that work. There is an enormous selection of rare conditions. It can be a desperate situation when some medicines are developed but take a long time to be given the all-clear by NICE. Some medicines are not available in England on the National Health Service but are available in other countries, sometimes even in Scotland. That is devastating and frustrating.
I support Amendments 266 and 293, on the cosmetic surgery industry, which must be made safer. It is extraordinary that this business is only partially registered. Many people who have such a procedure take for granted that the practitioner will be registered and fully insured. There have been some disastrous results when things go wrong with a beauty procedure. I know of some plastic surgeons who work only in the National Health Service, as they do not want to be tarred with the same brush as uninsured cowboys. Amendments 266 and 293 deal with a wide selection of cosmetic procedures, some of which are psychologically important to many people. There is wide interest in making this trade safe and getting it registered. I hope the Minister realises that this is an important matter that needs putting right.
Lord Hunt of Kings Heath (Lab)
My Lords, I have Amendment 176, the second amendment in this group, and two other amendments. I shall start with Amendment 176 which is concerned with the treatment of thyroid patients who continue to be denied liothyronine, otherwise known as T3, as the most appropriate treatment for them. For some patients, the standard treatment is not effective. T3 has proven to be a much better treatment, but tragically, a few years ago the manufacturers grossly inflated the cost of T3 by a massive 6,000%. Understandably, NHS England and its associated prescribing advising machinery strongly discouraged the use of the drug and, as a result, many patients had T3 withdrawn and suffered quite considerably or had to fund it privately or source it from abroad. Happily, the price of T3 has come down by 75%, although it could go down further, but I believe it is no longer categorised as a high-cost drug.
The problem is that clinical commissioning groups still treat it as a high-cost drug, so the situation is still very difficult for patients who need it—those for whom the standard treatment is not appropriate. The current guidance states that T3 can be prescribed to patients who have unresolved symptoms on the standard treatment if it is initiated or confirmed following a review by an NHS consultant endocrinologist. A statement in July 2021 restated NHSE guidance, but it has not been followed by clinical commissioning groups. A survey done recently by UK thyroid charities, to which I pay huge tribute, says that 44% of CCGs have not fully adopted the national guidelines or are wrongly interpreting them.
What are we to do? What is the situation here, where we have clear guidance that is not being followed? This goes back to our previous debates about the various mechanisms being brought in to ration treatments, against national guidance or technology appraisal advice from NICE. It is the same issue. I am not expecting the Minister to issue a direction but I am expecting him to tell CCGs and, in future, integrated care boards to get off their backsides, start implementing the guidance properly and realise that this is no longer such a high-cost drug. I appeal to him to do something about that.
I also hope that the Minister will do something about hospital catering. I confess to your Lordships that I am president of the Hospital Caterers Association, where I work very closely with some great professional staff who have to work with their hands tied behind their back. Often they do not have the resources to provide the high-quality food that everyone wants and expects.
During Covid we saw in many local NHS facilities a determination to do everything possible to improve nutrition for both patients and staff. Miraculously, hot food was made available to staff overnight, which, as noble Lords know, seems to have been beyond the capacity of the NHS for many years. I do not know why I am looking at the former Chief Nursing Officer as I say this; I think it is an appeal for support.
This clause is highly welcome as I believe it will lead to higher standards, but my amendments would enable the caterers to deliver on them. The first key point is this: they need the resources to be able to do it. The amount of money spent on hospital food per day at the moment is simply not sufficient. Secondly, we need more training for staff. The training programmes have disappeared, and we need to get them back in to give staff the opportunity to show what they can do. Thirdly, we need to make sure that NHS trusts and foundation trusts are fully on board with bringing forward these regulations. There is no doubt that the efficiency programmes have taken their toll on the budgets for hospital catering and that, equally, the old-style national training schemes fell away and have not been replaced. The pay grade of qualified chefs and cooks needs to be reviewed to reflect the importance of their role. This issue is important in terms of the standards of food and nutrition for our patients and for the well-being of our staff.
My final amendment in this group is Amendment 264. What links all these amendments is that we need more consultants appointed—a small effort to enable us to improve the efficiency of the system. I remind the Committee of my GMC connections in relation to this. The amendment would add the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow, and their associated dental faculties, to the colleges that may be involved in the appointment of NHS consultants. My amendment was inspired by the Royal College of Surgeons of Edinburgh, which noble Lords might be surprised to learn has an office in Birmingham because many consultants who work in the English NHS are members of the Scottish colleges.
There seems to be a lacuna in the current regulations. According to the National Health Service (Appointment of Consultants) Regulations 1996 and subsequent guidance issued by the department in 2005, only the Royal College of Surgeons in England is permitted to review surgical consultant job descriptions and send a royal college representative to the advisory appointment committees when it comes to the appointment of consultant surgeons. Other elements of my amendment apply to the appointment of physician clinicians, and the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine are also supportive. Although the process and guidance apply only to NHS trusts, foundation trusts are encouraged to follow it.
The Minister has yet to accept any amendment to the Bill. The usual line from the Government is, “We will do this when legislation is available to do so.” Here is a great opportunity for the Minister, as we are here on day 6 of Committee, to get up and say that he is going to accept my amendment.
Baroness Barker (LD)
My Lords, in following the noble Lord, Lord Hunt, I declare an interest as the patron of the National Association of Care Catering, a position that I took over from the noble Baroness, Lady Greengross. I admit that, when I had this great honour thrust upon me, I had little idea what I was getting into—and I have discovered a world of highly dedicated, professional people whose contribution to the health of the nation is very much overlooked. I managed to attend their national conference in Nottingham last October, and I have to say that it was one of the most harrowing afternoons I have spent, as they talked about what they had gone through as the people who supply catering not only in hospitals and acute hospitals but in care homes, as well as doing meals on wheels.
I will pick up one point that the noble Lord, Lord Hunt, made, on training. He is absolutely right that this area has suffered a great deal because of various changes not just to training in the NHS but to the training in higher education. We do not have a recognised qualification in care catering in this country, yet these are people who have to produce food for people who have dysphagia, multiple food intolerances and dementia, people who quite often are suffering from malnutrition when they come into hospital, and people who have allergies and often suffer from dehydration. The people who have worked in this field, and some of them have worked in it for many years, suffer a deep sense of frustration, which is that when young people in school or college show an aptitude for or a willingness to go into the world of catering, they are directed towards restaurant catering, because that is where the teachers and lecturers think the money is to be made. Actually, catering for people with difficult medical conditions is a lot more complicated.
I say to the Minister that I am also really impressed by the specialist companies that work in this field—those that produce specialist menus and enable people to order ingredients for complicated menus in complicated settings, as well as those that manufacture cutlery and crockery and vessels that can be used by people whose interaction with that sort of thing is hampered. These can bring a dignity and focus to something that is much overlooked—but talk to dieticians and you will increasingly understand the importance that food plays in maintenance of health and recovery.
I do not know whether or not this will make it into the Bill, but will the Minister go back to the department and ask whether his officials might meet some of the people who do a remarkable and much overlooked job, day in, day out, and who these last two years, perhaps more than anybody else in the NHS, deserved the clap, if only people knew what they had done?
Baroness Fraser of Craigmaddie (Con)
My Lords, in this rather large group of amendments, I shall take us from catering to my Amendment 242 on professional regulation. I thank the noble Baroness, Lady Finlay, for adding her name. I draw your Lordships’ attention to my registered interests, in particular as chief executive of Cerebral Palsy Scotland. I am involved with the employment of regulated allied health professionals.
Clause 142 gives the Secretary of State far-ranging powers to alter the professional regulatory landscape, with the potential to make significant changes to how certain health and care professions may be regulated, including the power to remove professions from, or bring professions into, statutory regulation.
The UK model of regulation for healthcare is rigid, complex and needs to change to better protect patients, to support our health services and to help the future workforce meet future challenges. The case for reform has been acknowledged.
Whether a health and care profession falls under regulation is a major decision affecting not only the professions themselves but employers, patients and service users who place their trust in those professionals. My Amendment 242 is a probing one. I want to explore some of the issues that will be particularly important for the Government to consider as and when they might seek to use these extended powers.
I want first to thank my noble friend the Minister and the Bill team for the time they have taken so far to discuss the issues around my amendment. We are all agreed on the importance of encouraging greater collaboration between regulators, with the ability to share data and intelligence, but I remain to be convinced that the legislation is being used to reduce regulatory silos, which is crucial to reducing regulatory failures in the future.
I want to be clear that I am not advocating for a single super regulator, which would be a step in the wrong direction, not to mention complicated, disruptive and expensive. I would rather harness the best elements of professional regulation and give the regulators the tools to work more closely together and share best practice more consistently.
I accept that work is being done in the department on various regulatory reform initiatives. These are all important, but it strikes me that they are all focused on individual regulators and amend specific operational issues, rather than looking at the landscape as a whole and what could be achieved.
We have sadly seen all too many reviews and inquiries which have identified regulatory silos as a key factor in why something went terribly wrong. My noble friend Lady Cumberlege’s First Do No Harm report highlights the issue starkly, but the Paterson inquiry, the Sir Robert Francis report on Mid Staffs, the Shipman inquiry and others have all underscored the value of greater collaboration between regulatory bodies, sharing data and intelligence as well as adopting shared professional standards. Reducing and removing silos is also good for professionals and employers, with benefits in terms of intra-professional learning and for professional and patient safety.
I am grateful to the Health and Care Professions Council for its briefing, but I was concerned to note something which regulators have stressed to me: that due to their tightly defined duties, they have often been forced to resort to informal memorandums of understanding to try to make the system work better. That is piecemeal and inefficient— frankly, I would be extremely disappointed if the Minister in his response was to rely on such MoUs to fix the issue.
Do not the powers in this Bill offer a chance to look at things differently: a whole system regulatory approach rather than a set of silos? Amendment 242 identifies some principles and considerations that I believe the Government would find beneficial in developing this more collaborative landscape.
Maintaining regulatory independence is crucial. The Government have rightly recognised this in other legislation recently, but I would welcome confirmation from the Minister that this remains a cornerstone of any future regulatory reform proposals. I would be grateful for reassurance that no regulatory reform would be undertaken by the UK Government without working with the devolved Administrations to ensure that it worked for all parts of the UK.
I particularly want to highlight the benefits of multi-profession regulation, which, as the CEO of an organisation that relies on a range of expert allied health and care professionals registered with the HCPC, I see at first hand, supporting improvements across professions that are increasingly interconnected. As the Minister is aware, the HCPC regulates 15 professions, so is able to utilise common frameworks and outcome-based standards. This approach could, and should, be spread among all the professional regulators.
This is particularly important as the Government, NHS England and NHS Improvement seek to create a more flexible workforce with an ability to move between professions, work as multidisciplinary teams and support career progression. From my own experience, I know that this is positive, but we need our regulatory system to keep up with innovations in delivery. Can my noble friend the Minister therefore tell us about how we can harness the benefits of multi-profession regulation and how he anticipates this will influence the Government’s thinking in terms of reform? Collaboration and the development of a system-wide approach to overcome fragmentation and silos is critical to the future success of regulation. It is an enabler of better care, and a collaborative structure would generate considerably higher and richer levels of data.
Finally, this holistic approach would offer an opportunity to create consistent criteria for making decisions about which professions may be brought into or taken out of regulation. Could the Minister put it on record today that the issues in the amendment are principles that would govern the future use of the powers within Clause 142, that they are all principles that the Government are actively considering and that no decisions on regulatory change would be taken if the criteria set out in this amendment were not met? Once again, I thank him and his team for his engagement so far, and I look forward to his response today. I hope we can continue discussions between now and Report.
Lord Patel (CB)
My Lords, I rise to speak to Amendment 243 in the name of the noble Baroness, Lady Merron, and Amendment 264 in the name of the noble Lord, Lord Hunt of Kings Heath.
Yesterday I was chastised—wrongly, in my view—for speaking at length. Such boldness requires training in speaking up, confidence in being right and using authority. The comments came from a government Whip, who happens to be a registered nurse. As a doctor, I am used to that. When a nurse speaks up, patient safety improves, health equity improves, collegial relationships are stronger—again, as a doctor I can vouch for that—and healthcare systems improve. This is because of their training. Not recognising legally the status that the title of “nurse” brings to those that are highly trained and qualified and on a nursing council register is wrong.
We all know what a nurse is; a nurse is highly trained, highly competent, can do the job well and is on a nursing register. Anybody else is not a nurse. It is right, therefore, that we recognise this and give it a legal status. Furthermore, the NHS and health providers should not employ anyone as a nurse who does not meet the above criteria. I understand that last year there were 195 advertisements for nurses in the NHS which did not say that the qualification of being registered was necessary. In my view, that is wrong. I strongly back this amendment, and I look forward to the contribution of my noble friend Lady Watkins.
Turning to Amendment 264 on the appointment of consultants in surgery, I am a fellow of the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow, so I speak on behalf of all surgical colleges. Let me give your Lordships an example: there is a surgical post empty in Birmingham. A highly qualified person, who was well-trained in Scotland and holds a fellowship of the Royal College of Surgeons of Edinburgh, is a key candidate for application but cannot be appointed because the Royal College of Surgeons of England cannot provide an assessor. On the other hand, there is a surgical vacancy in Glasgow, and the top candidate is a fellow of the Royal College of Surgeons of England but can be appointed without a Royal College of Surgeons of England assessor being there. That is a total anomaly.
A person can be appointed who is fully trained in Scotland, is a fellow of the Royal College of Surgeons of Edinburgh, works in Cambridge, applies in Cambridge, but you cannot have an assessor from the Royal College of Surgeons of Edinburgh. In all other specialties—the Royal Colleges of Obstetricians and Gynaecologists, of Ophthalmologists, of Radiologists, of Psychiatrists, of Anaesthetists, and in public health—the assessor can come from any part of the United Kingdom. This anomaly can be stopped very easily. I agree with the noble Lord, Lord Hunt of Kings Heath, that it is not a big deal; just change it in legislation. I do not know who opposes it.
Baroness Watkins of Tavistock (CB)
My Lords, it is a pleasure to follow the noble Lord, Lord Patel, on the term “nurse”, which is protected in law at the moment only for those who are a “registered nurse”. This means that anyone can describe themselves as a nurse, as the noble Baroness, Lady Wheeler, outlined. They can even describe themselves as a nurse if they have no qualifications or experience—or, perhaps more seriously, have just been struck off the register. As somebody who was a member of the forerunner to the Nursing and Midwifery Council, I can say that we do not strike people off the register lightly, so the risks of such people being at large and describing themselves as nurses are serious. For this reason, a petition was created calling for the title “nurse” to be protected further in UK law.
In the initial response by the Government to the petition, recognition was given that the protection of professional titles
“provides assurance to the public that someone using that title is competent and safe to practise.”
The response references a consultation by the Department of Health and Social Care on professional regulation, Regulating Healthcare Professionals, Protecting the Public. In the Nursing and Midwifery Council response to this consultation, the nursing regulator recognised issues around the limitations of “nurse” not being a protected title and said it did not think that its current powers are sufficient,
“given that they are primarily based around titles that are not widely understood by the public or used by the professions.”
This amendment is designed to ensure that there are sufficient regulatory levers to be able to protect the public in the future.
Nurses on the NMC register find it difficult to understand why the Government are reluctant to protect the title. As part of the statutory regulations of the Health and Social Care Act 2012, it was mandated that registered nurses would be part of the clinical commissioning group governing body. In Regulation 11 of the National Health Service (Clinical Commissioning Groups) Regulations 2012, the CCG governing body is required to include at least one registered nurse within its membership. This created a statutory commissioning role for nursing leaders in England that will be lost should this not be required within integrated care boards’ executive membership. Please can the Minister explain whether guidance will include a recommendation that there should be a registered nurse as part of the executive team on integrated care boards?
Lord Kakkar (CB)
My Lords, I support Amendment 264, in the name of the noble Lord, Lord Hunt of Kings Heath, to which I have added my name. In so doing, I remind noble Lords of my own interests, particularly as a fellow of the Royal College of Surgeons of England, a fellow of the Royal College of Physicians of London and an honorary fellow of the Royal College of Surgeons of Edinburgh.
This is a critical amendment, as the noble Lord, Lord Hunt of Kings Heath, indicated, strongly supported by my noble friend Lord Patel. Currently, the National Health Service (Appointment of Consultants) Regulations 1996, with additional guidance provided by the department in 2005, restricts membership of advisory appointments committees for consultants to certain royal colleges, as we have heard with the appointment of surgeons by the Royal College of Surgeons of England alone—and, indeed, for physicians by the Royal College of Physicians of London. This is an anomaly. The medical royal colleges across the United Kingdom are recognised in terms of the postgraduate training that they are able to supervise, the continuing professional development they are able to provide and, indeed, collaborate with regard to postgraduate examination which is required for provision of the certificate for the completion of specialist training. However, when it comes to the question of consultant appointment, there is this restriction.
Noble Lords might ask why it is important that this matter be dealt with. The provision by a medical royal college of a professional member to serve as part of the appointment process for a new consultant is critical. Those representatives provide expertise and insight with regard to the nature of the job description, the requirements for the individual post, and the assessment of individual candidates as part of the selection process on the day.
Lord Lansley (Con)
My Lords, can I just take us back to Amendment 266, to which I have added my name, before we lose sight of it? It was helpfully introduced by the noble Baroness, Lady Wheeler, and its purposes were explained very well by the noble Baroness, Lady Brinton.
I just want to add a bit of context, which I hope will commend itself in particular to my noble friend Lord Howe on the Front Bench, in that he and I tackled together the PIP breast implant problems that emerged in December 2010 and which led directly, subsequently, to us asking the distinguished first medical director of NHS England, Bruce Keogh, to undertake an inquiry. Since the report of that inquiry, we have made considerable progress. Most recently, noble Lords will recall that the noble Baroness, Lady Wyld, took through the Private Member’s Bill from Laura Trott in the other place to assist in the regulation of Botox treatment for under-18s.
The point is that there is still unfinished business. Amendment 266 relates to giving the Secretary of State the power to set up a licensing process for non-surgical cosmetic procedures—not through the CQC in this case, because the CQC regulates healthcare professionals, but almost certainly through the mechanism of asking local authorities to undertake a licensing process. It gives the Secretary of State all the flexibility that we have grown accustomed to legislation having to give them, but it does so in a way that enables the regulation that would be brought in using this power to be proportionate, being very clear that it should apply only to those activities that present a significant risk. It makes sure that it takes advantage, for example, of the national standards that have been put in place by the Joint Council for Cosmetic Practitioners. It would be very helpful in trying to mitigate the risks associated with non-surgical cosmetic procedures.
Amendment 293 in my name is a follow-up to a Private Member’s Bill that made no progress. It again follows Bruce Keogh’s report and looks to give the General Medical Council the legislative opportunity and requirement to bring forward a scheme to put surgeons who have a specialty relating to cosmetic surgery on to its specialist registers. With Amendment 293, we have the benefit of being able to do this by virtue of the recommendations in recent years from the Cosmetic Surgery Interspecialty Committee of the Royal College of Surgeons. It gives us an opportunity to give those who wish to undertake surgical treatments for cosmetic purposes the opportunity to see who is on the specialist register. All this relates to the safety of those undertaking cosmetic treatments, which is a large number of people; there is a large amount of activity and a significant need for the consumers of these services to have a degree of protection. I think we can make progress on that.
In the rest of this group, we have another opportunity to take action. My noble friend was right when she spoke about a more general approach. She will recall that, in April 2014, the Law Commission produced its recommendations on the regulation of healthcare professionals, so there is an opportunity to do something here. If we do not do it in this Bill, it would not hurt for the Government to tell us more about how they might make progress on the broader regulation, in addition to what is being proposed here.
I want to mention two other things. First, we had an earlier debate about access to innovative medicines. This is another opportunity for my noble friend to tell the Committee that NHS England is proceeding with its consultation on the implementation of the innovative medicines fund. Secondly, we do not need to repeat the short debate we had in Grand Committee not so very long ago under the auspices of my noble and learned friend Lord Mackay of Clashfern, who enabled us to present a lot of arguments about the future of NHS Resolution and clinical negligence within the NHS. We do not need to repeat that, but Amendments 178 and 297E would of course help us in that direction, not least by repealing the redundant NHS Redress Act 2006, which has never been implemented. With that thought, I pass the ball to the noble Lord, Lord Storey.
Lord Bethell (Con)
My Lords, I support Amendment 266 in the name of the noble Baroness, Lady Merron, and Amendment 293 in the name of my noble friend Lord Lansley for all the reasons that my noble friend just articulated. I will not repeat them as he put them so very well. However, I would say to the Minister that, coming from the innovation space, I can see that the technologies for both cosmetic surgery and non-surgical cosmetic interventions are improving all the time. There is an incredibly rapid pace of change. They are set to continue to get better and better, so the marketplace is getting more sophisticated and their popularity is also exploding. We have been briefed on evidence about the role of social media in promoting non-surgical cosmetic interventions in particular. This is exciting, because it is great that people have access to these interesting products, but also extremely worrying, because not all the surgeries and non-surgical interventions are successful. It is the right time for the Government to intervene, so that we have a register of cosmetic surgical practitioners and a much clearer regulatory regime for non-surgical interventions.
I am pro cosmetic surgery. As a young boy, I had an inherited condition of having very big, sticking-out ears, which my father had and my cousins and aunts have, and it was miserable. I had them pinned back and I am very grateful that that happened. It meant that I could be a much more confident person as I grew up. I am pro cosmetic interventions; if people want to use the benefits of medicine to improve their confidence in the way they look, I applaud that. However, standing next to my noble friend Lady Cumberlege, I am also aware of Bruce Keogh’s extremely good report and the very large number of interventions that have not gone well. I know that the Minister’s instincts are not to intervene unless absolutely required and my suggestion to him is that we have hit that moment. The marketplace is exploding and now is the right time to intervene.
Baroness Finlay of Llandaff (CB)
My Lords, as I address Amendment 266, I should declare that I am a vice-president of the Chartered Institute of Environmental Health. I stress that this amendment has been supported by the Beauty Industry Group, which represents 10 industry organisations—two voluntary registers for cosmetic practitioners, the Mental Health Foundation and others.
There are currently significant gaps in our regulatory system. Environmental health and licensing professionals work at a local authority level. They inspect, register and license premises for a very limited set of procedures, such as acupuncture, tattoos and piercing. Even for these procedures, however, there are no nationally set training programmes or qualification requirements for somebody to practise. For the riskier beauty procedures, such as the injectables, there are only voluntary registers of accredited practitioners. They have some approved education and training but that is not mandatory.
That means that there are many unaccredited practitioners on the high street providing services to people directly with no checks. A licensing scheme, as outlined in the amendment, would provide appropriate qualification and competency standards for practitioners wishing to practise, which is key to improving safety. The amendment as drafted is an open power for the Secretary of State, so it is easily amended as new procedures come online and on to the marketplace. The weakness of existing legislation in the area is that it fails to cover many of the newer treatments that are now popular.
When things go wrong, it is the NHS that has to pick up the pieces. Infections, injuries, scarring, burns and allergic reactions from a range of procedures often all end up in the NHS, sometimes with people being hospitalised and disfigured. Injection of fillers—or botulinum toxins—into blood vessels can cause dying back of tissues as well as blindness when administered by people who really are not adequately trained and certainly not registered. That means that there is no recompense for people damaged by these practitioners, who have no medical insurance or qualifications. In addition, there are unauthorised advertisements that breach advertising standards. There are strict laws around prescription-only medicines such as botulinum toxin, but these advertisements seem to bypass those.
Among members of the public who have had cosmetic procedures, alarmingly, three-quarters were given no information about the product, volume, brand or batch number of whatever was being used and just under three-quarters were not asked anything at all about their psychosocial or mental health or any body image issues. It is a vast and complex area and there are gaps in regulations. We need a national framework of standards with qualifications that can be recognised, so that there is a clear badge for members of the public.
To briefly address Amendment 297, I suggest that it is not needed because dermatological surgery and plastic surgery are subsections of medical practice and already registered with the General Medical Council. This gets nearer to credentialling than to requiring a separate qualification. These are doctors. They are highly trained, they have gone through a recognised training programme and they have been often examined as part of their exit from their training in whatever procedure they are undertaking.
I remind the Committee that, in a recent letter from the right honourable Michael Gove, he said that he is considering a licensing scheme. I hope the Government will see that this amendment would allow such a scheme without tying the Government down, and I hope that they will accept it, as well as Amendment 264 from the noble Lord, Lord Hunt, for which I should declare that I am an honorary fellow of the of the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine. I think the contents of the amendment would go wider than simply surgical procedures. The Royal College of Emergency Medicine was established as a separate medical college in 2008, but the guidance and regulations were written prior to that, so they are completely out of date for what is now emerging as a major specialty across medicine. That amendment would rectify a lacuna.
Lord Borwick (Con)
Briefly, I support Amendment 176 from the noble Lord, Lord Hunt. I first declare two interests as a patron of thyroid charities, particularly the Thyroid Trust, whose leader, Mrs Lorraine Williams, has done great work on behalf of patients. I should also declare that I once suffered from Graves’ disease, with an unpredictably hyperactive thyroid gland. This may have been one of the few parts of my body that was hyperactive, but it was surgically removed and, ever since, I have taken daily levothyroxine. However, some patients cannot take levothyroxine but need liothyronine instead. It is a shame that some patients have been unable to get that drug when they need it so badly. I know that the NHS must control total drug costs, but the history of its control of that particular drug has perhaps not been perfect. The fault is originally that of the manufacturer, not the NHS, but it is patients who have suffered. The amendment of the noble Lord, Lord Hunt, would solve this problem.
Lord Sharkey (LD)
My Lord’s, I shall speak to Amendments 178 and 240, and I remind the Committee of my interest as chair of the Specialised Healthcare Alliance.
Amendment 178 deals with innovative medicines and medicinal products. The debate on this amendment is very timely, given the recent conclusion of NICE’s review of its methods and processes and the current consultation on the innovative medicines fund. Both the review and the IMF consultation are to be welcomed. It is clear that they will result in improvements in the system of assessing medicines and medicinal products, particularly in respect of analysing and addressing uncertainty and incorporating more real-world evidence into decision-making. However, it is also clear that both the IMF proposals and the outcome of NICE’s review are at risk of falling short of the hopes of many patients, clinicians and the life sciences sector more generally in a number of important ways.
First, there is still a lacuna in NICE’s approach to considering treatments for rare disease. For ultra-rare diseases—those affecting fewer than 1,000 people—NICE retains its highly specialised technologies process. For more common conditions—those affecting more than 25,000 people—NICE has its separate technology appraisal process. But for patients with rare diseases—those affecting between 1,000 and 25,000 people—there is no process, and so treatments for these patients have to be considered instead through the unsuitable technology appraisal process. This gap sets us apart from other countries, such as the more generous ASMR system in France and the AMNOG system in Germany for evaluating rare disease treatments.
It was therefore very disappointing to see that the case for the rare disease modifier was again rejected in NICE’s review. It was rejected on the grounds that society does not value treatments for rare disease more highly than those for more common diseases. Those representing rare-disease patients would contend that the fact is that these treatments are inherently costly. The Government accept this in relation to ultra-rare disease, so why do they not do so for rare disease treatments? I would be grateful if the Minister could address that specific question when he replies.
Secondly, NICE’s own consultation looked favourably on reducing the discount rate at which NICE assesses the future costs and benefits offered by a treatment, saying that such a change
“could make a particularly big difference to some treatments, like gene therapies.”
However, NICE has now said that this change would not be possible, due to the views of “system stakeholders”, and this has disappointed many people. When the Minister replies, I would be grateful if he could expand on what “system stakeholders” really means in this context. Who is NICE talking about and why did it assign conclusive weight to their views?
Thirdly, the system in England still fails to formalise the input of patients and clinical experts in the way that, for example, the SMC in Scotland does through its patient and clinical engagement process.
Finally, proposals for the innovative medicines fund now move far beyond the originally planned narrow focus on autoimmune and rare diseases. This causes some SHCA members to worry that rare diseases will get less attention than originally envisaged.
These proposals fall short of the hoped for bridge between the MHRA’s licensing process—which reforms are speeding up in some cases—and NICE’s reimbursement process. Without such a bridge, earlier licensing will not deliver benefits to NHS patients, and ultimately companies will lose interest in making bespoke licensing applications to the MHRA. The Government’s own figures—the life sciences competitiveness indicators, published by the Office for Life Sciences—demonstrate that it is already the case that the per capita uptake of new medicines remains lower and slower in this country than in comparable countries.
Our Amendment 178 suggests that the Government review the situation by the end of the year, when we will have a good half year of experience of the changes to NICE and the operation of the IMF, and when we will be able to see that the hoped for improvements have materialised. I hope that the Minister will consider this suggestion.
I now turn to Amendment 240, which seeks to probe the Government’s actions to improve awareness of rare diseases among healthcare professionals. There are more than 7,000 rare diseases, and it would clearly be impossible for every healthcare professional to receive training on every single one of them. However, as the Government’s rare disease framework notes, healthcare professionals can improve their awareness of rare diseases more generally, be more alert to considering them and be provided with the educational resources that help them recognise rare diseases in patients. Healthcare professionals can also be better supported to help signpost patients with rare disease to information about their condition and to help them understand it.
In a 2016 survey by Rare Disease UK, it was found that 70% of patients were not provided with sufficient information on their condition following diagnosis, and that 35% of patients given information did not understand the information that they were given.
More recent surveys demonstrated that these challenges continue. The Government’s national conversation on rare diseases in 2019 found that almost one in five people living with a rare condition reported that a lack of healthcare professional awareness of their disease was the number one challenge that they faced, and healthcare professionals themselves identified it as the second biggest challenge they faced behind only the well-known difficulties in obtaining an accurate diagnosis. I accept that healthcare professional regulators can do only so much to make improvements, but it would be helpful to understand from the Minister what steps they might be able to take to help better embed rare disease content in training frameworks.
Finally, there is a wider question of how the Government currently track progress in increasing awareness of rare diseases among healthcare professionals. How do the Government do that? I look forward to the Minister’s reply.
Baroness Meyer (Con)
My Lords, in speaking to Amendment 266, I shall not speak for long because everything has been said. The noble Baroness, Lady Finlay of Llandaff, explained the problem very clearly as did other speakers.
The only reason I want to speak is that in April last year I spoke in favour of the Private Member’s Bill introduced to this House by my noble friend Lady Wyld which sought to prevent cosmetic procedures being performed in England on people aged under 18 unless under the direction of a medical practitioner. The Bill was passed with cross-party and government support. As a result, children are now better protected. It is high time that we protected the population at large. When one hears of all the side-effects and that people can buy a product online and inject it into themselves or somebody else, it feels like the wild west, and the consequences can be quite dramatic, as we have heard. I very much hope that the Government will be able to support this amendment. This is not complicated and needs to be done quickly.
Baroness Pitkeathley (Lab)
I want to follow the noble Lord, Lord Sharkey, because I am former chair of the Specialised Healthcare Alliance. I shall speak very briefly in support of Amendments 164 and 178 in his name and that of my noble friend Lady Wheeler.
Every reorganisation of the NHS leaves patients who have a rare or less common condition anxious about how their particular needs will be assessed, how they will be met and even how they will be noted. It is sadly true that the rarer or more specialised a condition, the more it comes down to a postcode lottery whether the patient will be able to access care in spite of established national standards. Not only is it harder to access care, it is also harder for these patients to access the support groups or information networks which are vital when finding out the sometimes rare information about these conditions. The suggestion in Amendment 164 that the CQC assess the provision by ICBs of care for those with rare or less common conditions would provide the assurance that is so badly need.
Baroness Bennett of Manor Castle (GP)
My Lords, in part because I listened to the lecture with which we started this session but more because it is an old anecdote, I shall forbear from telling my hospital food horror story. However, I will pick up on the points made by the noble Lord, Lord Hunt, and the noble Baroness, Lady Barker, about hospital food and how hard people are trying to improve the situation. This relates to the answer the Minister gave me on Monday in Oral Questions. Of course, it is dependent on the budget that caterers have and the quality of the food that is available to them. I was pleased that the Minister then said that the Government are looking to tackle government procurement to improve the quality of vegetables and fruit. In terms of joining up the dots, that is a useful point to make.
On Amendment 243, I offer the Green group’s support and note that, having been in your Lordships’ House for only a little more than two years, I have debated a very similar amendment at least once before—I think it must have been on the Medicines and Medical Devices Bill. We have all seen briefings that are very much a cry from the heart from the nursing profession for this to happen. Surely we can get this into this Bill.
Baroness Watkins of Tavistock (CB)
My Lords, I apologise to the Committee for omitting to say that I am a registered nurse on the NMC database. I think this is important in relation to Amendment 243.
Baroness Walmsley (LD)
My Lords, I will be as brief as I can. I have a few words about some of the amendments in this wide-ranging group.
Amendment 243 would protect the title “nurse”. I know from family members that the qualification of registered nurse is always hard won, the result of very hard work. It involves rigorous basic training, often followed by further training in a specialty such as mental health nursing or surgery. The title provides a high level of trust among patients and the general population, because we know that a nurse must be registered with the Nursing and Midwifery Council, or a different responsible body for dental or veterinary nurses. There should therefore be clarity about who can use the title, and it could be sorted out very simply by the Minister—I hope he will do it.
A further anomaly, which the Minister can easily sort out in his reply, is that of the appointment of surgeons. I hope he will remove that anomaly as well.
I commend the work of my noble friend Lord Sharkey on rare diseases. I will not repeat what he said about what is needed, but I hope the Minister can give him some assurance.
I strongly support Amendment 266 on the need for a register for those who practise aesthetic non-surgical interventions. I will not repeat what my noble friend Lady Brinton and others have said about the reasons for this.
Amendment 293 requires a special register for cosmetic surgery. It is important that we have an up-to-date, comprehensive and rigorous method of assessing and registering the qualifications of surgeons safely to carry out cosmetic surgery. The question is: how is that done? I have received a briefing from the GMC, which tells me that it does not support the creation of a separate register for cosmetic surgery practitioners. Instead, the GMC believes that its proposal to move to a single GMC register that includes all doctors, anaesthesia associates and physician associates, and special annotation with work to develop relevant credentials, will provide additional assurance beyond that which could be provided by a separate additional register.
We are told that something better is coming down the track and that the forthcoming regulatory reform programme is intended to rationalise and streamline registration across all the UK healthcare regulators, and will allow the GMC to deliver an accessible, flexible and discretionary registration framework for all registrant groups. That is why the GMC believes that that will provide greater flexibility to develop and amend registration rules and improve its ability to innovate. Given the rapid development of new spheres of medicine and practices, such flexibility could be advantageous.
I understand that the GMC is now developing credentials with royal colleges and health education bodies, and that the first group of those is led by one on cosmetic surgery, plus four other disciplines. So, while I heartily agree with the intention of Amendment 293, I ask the Minister: when will the regulatory reform mentioned in the GMC briefing be completed? When will Parliament be able to see it and, in the meantime, how can we be assured that the current system gives the assurance on patient safety that is required?
I too support the noble Lord, Lord Hunt, on hospital catering and I too will resist giving my anecdote.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank noble Lords for their contributions and for sharing their knowledge and expertise—and, in the case of hospital food, not sharing their tales of inadequate and unhealthy food. I will try to answer as many of the questions as possible but, given the experience of the noble Lord, Lord Patel, of being advised by a nurse Whip, I am keen to make sure that I do not suffer those same warnings, as it were.
On rare diseases, specifying requirements in the way proposed by the amendment would restrict the ability of the CQC to collaboratively develop its assessments of integrated care systems. However, the Government are committed to improving the lives of people living with rare diseases. The noble Lord, Lord Sharkey, rightly talked about the UK Rare Diseases Framework that we published in January 2021, which set out our key priorities for tackling rare diseases. England’s action plan will be published at the end of next month.
I have had conversations with some in the life sciences industry who are keen on the fact that we are focusing on rare diseases and extremely rare diseases, and see that as a positive. One of the things that we are trying to do across government is to make sure that we are seen as a hub for expertise in rare diseases and especially rare diseases. One of my predecessors as a Minister suffered from a rare disease. The momentum is still there in the department to make sure that we tackle the issue.
Also, the CQC, through its ICS assessment methodology, will seek to understand how system leaders are monitoring and meeting the needs of the local population, including those with rare diseases. We expect the CQC, in collaboration with system partners, to use its experience as the independent regulator of health and adult social care in England to develop an approach to those reviews. I know that noble Lords may be tired of hearing this but it is important that the legislation allows the CQC flexibility to do so.
On Amendment 240, while the Government have sympathy with the need to raise awareness, we do not consider it appropriate to put such a requirement into primary legislation. I hope I have reassured the noble Lord about our programmes and our push to raise the profile of rare diseases and extremely rare diseases. We prefer that all healthcare professional regulators require professionals to have the necessary skills and knowledge to practise safely, including awareness of rare conditions. It is the responsibility of the regulators to determine what specific role they should play in raising awareness of rare and less common conditions.
On—and I apologise if I mispronounce this—liothyronine and the power of direction, the NICE guideline on the assessment and management of thyroid disease, as the noble Lord acknowledged, does not recommend liothyronine for primary hypothyroidism. NICE states that there is not yet enough evidence that it offers benefits over levothyroxine monotherapy, and its long-term adverse effects are uncertain. If new evidence was to emerge, I am sure NICE would consider it.
In addition, we must be careful not to override NICE guidelines. But, given the concerns raised by the noble Lord, Lord Hunt, and my noble friend Lord Borwick, I would like a further conversation, if that is okay, to see what can be done in this area, as well as where it is appropriate for me to act and what conversations would be appropriate, given the noble Lord’s experience as a Health Minister.
On Amendment 178, we are committed to further strengthening the innovation metrics and to improving our understanding of how innovative medicines and these products are used in the NHS. Noble Lords will be aware that following the publication of the final report of the Accelerated Access Review, the Government established the Accelerated Access Collaborative—AAC—last year. In fact, last year alone we helped over 300,000 patients access proven innovations, resulting in 17,000 fewer hospital admissions and 140,000 fewer days spent in hospital.
As noble Lords are aware, we published our ambitious Life Sciences Vision, which laid out our priorities. We want to make sure that the NHS is seen as a partner in innovation and that research is embedded into everything the NHS does. I know that this has been raised in relation to other amendments. We are currently developing implementation plans for delivering on these commitments.
As noble Lords acknowledged, NICE is in the final stages of the review of its methods and processes, and is proposing a number of changes that will introduce real benefits to patients, including rare disease patients. The Government are also committed to developing an innovative medicines fund, which my noble friend referred to, and a consultation on detailed proposals for the fund closes on 11 February.
Finally, our rare disease framework outlines the key priorities for rare diseases in the UK over the next five years. One priority area is to improve access to specialist care, treatments and drugs.
On hospital food, although we recognise the expertise and declarations of the noble Lords who spoke, we believe that this amendment is unnecessary because the issues are already covered, either as part of the ongoing work to implement recommendations from the hospital food review or in the NHS food standards document, to be published in spring 2022.
The Government are supporting NHS England to implement the recommendations from the independent review. These recommendations cover a broad range of issues, including nutrition, hydration, healthier eating and sustainable procurement. It is important for me to learn more about this as a Minister, given what the noble Baroness, Lady Barker, said about many people not receiving the recognition they deserve. It would be appropriate, perhaps, for us to meet and follow this up.
In addition, the Government already have sufficient legal powers and obligations to enable them to consult on proposed food standards, and we have engaged with NHS trusts, the food standards and strategy group, and the NHS food review expert group through the NHS food review. We will continue to do all this.
On Amendment 264, the regulations already allow trusts to seek alternative members to contribute to the process. They can be from colleges such as the Royal College of Surgeons of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Emergency Medicine. However, the Government agree that the changes proposed by noble Lords in Amendment 264 would potentially be advantageous —to put it that way—and we have undertaken to review the situation with officials.
The National Health Service Act 2006 stipulates that consultation with affected parties must be undertaken before any changes are made. Therefore, before we jump to it and agree, we are required to consult the relevant parties. It does seem a clear-cut case, but we are still under a duty to consult.
Lord Patel (CB)
My Lords, the Minister suggested that, to have any changes in the appointment of surgeons, the department would have to consult first. I assume that the only body it would need to consult is the Royal College of Surgeons, which I understand is sympathetic to the change. If that is the case, it is a simple matter, so can it not be consulted before Report?
Lord Kamall (Con)
If it is as straightforward as the noble Lord suggests, I will see if that can be done.
Baroness Wheeler (Lab)
My Lords, I thank noble Lords for their many expert and very informative contributions. It has been a fascinating debate on a number of issues.
On specialised care services and rare diseases, I note the Minister’s comments and thank him for some of his reassurances, but there were some issues that he did not cover, particularly in relation to my noble friend’s Amendment 178. However, I welcome the dialogue that is taking place on these issues, and the recognition of their complexity, and am very hopeful that that will continue. We will take stock to see if anything else needs to come back on Report. I also thank my noble friend Lady Pitkeathley for her support on this issue.
In the general debate, noble Lords will, I am sure, follow up on the points that they made, as the noble Lord, Lord Patel, just did. I thought the contributions of my noble friend Lord Hunt and the noble Baroness, Lady Barker, on the hospital food situation, really drove home the importance of this issue. We must make progress on it and move forward.
On the title “nurse”, strong support was expected and we certainly got it from across the House. I hope that progress can be made. The issue will not go away, as the Minister knows, and neither will the determination of my noble friend Lord Hunt to pursue the issue of the availability of T3 for thyroid patients. We hope that progress can be made on that, because again it is a situation that a must be addressed.
The noble Baronesses, Lady Masham and Lady Brinton, and other noble Lords made valuable points on the vital need for a licensing regime for non-surgical cosmetic procedures, again underlining the need for urgent, step-by-step progress, and demonstrating in particular why the current situation is unacceptable. Progress can be made. As the noble Lord, Lord Lansley, pointed out, it was seen in the recent Private Members’ Bill on Botox fillers. We need progress to be made, and steadily.
Finally, on the reference to when the review of the regulatory system will be completed—the noble Baroness, Lady Walmsley, also raised this—the issue was about timescales. We know there is a review. We are told that KPMG is on the case and has delivered its report, but we need timescales and action as soon as possible.
With those comments, I beg leave to withdraw my amendment.
“Place based integrated care and Primary Care Commissioning Boards
(1) Each place based integrated care board is to be established by regulations made by the Secretary of State for an area within an integrated care board.(2) An order establishing a place based integrated care board must provide for the constitution of the board.(3) Before making, varying or revoking an order under this section, the Secretary of State must consult—(a) the integrated care board in which the place based integrated care committee is intended to operate;(b) the relevant local authority or local authorities;(c) the integrated care partnership in which the place based integrated care committee is intended to operate;(d) the local healthwatch organisations whose areas coincide with or fall wholly or partly within the proposed area of the place based integrated care board; and(e) members of the public living within the proposed area of the place based integrated care board.(4) The place based integrated care board may arrange under a scheme of delegation from the integrated care board for the provision of such services or facilities it considers appropriate for the purposes of the health service that relate to securing the improvement—(a) in the physical and mental health of the people for whom it has responsibility, or(b) in the prevention, diagnosis and treatment in these people.(5) In imposing financial requirements on integrated care boards under Section 223GB of the National Health Service Act 2006, NHS England may give additional directions in respect of placed based integrated care committees.(6) Integrated care boards may give place based integrated care board directions as to any of the functions to which it has given delegated functions. (7) The Schedule to the Public Bodies (Admission to Meetings) Act 1960 (bodies to which that Act applies) shall be amended as follows.(8) After paragraph 1(k), there shall be added the following sub-paragraph—“(l) Place Based Integrated Care Boards.””Member’s explanatory statement
It’s likely that ICBs will set up place based entities which may take many of the key commissioning decisions at the local/Constituency level. This amendment puts place based integrated boards on a statutory basis and subject to Parliamentary oversight and meeting in public.
Lord Hunt of Kings Heath (Lab)
My Lords, my Amendments 165 and 166 are rather more focused than the last group. They are probing amendments, rather than me urging that Ministers take the specific wording of them.
One of the rather surprising characteristics of integrated care systems is that they are not defined in the Bill, although people talk about these entities all the time. The statutory parts are integrated care boards and integrated care partnerships, but much of the real power, decision-making and influence potentially lies with non-statutory groups, whose membership, governance and procedures are not regulated. These are placed-based partnerships, provider collaboratives or networks, primary care networks, or companies accredited to the health system support framework. My two amendments would put the first two of these non-statutory groups on a statutory basis. Place-based partnerships are described and supported by NHSE and the Local Government Association as the foundation of integrated care systems. I am very grateful to the policy research unit in health and social care systems and commissioning at the University of Manchester for its very helpful work on this.
In our debate on primary care, the Minister referred to his hope that integrated care boards would
“exercise functions through place-based committees”.—[Official Report, 20/1/22; col. 1852.]
It is pretty clear that many ICBs will delegate considerable responsibility to them. I can see the potential for that, but given their increased responsibilities, there are legitimate questions to be asked about how place-based committees are to be held to account. What are their governance arrangements? Who will serve on them? What are their leadership arrangements? What functions will they be allowed to carry out? The noble Earl, who I think is responding, may say that that is best left to local decision-making. I see that up to point, but rather like with ICB governance, surely some framework and safeguards need to be built around them.
A similar argument might be made in relation to provider collaboratives. Such collaboratives are essentially partnership arrangements involving two or more trusts or foundation trusts. Participation is mandated for trusts providing acute or mental health services. They are expected to be part of one or more provider collaboratives, with discretionary participation of other providers. Such collaboratives may form at supra-ICS level, may partially cover multiple ICSs and may cover multiple places. Additionally, providers may be members of multiple overlapping collaboratives. The collaboratives may contain acute or mental health members only, or may include wider membership such as community providers and primary care. It is anticipated that they will deliver systems’ strategic priorities. The original White Paper, Integration and Innovation: Working Together to Improve Health and Social Care for All, indicates that “significant” delegation to both place level and provider collaboratives from integrated care systems is expected. It is also suggested that, in time, provider collaboratives may play a role in oversight. At Second Reading, the noble Lord, Lord Lansley, said:
“we have new provider collaboratives which, in fairness, is where the power in the NHS will lie. The Bill makes no provision for them in terms of transparency, openness or accountability”.—[Official Report, 7/12/21; col. 1789.]
This was confirmed on 2 December by the Health Service Journal:
“In the minds of most acute trust chiefs, it is provider collaboratives and groups, and not integrated care boards that will wield the greatest influence (although the former may act through their representation on the latter).”
So I want to put a few questions to the Minister. First, what degree of oversight will be exerted over the formation of these arrangements, and by whom? Secondly, if a lead provider contract is in place, or if providers agree how to spend their respective resources as a provider collaborative, who would oversee that arrangement and where would accountability lie in the delivery of outcomes or in the case of poor performance? How would it be ensured that the work of provider collaboratives took into account the interests, aims and work of the wider health and social care community, including the patient voice?
On the latter, the NHS England design framework made it clear that the involvement of patients, unpaid carers and the public is expected at place and system levels, with requirements for public meetings and published minutes in both the partnership and the NHS board. It is not specified how provider collaboratives, where significant decisions regarding the planning and provision of services may be made, will be publicly accountable.
I believe that the Government are going to discuss with noble Lords the formation and governance of integrated care boards and integrated care partnerships. I suggest that that discussion be extended to look at the position of place-based committees and provider networks, because at the end of the day Parliament is entitled to establish some kind of framework and governance and transparency arrangements without going too much into the minutiae of the detail. On that basis, I hope that the Government might be prepared to take away these amendments as part of that broader discussion. I beg to move.
Lord Lansley (Con)
My Lords, perhaps I may make two quick points. At an earlier stage in the Committee, using the example from the noble Lord, Lord Mawson, in relation to Bromley by Bow and north-east London, I asked why the legislation cannot allow clinical commissioning groups, as they have established themselves over years, to continue as place-based committees or subsidiary elements of an integrated care system. I am sure that many of them would be willing to do so; we should allow them to do exactly that, because there is otherwise a gap in relation to how large ICBs will do their place-based work.
Secondly, the noble Lord, Lord Hunt of Kings Heath, referred to what I said about provider collaboratives. I still think it. Where are we going to end up with this? It will be with NHS England having within it, as each integrated care board has within it, the provider interest and the commissioner interest. The Government purport to be abolishing the purchaser/provider split. Every Secretary of State prior to the former Secretary of State, Matt Hancock, seemed to believe in it, with the exception of Frank Dobson. There was a reason why we did that: because it is a fact. We might legislatively abolish the purchaser/provider split, but, in reality, it will exist. As my noble friend Lord Hunt of Wirral said earlier, if that conflict of interest is not properly recognised and managed, it will emerge with potentially damaging consequences. Transparency about how provider interests are to be properly managed inside the NHS is not something I yet see in the substance of the Bill. I hope that my noble friend on the Front Bench will agree to think hard about this and perhaps talk about how we might give transparency and accountability to that conflict of interest.
Baroness Tyler of Enfield (LD)
My Lords, I have added my name to Amendment 165 in the name of the noble Lord, Lord Hunt. This is a small but important group of amendments.
I have added my name to the amendment because I am interested in what is happening to primary care and particularly the voice of GPs in the new arrangements. Frankly, we are not hearing much about them. As it stands, the legislation will place NHS trusts and foundation trusts in quite a privileged position in deciding how plans are made and resources allocated. I am not quite sure where the voice of GPs comes into the new arrangements. I understand that NHS England has commissioned a review of the role of primary care in the NHS structures, but my understanding is also that it will not report until after the Bill has been passed if we continue with the current timetable. Frankly, by then, it will be a bit late to make sure that we have got the arrangements absolutely right.
It is right that primary care commissioning is undertaken at a local level by people with relevant knowledge and skills, and with the necessary experience of what primary care needs to look like at locality level. That is why it is right that the new place-based partnerships are to be given that commissioning role. However, like the noble Lord, Lord Hunt, I think it is important that these primary care commissioning arrangements are established in statute, because it is only if that happens that Parliament will be clear about the accountability arrangements and the governance and leadership. It is also important that there is real transparency in the system. At the moment, it all feels a bit opaque. I hope that the Minister can give some assurances on this point.
Lord Stevens of Birmingham (CB)
My Lords, I just wanted to respond to the last set of very important questions that have arisen. It is fair to say that the Bill increases the accountability for commissioning primary care services locally, as compared with its predecessor, the 2012 Act. That is because one consequence of having GPs represented on the clinical commissioning groups was that clinical commissioning groups could not, therefore, be the commissioners of local primary care services, at least in statute. One had the paradox that the most local of all the services in the NHS was stripped out from the local commissioning bodies, the CCGs, and instead given nationally to NHS England, as a work-around to deal with the conflict of interest that GPs would otherwise have had in commissioning themselves on the CCGs.
In practice, the CCGs have been given the ability to influence those local commissioning arrangements but, to be clear, that is not the accountability mechanism set through the 2012 Act. What this Bill does is to improve the position, in that it is local integrated care boards that have that local commissioning responsibility for GP and other family health services, as compared with NHS England nationally.
Baroness Walmsley (LD)
My Lords, we have been reminded many times during the debates in Committee of the aims of the Bill to improve the health and well-being of the population, to improve the quality of care and to use NHS resources sustainably through integration, co-operation and collaboration. Of course, the point at which these resources are used at the coalface, known as “place” in the Bill, is in these place-based organisations. To ensure integration at this level, we are told that the ICB must create an integrated care partnership, otherwise known as a place-based integrated care board, which probably has an acronym as well. There is, however, very little detail about those, despite their crucial importance, and these amendments from the noble Lord, Lord Hunt, are an attempt to put a bit of flesh on those bones.
I put my name to Amendment 166, but I could just as easily have put it to Amendment 165. Amendment 166 says that, within the place-based partnership, there should be mandated a provider network board with duties delegated to it by the ICB. It would be under parliamentary scrutiny and have an obligation to meet in public. These networks already exist and exert considerable influence, but it is essential that they operate in this new integrated care system under a regulated constitution, with obligations to consult and financial provisions. This amendment would ensure the transparency, for which the noble Lord, Lord Lansley, called, over how well integration is operating at this very important level so that there can be proper control and accountability and scrutiny as to where the money is being spent and whether it is achieving the duties placed on all these systems by the Bill.
Baroness Thornton (Lab)
I thank my noble friend for tabling these amendments; I have added my name to both of them. They are about transparency and legitimacy, raising very important questions which the Minister needs to answer.
I go back to what the noble Lord, Lord Lansley, said at Second Reading, which I think my noble friend referred to. He said that
“we have new provider collaboratives which, in fairness, is where the power in the NHS will lie. The Bill makes no provision for them in terms of transparency, openness or accountability.”—[Official Report, 7/12/21; col. 1789.]
I do not need to say any more than that. The Minister needs to answer that question, because it needs to be resolved before the Bill completes its passage.
Earl Howe (Con)
My Lords, I am grateful to the noble Lord, Lord Hunt, for bringing us back to the subject of place-based structures and taking us into the issues relating to provider networks. I hope it will be taken as a given that the Government have sympathy with the intentions behind his amendments.
On Amendment 165, we absolutely agree on the importance of place, and I hope I can provide the Committee with reassurances on that score. First, the linchpin to the accountability issue is, I suggest, the ICB constitution, which is required to set out how its functions will be discharged. That may include how functions will be carried out by committees and sub-committees, which will include place-level committees. The best size for an ICB area varies according to local circumstances, and some of the smaller ICB areas are coterminous with the local authority. In those systems, place arrangements will quite rightly look very different from the large ICB areas.
ICBs need to be clear about the expectations and roles of place-based structures, including what they are responsible for commissioning, what powers have been delegated to them, and what resources they are responsible for. The current legislation provides for the ability to establish place-based structures and set them out clearly in ICB constitutions. However, Frimley is not Cumbria, and Essex is not Manchester. We want to give ICBs the flexibility to determine structures that work best for them. To help them do that, NHS England has the power to issue guidance to ICBs on the discharge of their functions, and is working with CCGs and the current non-statutory ICSs to develop model constitutions for the future ICBs. Those constitutions will, of course, also have to be approved by NHS England before the ICB is established. This approach should achieve the right balance, because it allows us to support ICBs to develop, without the danger of putting in place further legislation which could act as a barrier to future evolution. Requiring the establishment of a separate place-based board is simply not necessary and would come at a bureaucratic cost.
I turn to Amendment 166. I appreciate the noble Lord’s concern about transparency and accountability for groups of providers working together where they are exercising functions that an ICB has delegated. I shall come on to the concern expressed by my noble friend Lord Lansley, about the purchaser/provider split. Provider collaboratives are intended to deliver the benefits of scale, with providers working together to implement best practice and reduce variation in access, experiences and outcomes for patients and populations. For example, this could involve sharing workforce and managing capacity on a wider scale. Depending on the local circumstances, such arrangements may include a delegation of ICB functions. ICBs and providers should have the flexibility, in line with guidance that will be issued by NHS England.
Baroness Thornton (Lab)
Has the Minister actually seen the model constitution that will be imposed by NHS England, and does it do what he is suggesting it does? Maybe the rest of us could see it, too.
Earl Howe (Con)
My understanding is that it is work in progress—so no, I have not seen it.
Baroness Thornton (Lab)
Is it not then unsatisfactory that we should complete the passage of the Bill without having sight of the constitution, so that we can be assured that the assurances that the Minister is giving us will in fact work?
Earl Howe (Con)
I do not think that is a reasonable ask by the noble Baroness, if I may say so. I am trying to describe a structure that should deliver what I am sure she wants to see—safeguards and good pointers for ICBs to make their own decisions, while also ensuring that some of the pitfalls mentioned in the debate are not fallen into. If I can let her see the work in progress, I shall certainly be glad to do so—I do not have a problem with that—but I suggest that it is not necessary for her to do that to accept the proposition that I am trying to put forward.
As I have mentioned, the Bill requires an ICB to set out in its constitution how its functions will be discharged, including any arrangements to delegate functions to provider collaboratives. Furthermore, as an additional safeguard, the Secretary of State may impose conditions on the exercise of the power through regulations.
Baroness Tyler of Enfield (LD)
Before the Minister sits down, is he in a position to answer the question I asked about the timing of the review regarding the position of GPs within this new set of arrangements?
Earl Howe (Con)
I shall need to write to the noble Baroness about that timing because I do not have it. I meant to say that I was grateful to the noble Lord, Lord Stevens, for his intervention on the way in which we hope that primary care will be better built into the commissioning arrangements than it has been up to now.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the noble Earl and to the noble Baroness, Lady Tyler, for her helpful interventions on primary care, which were very important.
In essence, the noble Earl said that we should be reassured because, either through the constitution of the ICB or through the more general guidance given out by NHS England, appropriate accountability and monitoring arrangements will be put in place. I accept that, but there are questions about the guidance and the constitution which mean that we may well want to come back. I think it would be appropriate for Parliament to give some oversight approval to that.
We are a bit jaundiced about NHS England guidance because we still cannot get hold of the guidance put out 10 or so days ago about the make-up of ICBs and the new timetable, which I mentioned on our previous Committee day. It is on something called nhs.net but not even our Library can get hold of it because there is a security wall around it, and I do not understand why it has not been put into the public domain. That is why we are a bit wary of any guidance that is going to be put out. I cannot resist saying that I hope the guidance is not going to say that local authority councillors cannot be on the place-based committees, because that would be a mistake. It could be helpful in some places for them to be so appointed.
On the more general issue of purchaser-provider tension, we have had a really interesting debate. The noble Lord, Lord Lansley, said that every Secretary of State apart from Frank Dobson, of blessed memory—my first ministerial job was serving under Frank before he was persuaded, if that is the word, by Tony Blair’s persuasive skills to go and fight Ken Livingstone for the mayorship of London—believed in it.
The point is that, whatever you call it, there is clearly going to be a relationship between the organisations of the NHS that have the dosh handed out by the department and those organisations that provide the services. There is going to be an unnecessary tension and an issue of accountability and monitoring. The puzzle that some of us have is how that is going to work within the integrated care boards when the big providers are sitting around the table. I think the clue was given in the Health Service Journal, which said:
“In the minds of most acute trust chiefs, it is provider collaboratives and groups, and not integrated care boards that will wield the greatest influence”—
an interesting phrase. I suspect the real dynamic is going to be between those collaboratives and the chair and chief executive of the integrated care board, while the board itself, which looks as though it is going to be very large, will be the legitimiser of those discussions and tensions. Still, it is a bit of a strange beast.
The noble Lord, Lord Stevens, raised the issue of CCGs and the fact that, because they were essentially membership organisations of GPs, they could not do the nitty-gritty of managing the contracts, which in the end was kind of half-devolved down to them but with accountability held at the NHS England level. That illustrates the problem of having providers and commissioners around the same table. For very good reasons people want to encourage them to integrate, but that poses its own challenges.
I think it is inevitable that we are going to come back to this issue. This has been a very good debate and I am most grateful. I beg leave to withdraw the amendment.
Lord Hunt of Kings Heath
“(4A) A direction under subsection (1) may be given only in relation to a particular instance, not generally.(4B) A direction under subsection (1) must provide for the direction to cease to have effect on a date specified in the direction, which must be no later than one year from the date the direction was given.”Member’s explanatory statement
This amendment, along with the other amendments to Clause 39 in the name of Lord Hunt of Kings Heath, would reduce the scope of the Secretary of State powers to direct NHS England by adding safeguards and additional exceptions.
Lord Hunt of Kings Heath (Lab)
My Lords, we come to Clause 39, which I think is one of the most significant ways in which the Bill will increase the powers of the Secretary of State over the NHS. The clause gives a general power of direction over NHS England in the exercise of its functions. It is a very significant change from the legislation the noble Lord, Lord Lansley, put through in 2011-12. It also is clear that many NHS bodies are, like the Nuffield Trust,
“concerned that these new powers will result in a more politicised NHS, with ministers dragged into micromanaging how local services work.”
I do not think you can consider this clause without considering further clauses in the next group, led by the noble Baroness, Lady Cumberlege, in relation to the power of the Secretary of State to intervene at any time in proposals to change services. In addition, Part 3 of the Bill gives the Secretary of State the power to move responsibilities between several arm’s-length bodies in health and to abolish them. We have already had the CQC debate today, about an increase in the Secretary of State’s capacity for intervention. There is also the question of the regulators, which will be discussed later, which again leads to the individual professional regulators, which, again, the Secretary of State can abolish.
Although I am going to talk about the general direction, I do not think you can do that without thinking about the other accretions of power that the Bill takes. Together, I believe it is a fundamental difference —a change in philosophy—from the 2012 legislation. NHS Providers, with which I have discussed this extensively, is concerned. As it says:
“Clinical and operational independence must be maintained in order to ensure equity for patients within the service; the best use of constrained funding; and clinical leadership with regard to prioritisation and patient care.”
Although I do not want to completely open up this debate, I have to say that the allegations made by Conservative MPs about threats made in the last few days by Government Whips, over the funding of services, are very apposite to how a power direction might be used by Ministers under this Bill.
Lord Lansley (Con)
My Lords, I shall intervene relatively briefly. The noble Lord, Lord Hunt, quite rightly said that this is a significant departure from the intentions of the 2012 legislation. The 2021 Act, among other things, created the body that is now NHS England and gave it independence. None of that independence was intended to mean, nor has proven to, that it was not responsive to even the day-to-day wishes of a Secretary of State, as I am sure the noble Lord, Lord Stevens, would verify. What it did put in statute was that, if the Secretary of State wants to set something as an objective of NHS England, they put it in the mandate. If the Secretary of State requires a change to those objectives, they publish a revision to the mandate.
Going beyond it is, I think, the product of circumstances where we had a Secretary of State who was encountering an emergency and thought he could press lots of buttons and things would happen, but pressed some and they did not. I think, even in his experience, that was more outside NHS England than inside it— I may be wrong, but that was certainly my impression. The point is that the Secretary of State did not even realise what powers he had in an emergency; they are all there and he was not required to change the mandate, because it was an emergency. In a public health emergency, none of this, strictly speaking, is within the same bounds.
Ministers have quite rightly said that this is the Bill the NHS asked for. But Clause 39 is not the clause that the NHS asked for; it is the opposite of what it is asking for. There are many practical issues. The noble Lord, Lord Hunt, is right; if it appears, including to the senior people and bright youngsters, that power is going to shift from NHS England back to the Department of Health and Social Care, they will go and work in the department. One of the things I was most pleased about was that some of the brightest and best, including civil servants in the department who I knew well, went to work in NHS England, because they thought, “This is a great future.” That is terrific, because one of the problems was that NHS managers were being imported into the Department of Health, rather than bright policymakers going to the NHS. The NHS is too important an institution for it not to have the best possible policymakers under its own purview.
The noble Lord, Lord Hunt, and the noble Baronesses, Lady Thornton and Lady Walmsley, have done a sterling job in trying to mitigate a general power of direction for the Secretary of State. Frankly, I have not heard a case for it, it is contrary to where we are and where we need to go, and the simplest thing is to simply take Clause 39 out of the Bill.
Lord Warner (CB)
My Lords, it is a delight to follow the noble Lords, Lord Lansley and Lord Hunt, on this set of amendments, with which I totally agree. I want to dilate for a few moments on the realpolitik of being a Minister in the great, august organisation called the Department of Health and Social Care. I can say some things that the noble Lord, Lord Lansley, as a former elected Minister, possibly cannot.
When I ceased to be a Parliamentary Secretary and was promoted to work with the big boys and girls as a Minister of State, and had to deal with issues such as reconfiguration, poor performance and so forth, I became used to regularly meeting elected MPs who wanted to tell me about the errors of their ways in decisions that had been taken in the public interest. There was a steady flow of them, which, if I may say, tended to get bigger the nearer you got to an election. If people wanted to go through the archives, I would refer them to the history of Lewisham Hospital and of Chase Farm Hospital, to name but two.
Very often in these situations, it is not about closing a whole hospital but about re-engineering—we will come to some of this in the next group. I give the example of stroke services in London. It is re-engineering a particular set of services, which the local MP is then put up for trying to ensure that change does not happen. That is where you need to help Ministers do the right thing, when it is in the public interest to make changes. The amendments from the noble Lord, Lord Hunt, help Ministers do the right thing.
The point the noble Lord, Lord Lansley, made is absolutely valid. In many of these circumstances, it becomes very difficult if you are an elected Minister—as distinct from an appointed Minister, who does not have to face the electorate—to resist some of the local pressures to avoid change which would be disadvantageous to a local hospital. For those realpolitik reasons, I think the noble Lord, Lord Hunt, is on the right track and we should support the amendments.
Baroness Walmsley (LD)
My Lords, I support the noble Lord, Lord Lansley. Clauses 39 and 64 give the widest possible powers of intervention to the Secretary of State and even the power to delegate that power to someone else. The noble Lord, Lord Hunt, and other noble Lords clearly believe that the Government are going too far, hence the large number of amendments in this and the next group.
I believe that the Clause 39 powers could justifiably be used only in the case of some cataclysmic failure of the NHS. There are four questions to ask. Is it possible that the Secretary of State would ever need these powers of intervention at an operational level, given that he already has the mandate? Does the Secretary of State have any other powers which could be used prior to this atomic bomb of a power? Has the NHS survived well enough over the last 10 years without the Secretary of State having such powers? Does Clause 39 upset the balance between the Secretary of State and the autonomy of NHS England? I think the answers are no, yes, yes and yes—your Lordships can work it out.
The Health and Social Care Act 2012 removed the Secretary of State from this sort of meddling. I thought at the time that it might also avoid him or her taking the blame for failure, but that was just me being cynical and there has actually been no failure of political accountability over the last 10 years. The ninth report of the House of Lords Constitution Committee refers to this issue. It notes that, in 2011, it
“raised concerns that that Bill could erode ministerial responsibility due to the proposed duty on the Secretary of State to promote autonomy for persons exercising functions in relation to the health service. What is now section 5 of the Health and Social Care Act 2012 was amended, such that the Secretary of State instead must have regard to the desirability of securing autonomy. This helps ensure a balance between enabling those providing health care services to deliver services in a manner that they consider appropriate, whilst ensuring ministerial responsibility.”
The Constitution Committee believes that, in combination with Clause 64, the powers taken for the Secretary of State by Clause 39 would undermine that autonomy and upset the balance. They also risk
“undermining accountability by making it more difficult to understand which body is responsible for a particular function of the NHS.”
The fact is that the Secretary of State already has the power to change the mandate of NHS England—as the noble Lord, Lord Lansley, pointed out—to adjust its funding or to bring political pressure upon it to behave in certain ways, without the need for the powers in this clause. Indeed, I think it would be very unwise to use these powers, and he or she will certainly get the blame if it all goes pear-shaped. The Bill, as has already been pointed out in some detail by noble Lords, the DPRRC and the Constitution Committee, gives the Government considerable regulatory and guidance powers, about half of which allow no parliamentary scrutiny at all. Does that not give the Secretary of State enough ability to ensure things are done in the way the Government wish? The Secretary of State already wants to be Henry VIII; does he also want to be King Herod?
Baroness Thornton (Lab)
My Lords, I am nearly convinced that I should have put my name to the opposition to Clause 39 standing part of the Bill.
We have had a very informed and interesting debate which comes to the heart of the balances of power that the Bill seeks to change. My noble friend Lord Hunt set out concerns over Clause 39, which gives general powers of direction to NHS England. Amendments 174A, 174B, 175A, 176A and 175 seek to mitigate the power and to put in safeguards. This is very much in tune with concerns expressed across the Committee, by the Delegated Powers and Regulatory Reform Committee, and by the Constitution Committee. Our amendments stop short of that from the noble Lord, Lord Lansley, and the noble Baroness, Lady Walmsley, but theirs is a more elegant solution in many ways. However, the Minister will need to explain why some powers of direction are required, and we on these Benches will listen very carefully indeed.
This is all part of the balance between the responsibilities of the Secretary of State, especially to Parliament, and the powers the Secretary of State has to enable them to discharge their duties. If there is a clear and consistent solution to this, we have yet to hear it. In a way, we are repeating debates we have already had in Committee. The Bill has been severely criticised as a clear and disturbing illustration of disguised legislation, and it will need to be changed. We will need to move on to proper talks about how to do that.
On whether Clause 64 should stand part of the Bill, the issue is a different one. The 2012 Act introduced the formal notion of NHS bodies having autonomy, and since 2003, foundation trusts have had some degree of at least theoretical autonomy. But in the years of austerity a lot of that has gone, and all trusts of all kinds are simply struggling to manage day by day. It may have been the noble Lord, Lord Stevens, who observed that the difference between a trust and a foundation trust was a distinction without a difference. For some years, the process of managing foundation trusts has been the same as for trusts.
We have been hearing in our recent deliberations about local flexibilities. Our scepticism about this has been strong, because it appears—and this group of amendments addresses this—that any flexibility will be as great as NHS England permits. Let us not reject autonomy. Why remove the duties to promote autonomy? Why not replace them, for example, as the noble Lord, Lord Mawson, said, with a duty around subsidiarity and localism?
I will not repeat what was said by the Constitution Committee, but it was very critical of the powers that the Secretary of State seeks to take. Indeed, I raise a different issue: the fact that I thought NHS England was undertaking implementation of the Bill before it has finished its passage through Parliament. It is all part of the same pattern. Since we have an undertaking from the Minister to respond to that concern, we will look for an undertaking from him to provide an explanation and perhaps further discussion about why he wants autonomy removed from the Bill.
Lord Kamall (Con)
I thank all noble Lords for their amendments and for challenging the issues around the power of direction. We believe that we must have the right framework for national oversight of our health system. Following the merger of NHS England with Monitor and the Trust Development Authority, NHS England will be one of the largest arm’s-length bodies in government, responsible for over £130 billion of taxpayers’ money. Without this power, we would be expanding the functions and responsibilities of NHS England without ensuring that there are enhanced accountability measures in place.
Accountability must run from NHS England to Ministers, from Ministers to Parliament, and from Parliament to the public. This is what the power of direction supports. Indeed, a number of politicians from different sides agree that if you walked out into Parliament Square and asked people who is responsible, they would expect us to have answers. Therefore, we want to make sure there is the appropriate power of responsibility.
I also want to give reassurances that we expect the situations where the Government issue directions to NHS England to be rare. Where it does happen, Ministers will of course ensure that the direction is clear, appropriate and has suitable timeframes. It is paramount that this power can be deployed quickly when required, and limiting it to specific instances, or prescribing a time limit as to its efficacy, would undermine the intent of these provisions.
That said, we agree it would be inappropriate to use this power to intervene in clinical decisions, and we have specifically exempted this in the Bill. For example, we have made sure that a direction cannot be given in relation to drugs, medicines or—interestingly, given our previous discussions—on treatments that NICE has not recommended or issued guidance on. The noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, rightly questioned the draft guidance that NHS England has given—we are trying to find a copy of that. However, we recognise the unique role the Secretary of State for Health and Social Care plays in the system. The Secretary of State could use the powers to request to see the guidance developed by NHS England before it is published, to ensure that NHS England is working effectively with other parts of the system, such as local authorities, given the concerns that both the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, raised.
On Amendments 176A and 174A, we have already included a number of exemptions to the power of direction in the Bill to ensure the Secretary of State is not able to intervene in day-to-day operational matters. There is also no intention that the power will be used to direct NHS England on procurement matters. Any decision to exercise the power will be subject to and guided by general public law principles and general statutory duties. This means, for example, that Ministers will have to use regulations where they exist, as they do for procurement, and that the Secretary of State cannot direct NHS England to breach procurement regulations, since this would be unlawful.
In relation to allocations to ICBs, NHS England uses a formula to allocate NHS resources to different parts of the country based on long-standing principles of equal opportunity of access for equal needs and informed by the independent Advisory Committee on Resource Allocation. There is no intention to use the power to interfere in this process.
In relation to local organisations, I make the point that the Bill will provide more practical autonomy at a local level by strengthening local leadership and empowering local organisations to make decisions about their population, while also allowing for national accountability. This is the approach we want to take with this power: directing NHS England only on the functions it holds in respect of local bodies, to provide necessary support and assistance to them, especially if they are failing. It is also vital that a power of this nature is accompanied with appropriate safeguards and transparency requirements.
On Amendment 174B, which relates to public interest, the clause already ensures that all directions must be made in the public interest.
On Amendment 175A, the noble Lord, Lord Hunt, has called for directions to be laid in Parliament. It is already the case that any direction issued must be made in writing and will have to be published. This will allow Parliament to hold Ministers to account for use of this power.
On Amendment 175, Ministers already work in partnership with NHS England, and any direction made would come after close working and considered discussion. NHS England will continue to make the vast majority of its decisions without direction, consulting the Government as it needs to. We believe that this power provides additional transparency by ensuring that where Ministers direct NHS England, it is clear, published and available for scrutiny by all. Any direction will come after a considered discussion with NHS England and advice, including on the impact and deliverability of such a direction. Ministers will of course consider, with NHS England and others, that the priorities being set are the right ones and whether they are affordable. However, it is important that we do not put in place too bureaucratic a structure that would bind Ministers’ hands when decisions have to be made quickly.
I end by addressing the questions put forward by my noble friend Lord Lansley and the noble Baroness, Lady Walmsley, about Clauses 39 and 64 being removed from the Bill. Clause 39 is part of our ambition to put increased accountability for the Secretary of State at the heart of these proposals while committing to the NHS’s clinical and day-to-day operational independence. We reiterate that the power will add to the existing ways that the Secretary of State and NHS England work together. The mandate to NHS England, which has been an established means of providing direction since 2013, will continue to be the main place for strategic direction-setting.
Lord Lansley (Con)
Let me give my noble friend one simple example of how this could shift decision-making from NHS bodies to the Secretary of State. We discussed previously, in an earlier group, the availability of in vitro fertilisation services. There will be pressure on the Secretary of State to issue a direction that the NICE recommended availability of in vitro fertilisation services should be provided. By what means is the Secretary of State going to say, “No, I can’t issue such a direction”? It is entirely within his power to do so. The pressures will all be on the Secretary of State to issue directions to do things that the NHS locally may choose or choose not to do. The power will shift. Is he aware of what he is wishing for?
Lord Warner (CB)
Before the Minister answers that question, could I add another? We have had 10 years’ experience of NHS England under three chief executives and a number of different chairmen. Can the Minister give any examples of where the powers the noble Lord, Lord Lansley, gave the Secretary of State have been inadequate for them to give direction to NHS England?
Lord Kamall (Con)
The Secretary of State cannot issue a direction to CCGs or ICBs on any of this using this power. We have been clear that direction cannot be given in relation to drugs, medicines or on treatments that NICE has recommended or issued guidance on. I gave the example of where we want this guidance—with the draft guidelines published for ICBs. The Secretary of State would be able to intervene and ask to see that guidance—
Lord Lansley (Con)
I am sorry to interrupt my noble friend again but let us be clear: the Secretary of State would be asked to give a direction in line with NHS guidance. There is nothing in the exception in Clause 39 which says that the Secretary of State cannot give such a direction.
Lord Kamall (Con)
If my noble friend will allow me, I will have to consider that and write, and make that available to all noble Lords.
We have included a number of exceptions to the power of direction in the Bill to ensure that the Secretary of State is not able to intervene in day-to-day operational matters. For example, there is no intention to use the power to direct NHS England on procurement matters.
On Clause 64, the rationale for removing these duties is twofold. First, the pandemic has highlighted the importance of different parts of the health and care system working together. The clause removes some barriers in legislation that hinder collaboration between system partners. It facilitates collaboration between NHS England and system partners and enables broader thinking about the interests of the wider health system. Secondly, removing the Secretary of State’s duty to promote autonomy will put increased accountability at the heart of the Bill.
Overall, these clauses encompass flexibility, allowing Ministers to act quickly and set direction, while balanced with safeguards and transparency requirements to ensure that they can be held to account. I understand that there are a number of concerns about this group of amendments and others. I am sure we will have a number of discussions, but in the meantime, I ask noble Lords not to press their amendments.
Lord Hunt of Kings Heath (Lab)
My Lords, this has been a very significant debate, because when the Minister referred to the fact that Ministers needed to have the answers, I realised that the intention is to go back to command and control from the centre. It was quite clear: that is the intention. I think that is very depressing, because I do not believe that the NHS is going to benefit at all. When he said that this will strengthen local accountability—oh no, it will not. There is no local accountability whatever in this structure. I am sorry to say this again, but the fact that the Government are taking local authority councillors out of ICBs is a visible demonstration that this is a centrally driven health service from the Department of Health.
Judicial Review and Courts Bill
Wednesday 26th January 2022
(2 years, 10 months ago)
Lords ChamberRead Full debate Judicial Review and Courts Act 2022 View all Judicial Review and Courts Act 2022 Debates Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 25 January 2022 - large print - (25 Jan 2022)
Ukraine
(2 years, 10 months ago)
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Baroness Smith of Basildon (Lab)
My Lords, this is one of those occasions where we start with questions because the Statement is not being repeated. I am sorry not to have the Statement repeated today because it is perhaps one of the very few occasions these days where there is, rightly, a very high degree of agreement between the Government and the Opposition, so the noble Baroness may have enjoyed repeating it on this occasion.
It is also significant that this issue was one of the questions when I was a panellist on BBC Radio 4’s “Any Questions?” programme last Friday. The audience response, first in putting forward that question and then their response to the answers, really highlighted what I think is genuine public concern on this issue.
Earlier today, I watched one of those live video film cams from Odessa. All of us have heard and seen interviews with those in Odessa, Kiev and other areas of Ukraine. People are trying to go about their daily lives and their work, but at the same time, they are living in fear of a Russian invasion as 100,000 troops with tanks and missiles hover at the borders.
Observing all this reminds me, and may remind others, just a little of reading George Orwell’s 1939 novel Coming Up for Air, where there is a pending war clearly in the atmosphere of everyday life. For those now living in Ukraine, it is more immediate and very much at their door. The Russian presence on the borders is unacceptable and unjustified aggression, and we have to be resolute in our total solidarity with Ukraine, with unreserved support for the country’s territorial integrity, sovereignty and independence. As the risk of conflict escalates, we support attempts at negotiation to de-escalate the current situation.
However, this Russian intimidation has not occurred in a vacuum. The annexation of Crimea and support for separatist conflict in Donbass illustrates why we should be so concerned at this further Russian aggression. We welcome all steps, as outlined in the Statement, to bolster Ukraine’s defence capabilities alongside those global efforts to find a diplomatic solution. International solidarity with Ukraine is crucial. Putin will seize on and exploit any division. Russia must be aware that its actions provoke unity that will have consequences both for its economy and its place in the world.
Ministers must prepare for all potential next steps, and that means working with targeted sanctions with allies to confront Russia’s access to the international financial system. Globally agreed sanctions are one of the most effective tools at our disposal, but they have to be agreed and implemented multilaterally. On that specific point, can the noble Baroness the Leader outline how the UK is working with our NATO and European allies to ensure these sanctions are readily drafted and able to be implemented?
On energy, the UK and Europe must also consider our overreliance on Russian energy supplies, including the proposals for the Nord Stream 2 pipeline which could fuel—bit of a pun there—even further dependency. On that point, can the noble Baroness the Leader confirm what recent steps the Government have taken to press for the cancellation of Nord Stream 2? Given recent reports that the United States is in talks with gas-producing Gulf states to increase supplies in the event of Russian invasion—however viable that may be or otherwise—can the noble Baroness confirm whether Ministers are currently engaging with European allies which are particularly reliant on Russian gas? While the impact on our supply may be less, it could well put further upward pressure on prices.
I want to turn to the issue of finance. I think we also have to address the long-term failure of the Government to rid our economic and political systems of the ill-gotten gains used to support the Putin regime. If we take our obligations to global security seriously, we cannot go on allowing ourselves to be the world’s Laundromat for illicit finance. It is astonishing that, more than 18 months after the Russia report was published, none of its recommendations has been fully implemented. We have put forward four proposals, and I hope the noble Baroness can respond on this.
First, we need to reform Companies House, because we need to crack down on shell companies. As a matter of urgency, we should be introducing a register of overseas entities. In your Lordships’ House, we have had debates—I can see the noble Lord, Lord Alton, nodding, as he has raised this issue on a number of occasions—about the origin and extent of Russian money buying up property and assets in the UK. Despite the Government’s Elections Bill that would make foreign donations to political parties easier, we need tougher regulations on overseas political donations. The Russia report was cross-party and at its core was our national security. It has to be implemented in full.
While we hope that all diplomatic efforts and threats of sanctions will lead to Russia changing course, the reality is that, whatever the outcome, we should have long ago addressed these issues. To be clear, we cannot stand up to Russian aggression abroad while facilitating Russian corruption at home. The Government need to get a grip and implement these measures. It would be helpful tonight if the noble Baroness could confirm that the Government will do that or explain why not.
As I said at the very beginning, at the heart of this are real people trying to live their lives, to go to work and to raise their families. They are having to stockpile food. They do not know what tomorrow brings. Ukraine should be free to determine its own future without fear or interference from Russia. It is up to the UK and our democratic allies to support that. However, we cannot escape the fact that, in recent years, Russia has produced a clear pattern of aggression which should have meant that we were better prepared for this moment and our ability to respond. As much as our immediate focus should be on deterring Russia’s invasion of Ukraine and acting accordingly if it does so, the recent actions of the Putin regime must represent a wake-up call for the UK, Europe and NATO.
Lord Newby (LD)
My Lords, as the Statement makes clear, the situation in Ukraine is now extremely perilous. The precise intentions of Russia are unclear, but if it were to launch a major invasion, as the Statement makes clear, the consequences would be horrendous. The Prime Minister set out the three strands of action which any attack would provoke from the UK and our allies: first, tougher sanctions on Russia; secondly, further steps to help Ukraine defend itself; and, thirdly, an increased NATO presence to protect our allies on the eastern front. These are all sensible and necessary, but I would like to concentrate on the issue of sanctions.
The Statement talks about imposing co-ordinated and severe sanctions against Russia should an attack take place. Clearly, economic sanctions are one area where we can really impact on the ability of the Russian regime to continue business as usual. It is, of course, unfortunate that sanctions are being discussed by the EU and the US with the UK often not being in the room. This means in reality that we will have no option but simply to follow what they decide. In practice, this may be of relatively little consequence, but it demonstrates how being outside the EU reduces Britain’s influence. More generally, it has been notable how small a diplomatic role the UK has played compared to France, Germany and the US. Having a Prime Minister who is spending several hours a day attempting to persuade his own Back-Benchers not to end his own political career does not help, nor does the Foreign Secretary’s peculiar sense of priorities, which puts a visit to Australia ahead of being involved in European and broader international discussions on Ukraine.
Whatever common sanctions are adopted, the UK has an ability to take unilateral action that can have a major impact on the kleptocratic Russian regime. This is by moving against Russians and their money in the UK, particularly in London. A number of measures need to be taken, but three could be instituted immediately. First, the Conservative Party is a major beneficiary of Russian money. This includes 14 members of the current Government, of whom six are in the Cabinet, including the Chancellor. The Conservative Party could decide today to stop taking donations from wealthy Russians, many of whom have links to the Putin regime. Will it do so? Secondly, one of the reasons so much Russian money is laundered in London is that it can done secretly. The noble Baroness, Lady Smith, has already alluded to this. For six years, the Government have promised to introduce a register of beneficial interests in overseas companies. Indeed, yesterday the Prime Minister stated—incorrectly, incidentally—that the Government were already doing so, but they are not. My colleague Layla Moran MP has just introduced a Bill to this effect in another place. Will the Government now fast-track this Bill, given that it enacts government policy, so that it can be in place before the end of the Session? Thirdly, Russian oligarchs benefit from “golden” visas which enable them to buy the right to live in the UK. Will the Government now stop this practice?
The Government are going to be faced with some extremely difficult judgment calls in the weeks ahead, as events on the Ukrainian border unfold. The measures I have just proposed are simple, easy to effect and would hit the Russian elite where it hurts most—in their pockets. The measures are all long overdue in any event, but the current emergency makes them even more necessary.
President Putin’s understandable desire to keep any vestige of democracy at bay in Russia means that he is willing to threaten, bully and, if he thinks he can get away with it, act illegally to preserve the regime. However, he acts only having weighed the costs. By the range of actions which we now take, or signal that we will take, if he crosses the Ukrainian border, I hope we can persuade him that the game is not worth the candle. Sanctions form a key part of those costs, and the Government should start acting on them without delay.
The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)
I thank the noble Lord and the noble Baroness for their comments. They are both absolutely right that Russia’s pattern of military build-ups on the border of Ukraine and in illegally annexed Crimea are unacceptable and an attempt to destabilise Russia’s democratic neighbours and exert control over them.
Russia’s deployment is not routine. It is equipped with tanks, armoured fighting vehicles, rocket artillery and short-range ballistic missiles. As we have made very clear—I am very grateful to the noble Lord and the noble Baroness for their support on this—a Russian incursion would be a terrible strategic mistake and subject to severe consequences, including, as both the noble Lord and the noble Baroness mentioned, co-ordinated sanctions to impose a severe cost on Russians’ interests and the Russian economy.
I can reassure the noble Lord and the noble Baroness that earlier this week, the Prime Minister agreed with the leaders of the US, Italy, Poland, France, Germany, the European Council, the European Commission and NATO that allies would enact a swift retributive response should a further Russian incursion into Ukraine happen, including an unprecedented package of sanctions.
I am afraid I do not recognise the noble Lord’s assertion that we are not central to these discussions; we are. My right honourable friend the Defence Secretary was at NATO today talking to the Secretary-General and, as noble Lords will know, the Prime Minister has been in regular contact with colleagues across Europe and the United States on this. We are working together and we are unified, and we continue to have these ongoing discussions. The Secretary of State for Defence also has an agreement with his Russian counterpart to meet. Details of those conversations and their timing are being discussed; obviously, we will make noble Lords aware once that has been confirmed.
We are looking at a package of broad and high-impact sanctions to raise the cost of further aggressive actions. We are working very closely with our allies, and sanctions have been central to our deterrence posture. The preparation of the package of sanctions, which is going on, by the UK and our allies is a clear signal to Russia of the significant economic cost it could and would bear if it invaded Ukraine.
Just to broaden on sanctions for a second, the noble Lord rightly said that we can take action ourselves, and we have done so. As he will be aware, last April we launched the new global anti-corruption sanctions regime, which enables us to impose asset freezes and travel bans on those involved in serious corruption around the world. We made immediate use of these powers and announced sanctions on 22 individuals who have been involved in serious corruption from six countries, including 14 individuals from Russia, and we have imposed sanctions under our autonomous global human rights sanctions regime on 25 Russian nationals who are responsible for appalling human rights violations in the case of Sergei Magnitsky. Therefore, across the board we have taken action and we will continue to do so.
The noble Baroness asked about energy. As she knows and said, we are not dependent on Russian gas supply; in fact, less than 3% of our gas was sourced from Russia in 2020. We meet around half of our supply from within British territorial waters and the vast majority of imports comes from reliable suppliers such as Norway. She is absolutely right: in our view, Nord Stream 2 is not compatible with Russia’s aggressive actions and we remain opposed to it. We regularly raise our concerns about Nord Stream 2 with our European colleagues and will continue to do so.
The noble Lord and the noble Baroness both mentioned the ISC Russia report. As they will be aware, we published our response immediately on publication of the report. Many of the recommendations are already in train and we are continuing work on further implementation. For instance, we have already implemented the NSC-endorsed Russia strategy and established a cross-government Russia unit. We have repeatedly exposed the reckless and dangerous activity of the Russian intelligence services, called out Russian malicious cyberactivity, and introduced a new power to stop individuals at the UK border to determine whether they are or have been involved in hostile state activity.
We have set out our plans to establish a register of beneficial owners for overseas entities that own UK property to combat money laundering and achieve greater transparency in the property market, and we have been clear about our intentions to significantly reform Companies House to strengthen our ability to combat economic crime.
The noble Lord asked about visas. The NCA has increased investigations into corrupt elites and we are currently reviewing all tier 1 investor visas granted before 5 April 2015, so action is going on there.
The noble Baroness asked about the registration of overseas entities. We are planning a Bill that will ensure transparency for foreign-owned land in the UK; currently it is easily disguised through offshore companies.
We are taking action on multiple fronts to crack down on economic crime. In recent years we have established a new National Economic Crime Centre to co-ordinate the law enforcement response, we have introduced new powers, including unexplained wealth orders and account freezing orders, and we have published a fraud strategy. I accept that there is more to do, but we have certainly been taking action in this area and will continue to do so.
More importantly, however, on the broader issue we are working closely with our allies and partners to make sure that we support Ukraine at this incredibly difficult time.
Lord Cromwell (CB)
My Lords, does the noble Baroness the Leader of the House share my concern that some western negotiators may view eastern parts of Ukraine as bargaining chips that could be included in a negotiation? Does she share my feeling that that would be a terrible precedent to set and that the Government of Ukraine would certainly view it as a betrayal?
Baroness Evans of Bowes Park (Con)
I agree with the noble Lord. Certainly, we are absolutely committed to Ukraine’s sovereignty and territorial integrity and to providing it with a full range of support.
Lord Campbell-Savours (Lab)
My Lords, instead of dwelling on Russian aggression, why do Ministers not read the recently released declassified material in the National Security Archive at George Washington University? It reveals the security assurances given to the Soviets against NATO expansion in the names of Baker, Bush, Genscher, Kohl, Gates, Mitterand, Thatcher, Hurd, Major and Wörner. The Russians, ever conscious of the 20 million lost in the last war, and with external threat in mind, nevertheless believed the undertakings and compromised. Talk now of the abrogation is causing today’s crisis. Before issuing irresponsible threats, should everyone not read the archive material, which is available in our Library?
Baroness Evans of Bowes Park (Con)
I am afraid I do not agree with the noble Lord. NATO does not pose an aggressive threat to Russia.
Lord Cormack (Con)
My Lords, the Prime Minister’s Statement ends with some important words:
“I believe that all Russia’s fears could yet be allayed and we could find a path to mutual security through patient and principled diplomacy.”
That is the way. I do not associate myself with all the remarks of the noble Lord, Lord Campbell-Savours, but one has to remember that 26 million Russians were killed in the last war. One has to remember that many Russians have folk memories and folk fears, and it is therefore very important that patient diplomacy, showing, as the Prime Minister says, that we understand those fears, provides the only real, sensible way forward.
Baroness Evans of Bowes Park (Con)
Certainly, I agree. In fact, NATO stands absolutely ready to engage in constructive dialogue with Russia to discuss mutual security concerns and has invited Russia to further sessions of the NATO-Russia council—it had its first meeting in two years recently—to discuss arms control, risk reduction and transparency measures.
Lord Alton of Liverpool (CB)
My Lords, does the noble Baroness agree that the issue of NATO is, as the Secretary of State for Defence, Ben Wallace, recently said, a straw man and that the invasions of Crimea and eastern Ukraine had nothing whatever to do with membership of NATO? Given the number of Statements and Questions—I am grateful to the noble Baroness for her remarks this evening, not least for what she said about economic crime—is there not a case for a full-scale parliamentary debate in your Lordships’ House? There was general indignation on Monday that it had taken a year for a report on Afghanistan finally to be debated when many of its prescient recommendations and points might have averted some of the catastrophe that occurred in August, which has so emboldened so many aggressors around the world.
In endorsing what the noble Baroness, Lady Smith, and the noble Lord, Lord Newby, said about sanctions, I refer the noble Baroness to the remarks of President Biden overnight. He said that this
“would be the largest invasion since World War II”
and would carry “enormous consequences”, including sanctioning personally Mr Putin. Is that also the position of Her Majesty’s Government?
Baroness Evans of Bowes Park (Con)
I have said that we are working closely with our allies to co-ordinate sanctions to maximise their deterrent impact and to limit as far as possible any negative impact on the UK or our partners. I am grateful that the noble Lord recognises the number of opportunities that the House has had to discuss these important matters over the past few weeks—there was a Question earlier today in which noble Lords had an opportunity to be involved—and there are opportunities for Back-Benchers to raise and debate issues.
Lord West of Spithead (Lab)
My Lords—the most reverend Primate beats me; he is senior to me.
The Archbishop of Canterbury
Scarcely. I have never commanded a ship.
First, I associate myself with, particularly, the wise comments of the noble Lord, Lord Cormack. Having listened to the questions, does the noble Baroness the Leader agree that mediation and diplomacy should be pursued until the last moment, seeking to find ways to give both sides the opportunity to withdraw—particularly the Russians from their completely unjustified threats? The one thing we can be sure of is that, once war starts, all control of the situation will be completely lost, possibly for years, and the casualties will be terrible. Secondly, what provision are the Government making, should the worst come to the worst, to support the very large number of refugees and the huge needs for humanitarian support that will inevitably be part of fighting in the late winter in eastern Europe?
Baroness Evans of Bowes Park (Con)
I thank the most reverend Primate. He is absolutely right: diplomacy is the only way out of the current situation, but Russia must uphold the international commitments it has freely entered into and respect the sovereignty of Ukraine. I reassure noble Lords that we remain open to efforts by Russia to reduce tensions and encourage her to engage with transparency and de-escalation mechanisms, such as the OSCE and the NATO-Russia Council, as I mentioned. Further such council meetings have been offered to discuss a whole range of issues, and that is the way forward: to de-escalate and engage in meaningful discussions. The US Administration has also confirmed President Biden’s willingness to have another meeting with President Putin, continuing the bilateral dialogue they began last week, so a lot of effort is ongoing on that side of things as well. We are providing £40 million in official development assistance and other funding to Ukraine in the coming year.
Lord West of Spithead (Lab)
My Lords, I do not need to rehearse the unacceptable things Putin has done, but we need to be very careful that we are not making empty threats but that they are co-ordinated, because, if something goes wrong, you have to show that you have made threats that you can fulfil, otherwise these things grow and grow and get worse and worse. I must say, as an aside, that sabre-rattling is not very good when the number of sabres you have seems to be getting fewer and fewer all the time.
I believe that Putin has been boxed into a corner now. He understands the problems, and does not want to get into a quagmire in Ukraine. It is incumbent on us to try to ease his escape from the corner he is in by negotiating or renegotiating an agreement. That will, I fear, mean there must be concessions on both sides; that is the whole point of an agreement. Difficult as it is, that is what one must do, but we must not concede any fundamental principle. Who from the UK, if anyone, is helping to redraft the proposed security guarantee agreement that Russia put to NATO—it put another one to the US? Who from our side is helping to redraft that, so that we can submit a new agreement proposal to Russia?
Baroness Evans of Bowes Park (Con)
My understanding is that there is a press conference this evening, possibly now, from NATO setting out NATO’s position. Antony Blinken did a press conference earlier, just before this Statement, on the US’s position. There is action on both those fronts that may well be public by the time we have finished this discussion.
Lord Campbell of Pittenweem (LD)
My Lords, in a previous answer, the Leader referred to the sovereignty of Ukraine, and a passage in the Statement reads:
“nor can we accept the doctrine implicit in Russian proposals that all states are sovereign but some are more sovereign than others.”—[Official Report, Commons, 25/1/21; col. 863.]
In the course of our discussion in this Chamber, reference has been made to the Minsk II protocol and the suggestion that it could be used as the basis for negotiation. I urge the Government, through the Leader of House, to consider the fact that there is a school of thought that the Minsk II protocol contains two irreconcilable interpretations of Ukraine’s sovereignty and that, were it to be implemented, it would destroy Ukraine as a sovereign country. If that is a serious opinion, I hope that the Government will take it into account.
Baroness Evans of Bowes Park (Con)
I thank the noble Lord for his contribution, and recognise his great expertise in this area. I will most certainly take it back to make sure that people are aware of it.
Lord Balfe (Con)
My Lords, to follow up on the question from the noble Lord, Lord Campbell-Savours, two months after Stalin’s death, Churchill said in another place:
“I do not believe that the immense problem of reconciling the security of Russia with the freedom and safety of Western Europe is insoluble.”—[Official Report, Commons, 11/5/1953; col. 896.]
The fact is that Ukraine was a creation, as much as anything else, of Winston Churchill and Joseph Stalin, and it is a very odd country indeed. We started many of the problems that we now have when we chased Yanukovych out of office. In the Prime Minister’s Statement, he says we should
“address any legitimate Russian concerns through honest diplomacy.”—[Official Report, Commons, 25/1/21; col. 861.]
The problem is that what we regard as legitimate, they do not, so I should like to rephrase that and ask Her Majesty’s Government whether they will seek to get together a conference, with everything on the table, to try to get some sort of agreement.
Baroness Evans of Bowes Park (Con)
As I said, the UK is committed to Ukraine’s sovereignty and territorial integrity, and we are providing a full range of support. There is no justification for Russia’s aggressive and destabilising activity towards Ukraine.
Baroness Bennett of Manor Castle (GP)
My Lords, in responding to the Front-Benchers, the noble Baroness the Leader of the House said, regarding dirty money, “I accept there is more to do”. She may be aware of the report yesterday from the Center for American Progress, a think tank known for being close to the Biden Administration, suggesting what to do if Russia invades. In its recommendations, it mentions, at paragraph 1.2, the formation of a
“U.S.-U.K. counter-kleptocracy working group.”
It explains this by saying that the US should propose the working group
“in part to prod stronger action from the U.K. government.”
Will the UK Government be waiting for that prod, or will they take stronger action immediately, not in the long-term future?
Baroness Evans of Bowes Park (Con)
In answer to questions at the beginning, I set out a whole range of things that we have done, and are doing, to tackle money-laundering and economic crime. We will continue with that work.
Baroness Neville-Rolfe (Con)
My Lords, I declare an interest as chair of Crown Agents, which supplies Covid vaccine to Ukraine. I think a further debate on Ukraine would be useful, as the noble Lord, Lord Alton, suggested. I am interested in the position of Germany and France, which were, of course, involved in the Minsk protocol, signed after the 2014 Ukraine crisis. How far are they aligned with UK thinking at present—especially Germany, given its particular trading interests across eastern Europe?
Baroness Evans of Bowes Park (Con)
We are working very closely with our allies. I am sure my noble friend will be aware that, today, there is a political advisers meeting taking place in Paris of the Normandy Format—France, Germany, Ukraine and Russia. Although we were not part of that process because we are not within that group, we actively support France and Germany’s efforts, and are working very closely with them.
Viscount Waverley (CB)
My Lords, President Putin might be shooting himself in his foot, because it is conceivable that any external troops might remain in the event of any cross-border activity. That is something that he particularly does not wish to have happen. That said, what are President Putin’s stated suggestions to defuse the situation, and what is his reaction to Ukraine and its allies’ responses to those suggestions? Finally, what note has been taken of the hardliners around President Putin, who are very much in play in what Russia does?
Baroness Evans of Bowes Park (Con)
As I have said in answer to a number of questions, we stand ready to engage in constructive dialogue with Russia to discuss mutual security concerns. Last week, for the first time in two years, there was a meeting of the NATO-Russia Council, and there has been an offer of further sessions to discuss arms control, risk reduction and transparency measures. There are, therefore, mechanisms by which issues can be discussed by all parties to try to defuse and de-escalate the situation.
Lord Sterling of Plaistow (Con)
My Lords, my noble friend mentioned the number of Russians who died in the war, but one must not forget the number of Poles killed and murdered when, together with Germany, the Soviet Union attacked Poland. To what extent do the Government really feel that, in the end, the only thing that is really important to Putin is the pipeline, and whether Germany, in due course, will give way to allowing it, because it needs that gas?
Baroness Evans of Bowes Park (Con)
As I said in response to the noble Baroness’s question about Nord Stream 2, we do not believe that it is compatible with Russia’s aggressive actions. We remain opposed to it and we continue to raise our concerns with our allies and partners to highlight the strategic risks of this project.
Viscount Stansgate (Lab)
My Lords, this might not be a popular question to ask, but it is a very dangerous situation. The House knows that one of the options is war if President Putin makes the fatal mistake of invading Ukraine, but just before entering the Chamber, I listened to Secretary of State Blinken make his statement that the United States has put questions to and answered questions from Russia. He made a point of saying that he will not reveal what the United States has said. The reason for that, as I understand it, is that if you are to have diplomacy and give it a chance, as the noble Lord, Lord Cormack, said, it is very difficult, and patient diplomacy takes a great deal of doing. Perhaps it is better that an element of space is given to enabling the negotiations to take place.
I remember the Cuban missile crisis from when I was a young person, and that was a terribly dangerous time but, as those who have read a little about it will remember, it was giving the other side the opportunity to withdraw and save face that stopped, in that case, a nuclear exchange. In this case, I hope it would stop a very unnecessary and deeply damaging war.
Baroness Evans of Bowes Park (Con)
The noble Lord is right, which is why, as I said, diplomacy is the only way out of the current situation. There are a number of forums through which diplomatic channels are open, and we want to use them; we are urging Russia to use them, as are our allies. We will try to make sure that we can de-escalate the situation because, as the noble Lord says, the quagmire of a long-running conflict would be catastrophic for all sides.
Health and Care Bill
Wednesday 26th January 2022
(2 years, 10 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-VI(a) Amendments for Committee (Supplementary to the Sixth Marshalled List) - (26 Jan 2022)
Baroness Thornton (Lab)
My Lords, I would much prefer that the noble Baroness, Lady Cumberlege, should open on this group. I will speak to the question of whether Clause 40 should stand part when that has happened.
Baroness Cumberlege (Con)
My Lords, I will speak to Amendment 179 and the other amendments in my name. I thank the noble Lords who put their names to these amendments: the noble Lords, Lord Shipley, Lord Hunt of Kings Heath and Lord Patel. We are told that the driving force of the Bill is to ensure that health and care services are delivered at place; and to empower local leaders—leaders who know what their local communities’ needs are and who will make decisions about how care is delivered. I am sure that is music to the ears of my noble friend Lord Mawson.
We are told that the integrated care systems—the ICSs—will be given the flexibility to plan, to commission and to provide services according to the specific needs of their population. This principle is undermined by the unchecked power that the Bill gives the Secretary of State over local configuration of services. I am pleased to tell your Lordships—particularly my noble friend Lord Howe, who is on the Front Bench for this item—that Amendments 179 to 183 have the support of a number of influential voices. These are voices from the health and local government sectors, the NHS Confederation, the King’s Fund, NHS Providers, the LGA, the BMA, National Voices and the Centre for Governance and Scrutiny. These organisations cover NHS leaders, local authorities, clinicians and patients. It is significant that they are united in their deep concern about the powers that the Secretary of State would have over local reconfigurations as the Bill currently stands.
Of course, there is an existing system for local reconfiguration and it works very well. It is overseen by the Independent—that word is very important—Reconfiguration Panel, the IRP. This has helped take politics out of the difficult decisions surrounding services. Crucially, the current process for service reconfiguration starts with local consultation and consideration of clinical advice. These elements are fundamental, and they must be maintained in a future process. In short, the Secretary of State should be able to intervene in a decision about local services only once local people have had their say on the proposed changes, and once clinical advice has been considered. It will be to the detriment of patient safety if it has not. Under the existing arrangements, when the process takes too long, it has often not been about the IRP but about the Secretary of State’s failure to reach a decision, yet the Government state that the new powers are needed to speed up the process.
The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
I call the noble Lord, Lord Howarth, who is participating remotely.
Lord Howarth of Newport (Lab) [V]
My Lords, your Lordships’ Select Committee on the Constitution, of which I have the honour to be a member, has advised the House, as has the Delegated Powers and Regulatory Reform Committee, that this Bill is a skeleton or framework Bill. It provides a multitude of vaguely delineated powers and duties. It is often impossible for noble Lords to scrutinise these meaningfully because their meaning is so unclear
The Bill is also an instance of a growing tendency in the Government’s legislative practice to create “soft law”—that is, guidance, rules and directions which are not susceptible to parliamentary scrutiny but are, in, effect binding. It also creates “hard law”, which is not susceptible to parliamentary scrutiny, as in the Henry VIII power in Clause 15, but is subject only to the negative resolution procedure.
This manner of legislating is part of a pattern documented in a long series of reports by the Constitution Committee, drawing the attention of the House to Henry VIII clauses which are convenient to the Executive but subversive for parliamentary democracy, and to the creation of delegated powers enabling Ministers to bring in significant policy change subject to little or no parliamentary scrutiny. The DPRRC has reported that the Bill contains no less than 155 delegated powers.
What is egregious, however, are the autocratic powers that the Bill accords to the Secretary of State. I had sought to indicate that I wished to speak on the previous group, but there was some confusion, and the Chair did not invite me to do so. I hope therefore that noble Lords will bear with me as I take us back for a moment.
As the noble Lord, Lord Hunt, and others, noted Clause 39, entitled
“General Power to Direct NHS England,”
states:
“The Secretary of State may give NHS England directions as to the exercise of any of its functions.”
It goes on to say:
“The directions that may be given include a direction as to … when or how a function is, or is not, to be exercised”
and
“matters to be taken into account in exercising a function.”
The autocratic power provided by Clause 39 is exacerbated by Clause 64, which repeals the duties previously placed on the Secretary of State to respect autonomy within the NHS.
The mischief, which the noble Baroness’s amendments in this group seek to mitigate, is further compounded by Clause 40 and Schedule 6, which confer comprehensive powers on the Secretary of State in regard to reconfiguration of NHS services. Effectively these three clauses together confer upon the Secretary of State, with only the exception stated at proposed new Section 13ZD in Clause 39, mainly in relation to clinical discretion, absolute power over the NHS.
We are told that the Secretary of State has no intention of bossing NHS England around and that he needs powers to sort out failures within the NHS system. In our earlier debate today on continuing care, and in his response to the last debate, the Minister said it is not the Government’s intention to interfere unduly in the affairs of ICBs. However, in a letter to the Times today, referred to by the noble Baroness, the chief executive officers of the King’s Fund, NHS Providers and the NHS Confederation warn of the danger that the Bill may lead to politicisation of decision-making in the NHS, of the kind which the noble Lord, Lord Warner, described in the last debate and which the noble Baroness, Lady Cumberlege, has just explained. The fact remains that Clauses 39, 40 and 64 make the Secretary of State untrammelled master of the NHS.
With such power comes temptation, not least for Department of Health officials. What might “unduly” mean in practice? The Secretary of State may often refrain from interfering, but too often he, or officials acting in his name, may not. In any case, to accord the Secretary of State such excessive power is wrong in principle. The legislation should strike an acceptable balance between the autonomy which NHS leaders and managers need if they are to do their jobs well, responding as they judge appropriate to local needs, and a due accountability of the NHS to the Secretary of State and, through him, to Parliament. Here, however, we have neither. The Bill concentrates power over the NHS in the hands of a Minister who is poorly accountable to Parliament in the exercise of much of his power.
Lord Stevens of Birmingham (CB)
My Lords, it is a privilege to speak to this group of amendments. I recognise that a public service as important as the National Health Service has to be democratically accountable to the Secretary of State and Parliament. I also recognise that the broad provisions of the Bill have wide support outside this House from organisations ranging from the Academy of Medical Royal Colleges to the representative organisations spoken of today, the Patients Association, and many others which, at the inception of these proposals, came forward to advocate for them.
However, unfortunately, when we turn our attention to Clause 40 and Schedule 6 there is no such support for the measures therein. These provisions manage, perhaps uniquely, to combine being unnecessary, undesirable and unworkable—a legislative trifecta that has little to commend it.
The measures are unnecessary for the reasons set out by the noble Baroness, Lady Cumberlege. There is already a well-established mechanism for local consultation, under which democratic local authorities can, if concern arises, bat a proposal up to the Secretary of State for a national decision with the advice of an independent expert panel. There is also established public law in this area, which can be tested through judicial review. Just about nobody, nationally, or locally, thinks that the proposals in this part of the Bill are needed. They are, in effect, a solution in search of a problem.
As well as unnecessary, these proposals are undesirable. They would confuse and obscure accountability for the quality and safety of patient care. The Court of Appeal held in Nettleship v South Tyneside and Sunderland CCGs in 2020 that there is no duty to include in a public consultation options which local commissioners deem to be unviable, unrealistic or unsustainable. Yet Schedule 6 would allow the Secretary of State to impose service changes that local clinicians, local patient groups and, indeed, local authorities deem unsafe or unviable. This clearly cuts across the statutory responsibilities of local boards for the safety and quality of care.
Where the Secretary of State has imposed such a service change on the local NHS, is it the Secretary of State who will then be in receipt of Care Quality Commission findings and scrutiny? Is it the Secretary of the State who will be on the receiving end of medical negligence claims, or potentially criminal proceedings? This set of measures completely obscures the well-established accountability for the quality and safety of local care.
I believe that these measures are unnecessary and undesirable, but they are also unworkable. As worded, the definition of a reconfiguration is vague and overly broad. It could capture just about any change in service provision. On page 197, the Bill refers to changes that have
“an impact on … the manner in which a service is delivered to individuals.”
That could cover just about anything, and if hospitals are proposing such a change, they have a duty to notify the Secretary of State.
By contrast, the long-standing Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, with which your Lordships will be intimately familiar, set a higher hurdle, which is that the consultation requirement applies to
“a substantial development or variation”
in services. In its place, we would instead have, through the Bill, a set of processes that would lead to second-guessing, centralising and politicising, a furring-up of the NHS’s decision-making arteries, which, had these measures been in place during the pandemic, would have handicapped the response, at precisely the time when the NHS needs to be agile and adaptable, and will do nothing to advance the changes needed across front-line care delivery.
For all these reasons, I believe that if the Bill is passed in its current form, Clause 40 and Schedule 6 will become a running sore, not only for patients and local service but for Ministers. There are two possible ways forward. There is the proposal that Clause 40 do not stand part of the Bill, as suggested by the noble Lord, Lord Lansley, which would surgically excise the problem, or there is the group of amendments tabled by the noble Baroness, Lady Cumberlege, which would apply sutures, analgesics and disinfectant. Either approach could work, but one or the other is needed.
Lord Shipley (LD)
My Lords, I am very glad I delayed my speech so that I could hear the noble Lord, Lord Stevens of Birmingham, because I agree with everything he said.
My name is on Amendments 179 to 183 in this group. I shall try not to repeat the comprehensive explanation by the noble Baroness, Lady Cumberlege, of the problems these amendments would address, which are similar to those that we debated in the previous group. I hope that the Minister will accept that the proposals in the Bill as they stand are overcentralising, and that this issue will have to be addressed by the Government on Report.
I agree very strongly with the noble Lords, Lord Howarth of Newport and Lord Stevens of Birmingham, who made unanswerable contributions. In the words of the noble Lord, Lord Stevens, these provisions are unnecessary, undesirable and unworkable, and they confuse and obscure accountability. I hope the Minister will take very seriously what is being said because the Bill’s ambition is to increase transparency and accountability. That is right, but it surely should be prioritised at a local level since that is where services are delivered. The Bill undermines that principle. It thinks accountability should lie in Whitehall, yet there has been no strong call to enable the Secretary of State to intervene earlier in the reconfiguration process and, anyway, there is already an established role for the Secretary of State in cases that are referred. Those processes should not be undermined.
Amendment 179 would change the definition of a reconfiguration of NHS services to ensure that only complex and significant changes to NHS services should be considered. Surely that is right. Amendment 180 would require the Secretary of State to consult all relevant health overview and scrutiny committees plus those organisations delivering relevant services locally along with the integrated care board. That must be right. Amendment 181 would require speedy decisions, and that must be right. Amendment 182 would require the Secretary of State to publish a statement demonstrating that any decision made by the Secretary of State on a reconfiguration proposal is in the public interest and has been taken with patient safety as a priority. That must be right. Crucially, Amendment 183 would prevent Secretary of State acting as the catalyst for a reconfiguration. That, too, must be right.
I hope the Minister will understand that there is much concern about the proposed new powers for a Secretary of State to intervene at any stage in a local service reconfiguration without any need to demonstrate the basis of the information on which their decisions might be reached. There is already a clear process for reviewing proposals for NHS reconfigurations, which are health overview and scrutiny processes charged with establishing whether proposals are in the best interests of their local communities.
What the Government are proposing is not in the spirit of the Bill, and I hope they will take note of the concerns expressed by the NHS Confederation and many others and bring back further amendments on Report to address them.
Lord Patel (CB)
My Lords, I support all the amendments in the name of the noble Baroness, Lady Cumberlege. She introduced them very comprehensively and I agree with what she said. My noble friend Lord Stevens of Birmingham added to it, so much has already been said and I need to be extremely brief.
I concur with my noble friend Lord Stevens of Birmingham that outside bodies, including professional organisations in medicine, oppose these powers and that they will lead to more chaos rather than solving problems. As a clinician, I find the unchecked powers for Secretaries of State over local service reconfigurations that the Bill proposes astounding. Local service reconfigurations should be driven by clinical advice and expert assessment of what services are needed to meet the health needs of a local community with patient safety at the heart, as well as considerations about what resources are available in terms of workforce, infrastructure and the proximity of alternative services.
The powers in the Bill would allow the Secretary of State to initiate service changes without any consultation. How can any Secretary of State feel sufficiently qualified to be making unilateral judgments about what constitutes “safe”? The existing, largely successful, processes, which have already been mentioned, take account of clinical advice and the views of local communities in the final decision have been effective. The noble Baroness gave the example of Kent and Medway stroke services, which were held up by the Secretary of State, not by the consultation. I strongly support these amendments and I hope that the Minister will think about removing the provisions from the Bill.
Lord Lansley (Con)
My Lords, I shall be brief. I put my name to Clause 40 stand part, and I think that is the best way to go. I shall add one or two things. First, as Secretary of State, I asked the now noble Lord, Lord Ribeiro, to lead the independent reconfiguration panel, and I never had cause to regret doing so. Secondly, I can say something which other noble Lords cannot, because I am on this side, and I am hoping that we continue to have Conservative Secretaries of State for many years hence. They will be much better off if they do not do this. If the Government take Clause 40 out, they will equally not regret doing so.
Lord Hunt of Kings Heath (Lab)
My Lords, I described at Second Reading, or at some point in a meeting with the Minister, an attempt to save Ministers from themselves. I do not understand why on earth the Government want to put this burden on them. The Government have set out an ambitious programme for reform of the NHS. Why put in a clause that guarantees that that reform will be stalled? We know that reconfigurations—most of us have experienced the issue locally, if not nationally—are very difficult. There is always local opposition, often from some leading consultants, and to get it through you have to be very determined. The noble Lord, Lord Warner is right; once Ministers can intervene at any point—for example, if an MP’s local services are threatened with an unpopular change—even in the Lords, the pressure on them to intervene can be huge.
Lord Lansley (Con)
If anyone cares to look at it, it was also a very good illustration of the benefits of the Independent Reconfiguration Panel. Not only did it do something that Ministers could not do; it also did something that NHS management did not do. It is not that we are giving it back to the NHS to do what it likes—it genuinely does something independent.
Lord Hunt of Kings Heath (Lab)
Indeed, we have a rigorous process involving the overview and scrutiny committee, as has been said, plus an Independent Reconfiguration Panel. As the noble Lord, Lord Stevens, said, it is rather like the last debate: before us we have a set of amendments which seek to constrain the power of Ministers, and then an amendment which seeks to remove this power. I am clear that we should try to remove this power, and that this is the best course. It will be very interesting to hear from the Minister exactly why Ministers want to put this burden on them, and what benefit they can possibly see in it.
Lord Warner (CB)
My Lords, I want to briefly make clear my support for this group of amendments and try to be consistent with what I said on the previous group. The only amendment which causes me to have pause for thought is Amendment 183. The NHS, perfect in every form of course, has been known to have its arteries fur up occasionally. Sometimes there is a need for scale in some services. I want to mention three or four services where scale, after clinical consideration, is important. Pathology is a good example, where we need to have more scale than many of the local pathology departments. Another one, which the Royal College of Surgeons has advocated, is elective surgery hubs, which may mean taking stuff away from a particular local hospital. Another good example is the issue of stroke specialisation, which is beneficial for patients. I have given you three examples where we do not want to totally neutralise the Secretary of State. Sometimes Ministers have a use; it may be few and far between, but occasionally they have some use. We do not want to say that you cannot ever be a catalyst for change. That seems a bit drastic in Amendment 183, and I ask the noble Baroness, Lady Cumberlege, to think about that, because sometimes scale is important, with clinical advice for the benefit of patients.
Baroness Walmsley (LD)
My Lords, I am in favour of surgical excision. I oppose the powers of the Secretary of State in Clause 40 and Schedule 6 to intervene in decisions on reconfiguration of health services. Far be it from me to want to protect Conservative Secretaries of State for Health from themselves, but I warn that if they use these powers they will eventually get the blame.
The noble Lord, Lord Stevens, gave a number of very good reasons why this clause should be deleted from the Bill. My reason is somewhat different. I think these powers are very dangerous. We have recently seen how the Government’s powers to provide or withdraw funding from a proposal, let us say, to build a new school or improve infrastructure in a particular constituency have got them into trouble. We have heard allegations made against Government Whips by Members of Parliament of actions which could be criminal offences of bribery. It is alleged that, in seeking to ensure support for their leader, they are threatening Members of Parliament that funding for their projects, which have already been declared to be in the public interest of their constituents, will be withdrawn unless they behave in a certain way, so political considerations would trump public interests.
Like the former Member of Parliament to whom the noble Lord, Lord Hunt, referred, all politicians know that the provision of a new hospital or clinic or, on the contrary, the closing of a healthcare setting are very sensitive considerations in elections. All parties ensure that the voters know their views on these matters at election time and in between elections. The Prime Minister knows this. Why else would he put such emphasis on his promise of 40 so-called new hospitals by 2030 if this were not the case? It makes a good headline, even if we know that some of them are not new and some of them are not hospitals.
The powers of reconfiguration sought by the Secretary of State in Clause 40 would give the Government the ability to change the decisions of those put in place locally and well qualified to make them in a non-partisan and needs-based way, thus allowing the Government to wield unwarranted political power. It is probable that this Government would not be able to resist doing so, for the wrong reasons, and it is incumbent on all parties to stop them by deleting Clause 40 from the Bill. Indeed, I do not think that I would be in favour of giving these powers to any Government of any political party; they are just too liable to be misused.
Baroness Thornton (Lab)
I think the Minister is probably getting the message by now. I shall speak to my Clause 40 stand part debate and the amendment in the name of my noble friend Lady Merron. Somebody said earlier that we can be sure that the proposals to allow greater powers for the Secretary of State to intervene in reconfigurations is not something that the NHS asked for. That is almost certainly true.
I congratulate the noble Baroness, Lady Cumberlege, on her great coalition- building; she is very good at building coalitions in support of the things that she cares about, and she has definitely managed to do that with this group of amendments.
Noble Lords have pointed out that, at the moment, we have a system which works. It may be slow, and it is absolutely true that it has processes which take too long, but there are elements of public and patient involvement through consultations. The changes made in 2012 under the noble Lord, Lord Lansley, brought in four tests and some rigour of external independent evaluation. The core of that process still exists. As a non-executive member of the board of the Whittington, I can say that this is exactly the kind of thing that we have been involved in in our own hospital.
The consultations might be improved, but they will not be improved at all by this proposal. In fact, I think that this clause is very odd indeed. It is a bad idea, and it adds nothing to the core of this Bill and its central aim, which is to grow place-based independent and innovative healthcare, and it probably needs to go.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank all noble Lords and noble Baronesses for their contributions. I would be pretty blind or deaf not to understand the level of concern across the Committee. However, if noble Lords will bear with me, I shall try to set out some justifications. I preface my remarks once again by saying that I strongly hear the views of the Committee, and I welcome the fact that previous Ministers and Secretaries of State are warning us not to fall victim to this, as it were.
I start by explaining some of the justifications. It may be helpful to start with some of the observations. The public expect Ministers to be accountable for the health service, which includes service change. We see the new intervention powers enabling the Secretary of State to act as a scrutineer and decision-maker for reconfigurations, to intervene when, for example, they can see a critical benefit or cost to taking one or other course of action, or to take action where there is a significant cause for public concern. Having said that, we accept that public concern could well be a political one, so we understand the concerns expressed by noble Lords.
We expect this power to be used infrequently and, when it is used, it will be done proportionately and transparently. All decisions made using the new reconfiguration call-in power in the Bill must be published, which will ensure transparency and proper scrutiny. The new call-in power for reconfigurations will allow the Secretary of State better to support effective change and respond to stakeholder concerns, including from the public health oversight and scrutiny committees and parliamentarians in a more timely way.
I turn to Amendment 183. Given the role of the Secretary of State, it is proportionate to ask him or her to ask local commissioners to consider service change where there is concern. Once again, we do not expect this power to be used frequently, and all service changes, regardless of whether a Secretary of State has been a catalyst, will still be required to go through due process and where appropriate local consultation. Before any proposal was agreed, the planning and assurance for a proposal would still have to include strong public and patient engagement, consistency with a current and prospective need for patient choice, a clear clinical evidence base and support from commissioners.
I turn to a couple of points from my noble friend Lady Cumberlege and the noble Lord, Lord Stevens, who said that the powers were unnecessary, undesirable and unworkable. To look at the necessity of the power, the current system can lead to referrals coming very late to the Secretary of State, and the power will allow the Secretary of State to intervene earlier to avoid that. For example, my noble friend Lady Cumberlege referred to the Kent and Medway stroke services reconfiguration proposal. One reason why it was lengthy was the need to review the right options for the system. We are hoping that it goes something like this—that you could either knock heads together or, as someone put it more starkly, have a sword of Damocles over them to come to a decision more quickly. But once again we understand the concerns.
I turn to Amendment 180. It is vital that all local views, including that of the health overview and scrutiny committees, are represented in the reconfiguration. The new power in the Bill will not replace the important local scrutiny and engagement that plays such an important role in service change decisions, and a duty for those locally responsible for service change proposals to consult local authorities will remain. It is right that for commissioners and providers who are responsible for planning, assuring and delivering reconfigurations the duty to consult HOSCs and other local stakeholders continues. We are also introducing a duty for NHS England, integrated care boards, NHS trusts and foundation trusts to provide information and other assistance required for the Secretary of State to carry out functions. That will allow the Secretary of State to take into account local views. We expect the Independent Reconfiguration Panel to consider the views and carry on the way it works.
On Amendment 181, we recognise the importance of timely decision-making—
Baroness Thornton (Lab)
Is the Minister saying that the Government and his department do not trust NHS England to fulfil this function any longer?
Lord Kamall (Con)
No, we are saying that, where there is an issue and it is taking a long time, this measure allows the Secretary of State to come in in a more timely manner rather than waiting for a late referral.
Baroness Cumberlege (Con)
My Lords, before the Minister goes on—just so I do not lose the thread here— could he tell us why the Independent Reconfiguration Panel has to go? What are the problems with it? Why do we have to move it off in order to bring in a politicised system with the Secretary of State making the decisions?
Lord Kamall (Con)
I must clarify here. I have said that we expect the Independent Reconfiguration Panel to continue to consider views. We are not getting rid of it.
Baroness Cumberlege (Con)
So that presents a problem. What does the Secretary of State do, and what does the independent panel do? Is it a question of the scale of the change that is being proposed? Where are the boundaries?
Lord Kamall (Con)
The Secretary of State will be advised by the Independent Reconfiguration Panel, especially where there is a difficult decision that takes time, just as in the case of the Medway.
On Amendment 182, the Secretary of State’s decision-making process must already take into account the public law decision-making principles, all relevant information and his legal duties, including the public sector equality duty. The Secretary of State is also under several duties in the National Health Service Act 2006, including to promote a comprehensive health service and to support continuous improvement in services.
Lord Hunt of Kings Heath (Lab)
There are a lot of marginal seats, and there is going to be a general election in two and a half years—maximum. A lot of the reconfiguration proposals usually relate to smaller places with smaller hospital or DGHs because their viability is often in doubt. So it is quite clear to me that any MP, particularly government MPs, will immediately take any threat of that sort to their local services to the Secretary of State. That will not speed up the process; it will guarantee the opposite. The signal that I would get from the health service as a result of this is: “Forget reconfiguration proposals until after the next election because you ain’t going to get any through.” That is why we think this is a disastrous move.
When the Minister says there will not be many interventions, that is just nonsense. The moment that MPs know the Secretary of State has the power to intervene at any stage, they will be knocking at the door of the Government, who will wilt under that pressure, because that is what happens. Then they will go back and say, “We need to have an independent review of that before you start the process.” There are so many dodges available to a Minister, if you want to dodge making a hard decision in this area, that it will completely paralyse the health service. That is why this debate is so important because it is related to the last one; the result of Ministers gaining direct control will be to delay and reverse, and I am afraid that the hopes that Ministers have for a dynamic, forward-looking health service will come to nothing.
Lord Warner (CB)
My Lords, following on from the noble Lord, Lord Hunt, I ask the Minister to consider the point that I was trying to make about Amendment 183. The Minister and the Government have got this the wrong way round: if he is actually concerned about levels of efficiency, the supply of services and the issue of scale—and the issue of scale is a very real one—then he needs to be at the front of the process, not the end of it. It is a bit late in the day to be having these ideas about scale in a particular set of services when you have gone through the agony of the local consideration of reconfigurations. As a Minister, it would be better, if I may say so, to set out your views at the beginning with the clinical arguments for why this makes sense. Doing it at the end is bound to lead to suspicions. That is why I was asking the noble Baroness, Lady Cumberlege, to look at the wording of Amendment 183. I say to the Minister that he is putting his involvement at the wrong part of the process.
Lord Kamall (Con)
We agree with the noble Lord. We do not want to waste time by being able to come in only late in the process. To avoid egregious uses of power, all uses are subject to public law principles and challengeable by judicial review.
We agree with the intention behind Amendment 216 but we do not feel it is necessary. Commissioners, NHS England, NHS trusts, NHS foundation trusts and a range of other bodies are required to have regard to the NHS constitution in performing their functions, as set out in Section 2 of the Health Act 2009, which goes wider than this proposed duty that would apply to the Secretary of State.
In addition, the NHS pledges that all staff will be empowered to put forward ways to deliver better and safer services for patients and their families. If a service change is material, the commissioner has a duty to consult with all impacted parties to understand their views and these existing engagement duties can encompass NHS staff. Anyone can respond to a public consultation and there is well-established process and precedent for taking these views into account. Beyond the pledge itself, it is the responsibility of an employer to ensure that staff are appropriately engaged and involved in service change decisions. The need to engage and consult is contained within organisational policies and relevant employment legislation.
I have heard what a number of noble Lords have said, especially former Ministers, Secretaries of State and others involved in the system, and it is quite clear that I need to go back and consult further. In that spirit, I ask that noble Lords do not move their amendments, and hope that I have explained the reasons why.
Lord Crisp
“(a) an individual trust, and(b) the capital expenditure limit.”Member’s explanatory statement
This amendment along with the other amendments in the name of Lord Crisp to Clause 54 seek to deliver the legislative proposals agreed with NHS England and NHS Improvement in 2019.
Lord Crisp (CB)
My Lords, my five amendments to Clause 54 follow on quite closely from the discussions we have just been having about direction. I am very grateful to the noble Baronesses, Lady Walmsley and Lady Morgan of Huyton, and my noble friend Lady Neuberger for their support for these amendments.
The Bill introduces a new power for NHS England to set capital spending limits for NHS foundation trusts. There are two points of context that are worth exploring here. First, obviously the Bill is all about integration, partnership and collective action, within which individual parties need to retain some autonomy as well as giving out more, or perhaps pooling, some sovereignty at the local level. We should also be aware that at the national level NHS foundation trusts’ capital comes within the overall capital allocated by Parliament, and so recognise that, at the end of the day, there needs to be some kind of reserve, backstop power to set foundation trusts’ capital limits.
It is all about achieving the right balance. I understand that three years ago, as part of the thinking behind these wider changes in the NHS when they were being developed, NHS England and NHS Improvement agreed with foundation trusts a set of proposals for this that were set out in the NHS’s 2019 legislation proposals. I am sure my noble friend Lord Stevens of Birmingham can comment on that as appropriate. This clause cuts right through these agreements.
My explanatory statement makes the terribly simple point that what I am trying to do here is to
“seek to deliver the legislative proposals agreed with NHS England and NHS Improvement in 2019.”
I do not see why that is not happening. So, my first question to the Minister is: please could he explain what has changed since 2019 and why the agreement that was struck then is no longer good enough for the current circumstances?
Secondly, these capital freedoms are important. NHS foundation trusts need to be able to invest in order to deliver their services. They need to be able to do so for their boards to be able to exercise their own accountability, and they need to be able to plan. There is also a slightly softer reason why these are important as well, which is about motivation. It is very clear that working efficiently to generate capital to create that freedom is a significant motivator for clinicians within these trusts. I say that as somebody who led two trusts—not foundation trusts—into trust status in the 1990s, and I know how big an issue that is in terms of the staff within these organisations.
So, against that background, these directions should be exceptional and not the rule, and these amendments set out quite clearly ways to make this work in practice. Amendment 188 states that any direction must be about an individual trust and for a specific region and not in any sense a blanket action. Amendment 189 says that it should be used only after all other means of managing a capital expenditure problem have been exhausted; it must be very much a last resort. Amendment 190 says that NHS England should account to Parliament for the action, giving the reasons—telling the story, if you like—and publishing them so that they can be seen very clearly. Amendment 191 makes it clear that any directions should cease after one year, and Amendment 192 is more minor tidying-up. This is a very clear set of amendments which would put in place the 2019 agreement. I see no reason why that should have changed.
I have three questions for the Minister. First, why is this a change from that agreement? What has changed? Why can we not just have that agreement? Secondly, does the Minister agree that this must be very much a last resort, and therefore needs to be hedged round with these sorts of amendments? Thirdly, will the Minister ask his officials to look at this again, perhaps with the involvement of representatives of NHS foundation trusts and NHS Providers, as indeed happened in 2019? I beg to move.
The Deputy Chairman of Committees (Baroness Henig) (Lab)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.
Baroness Brinton (LD) [V]
My Lords, the amendments in this group, so ably introduced by the noble Lord, Lord Crisp, aim to restrict the powers of the Secretary of State to limit the capital spending of NHS foundation trusts and to ask for the reinstatement of the 2019 agreement. It is important to note that these amendments do not remove the powers as a whole but tighten them to avoid changes by the Secretary of State to funding that would delay capital works which are needed and urgent on health and safety grounds.
Lord Lansley (Con)
My Lords, I intervene briefly to say that I support the amendments in the name of the noble Lord, Lord Crisp. We are grateful to him for tabling them, and indeed for presenting them so very well.
I also rather enjoyed the opportunity from the noble Baroness, Lady Brinton, to think back to 2011, as I think it was, when I went to visit Watford General—I probably announced a new hospital then, but I cannot quite remember. She said the local connections were all funded by the local authority, and I seem to remember paying for the roundabout outside Watford General Hospital, because it was so instrumental to the process of the redevelopment. Anyway, that is by the way.
What I am really looking for from my noble friend on the Front Bench is to understand the mischief to which the Government’s proposals in Clause 54 are the remedy. Certainly, when I was Secretary of State—which is a long way back; we were not in deficit but we did not have a lot of money—the issue every year with the capital expenditure of FTs was that they always told us that they were going to spend a lot and then did not spend anything like as much. To account for that in the public accounting system, we had to make some heroic assumptions about how much less they would spend than they said they were going to spend.
It may be that the department is saying that the way we get round all this is to set very tight limits in the first place—to say where we think they are going and what we think they can spend. This, frankly, is a recipe for disaster for many trusts, because the reason they underspend is that there are so many difficulties in planning and executing capital expenditure projects.
I am trying to find out the purpose behind the Government taking such strong powers in relation to capital expenditure. I rather hope that they might see merit in the amendment from the noble Lord, Lord Crisp.
Lord Stevens of Birmingham (CB)
My Lords, I will be brief. In response to the noble Lord, Lord Lansley, in fairness, there is logic to the broad direction being set out by the Government here. As the financial health of foundation trusts improves, their ability to seek self-generated capital investment will, in all likelihood, be much higher, looking over the next four or five years, than it has been during the more constrained financial circumstances of prior years. So it is not unreasonable to have a set of measures in the Bill that would enable Ministers to ensure that the NHS sticks with the capital expenditure, voted for by Parliament, for the NHS in any given year; nor is it unreasonable on the part of the Government to seek to ensure that there is a mechanism by which that capital can be allocated fairly across the country according to need, rather than purely according to an individual institution’s ability to finance it.
All that being said, rather than this being a fundamental matter of principle in the way that our last two discussions have been, these amendments have a lot to commend them. They are entirely pragmatic and put the right safeguards around what should be only an emergency power. As the noble Lord, Lord Crisp, laid out, that was the basis on which a consensus was achieved back in 2019. It provides good incentives at trust level for sound financial management and, frankly, it provides a bit of a pressure release or a safety valve against an overly artificially constrained capital settlement in certain years or parts of the country.
I very much hope that, in the constructive spirit with which I think these amendments are being advanced, this is something that the Government might consider favourably.
Baroness Neuberger (CB)
My Lords, I declare an interest as chair of University College London foundation trust. I want to echo everything that has been said. I do not really understand why what was a carefully negotiated agreement seems to have been reneged on. I think it would be great to have some kind of explanation from the Minister as to why that should be the case.
I rather agree with the noble Lord, Lord Lansley, that some of those freedoms for foundation trusts are essential, and that fettering foundation trusts too much will not do much good. I really want to agree with everybody and not waste any more time, but please can we have an explanation?
Baroness Walmsley (LD)
My Lords, I have added my name to the amendments in this group, so ably introduced by the noble Lord, Lord Crisp. The noble Lord, Lord Lansley, asked: what is the problem to which Clause 54 is the solution? But I want to know why the Government think that Clause 54 is the solution to the real problem. The real problem is that, over recent years, the funding focus has been on revenue to support the greater demands made on the health service, and, apart from occasional injections of extra capital funding, capital budgets have been inadequate. In the meantime, hospital trusts of both types—foundation and NHS—have found it impossible to keep up with the need for repair and maintenance to buildings and plant and, crucially, to invest in modern technologies that would enable them to deliver more effective care.
An NHS Confederation survey prior to the spending review in October last year found that 81% of leaders said an insufficient capital settlement could impact their ability to meet estate and service safety requirements, and 69% of leaders said a poor capital settlement threatens their ability to fully embed digital transformation in their care and even hampers their efforts to maintain staff levels or keep appropriate records of patients who need elective care. Many of our hospitals and clinics are located in very old buildings and some certainly show it, but capital funding has not kept up with demand for years, and this new Secretary of State power in Clause 54 will not solve the wider problem. St Mary’s Hospital in Paddington will need £1 billion to repair the hospital or services could be shut in six to nine years. Many buildings on the site date back to the hospital’s founding in 1845. One part of the hospital can no longer be used, as the building will no longer support the weight of modern hospital beds.
Annual statistics show that each year we do not invest enough and the problem only becomes bigger. We must keep reminding the Government of the consequences of this. It is worth noting that many areas of the country with the worst health outcomes have older estates, so upgrading these estates will lead to better outcomes for these populations. This is a health inequality issue. The problems are not confined to England. I could tell noble Lords some terrible stories about my local hospital in Wales, where health is devolved. It is easy to find examples of maintenance issues from hospitals, as these get a lot of coverage. The headline “Hospital roof crumbling” is always of interest to local media. However, there are also thousands of small community hubs and mental health trusts that desperately need new and updated facilities and equipment too, and they cannot shout as loudly. The backlog currently stands at £9.2 billion, with half of that, as we have heard, described as involving a high or significant risk to staff and patients.
The new powers for the Secretary of State proposed in Clause 54 would restrict the spending of any individual foundation trust in the same way as NHS trusts are currently limited. This may appear to be fair, and I do not oppose the principle of the Secretary of State having the power. However, it appears to me to be contrary to the principle of freedom of the foundation trusts as outlined by the Government when they were set up, and certainly contrary to the agreement made by NHS England and NHS Improvement with the sector through the September 2019 legislative proposal mentioned by the noble Baroness, Lady Neuberger, which was the result of detailed negotiations with NHS Providers on behalf of their foundation trust members. The reason given by the Government is that this is in order to avoid the overall health budget being exceeded. However, the power needs to be a very narrow reserve power, to be used when all else has failed, and that is what these amendments would ensure.
The Health and Social Care Committee in another place has made it clear that the powers should be used only as a last resort. It has to be remembered that, if a repair needs to be done on the basis of health and safety but is not done, it is the trust that will be blamed for any harm that comes to staff or patients, not the Secretary of State. They are accountable, and that is right, but it does not help them to keep people safe. The noble Lord, Lord Crisp, has tabled this group of amendments to narrow the scope of the power, to ensure in outline what must be done before it is used and, crucially, in my opinion, to require the agreement of Parliament. Currently, the proposal, like many others in the Bill, cuts Parliament out completely. Where the Government are proposing to wipe out an agreement with the sector which is only just over two years old, there must be compelling reasons, mitigating actions and parliamentary scrutiny.
Baroness Merron (Lab)
My Lords, I am grateful to the noble Lord, Lord Crisp, for introducing this group of amendments and setting out for your Lordships that what we need to see is a reasonable system of checks and balances which will serve financial flows and objectives and where, if tensions arise, they can be resolved quickly, fairly and transparently. Certainly, these amendments provide for this.
Earl Howe (Con)
I am grateful to the noble Lord, Lord Crisp, for bringing this debate before the Committee. I have listened to him and other noble Lords with care. Before I turn to the detail, it may be helpful if I explain the reason why Clause 54 is in the Bill.
Clause 54 originated as a legislative proposal made by NHS England and NHS Improvement to the Government in 2019. In making this recommendation, NHS England, under the leadership of the noble Lord, Lord Stevens, worked closely with representatives of the foundation trust sector. The key principle behind this clause is a recognition that the interests of the whole system should be prioritised in decisions about capital spending while also respecting the freedoms and accountabilities of NHS foundation trusts.
The noble Lord, Lord Crisp, asked whether it was our intention that the power in the clause would be a last resort—absolutely yes. Clause 54 is a reserve power to be used only in extreme circumstances to avert the risk of a foundation trust pursuing its own private capital objectives—if I can put it that way—that are not prioritised at a system level. I say to my noble friend Lord Lansley that that is the potential mischief that the clause is trying to address.
The control will operate in the context of the new NHS capital regime, introduced in 2020-21, at ICS area level with planning at a system level to take a holistic view of the local healthcare needs and balancing the allocated operational envelope for providers at that level. Having a power to set capital spending limits for NHS foundation trusts, as can already be done for NHS trusts, ensures an equitable distribution of capital to better enable the investments with highest priority and that achieve the greatest benefits for patients.
At this point I will push back, in the nicest possible way, at the noble Baroness, Lady Walmsley, about the actual level of capital spend. At the spending review 2021, capital spending was set to increase over the Parliament to £32.2 billion for the period from 2022-23 to 2024-25. That includes a £5.9 billion capital investment for the NHS to tackle the backlog of non-emergency procedures and modernise digital technology. As a result, the Department of Health and Social Care’s core capital budget will reach its highest real-terms level since 2010.
Baroness Walmsley (LD)
Governments always tell us how much money they have spent, but the question is always: has it met the demand? The money that the Minister has just mentioned is to try to cover the backlog of elective procedures; it does not cover the backlog of repairs.
Earl Howe (Con)
There will be money to address the backlog of repairs within that total.
Of course, it is our intention that a capital limit would be imposed by NHS England only if other ways of resolution had been unsuccessful. I will take the Committee through some of the detail, because it is important.
Amendments 188 to 192 would further restrict how the power can be applied. Amendment 188 would modify the clause by inserting “individual trust”. This modification is unnecessary because new Section 42B already ensures that an order relates to a single trust.
Amendment 191 would limit the order to one financial year, but, instead of that, the guidance prepared by NHS England will set out that any capital expenditure limits will apply to individual, named foundation trusts. We envisage that most will apply for the period of budget allocation, which is a single financial year.
Amendment 189 would insert steps that NHS England must take before applying the control and limit when an order may be made. The amendment also links the power with the capital planning function held by ICBs in new Section 14Z54. That plan may not always relate to a single financial year and can be amended in year; for example, for big capital projects, the plan could be set for several years, and in such a scenario it would be difficult to determine whether a foundation trust exceeded the plan in the early years. Amendment 189 would undermine the ability to impose the limit in a timely way and would mean that any limit could realistically be applied only when an overspend had already occurred or was committed to. That would risk funding being unfairly taken away from other areas.
Amendments 190 and 192 contain a requirement to lay a report before Parliament alongside a statutory instrument containing the order. That would cause significant delays in the power’s application. There is already a requirement in the Bill for NHS England to publish any orders which place a capital limit on a foundation trust and for guidance to set out the circumstances in which it is likely to impose a limit. We expect the guidance will also state that representations made by the trust will be published by NHS England.
As I mentioned, it is our strong view, supported by NHS England, that the powers and safeguards in the Bill create a proportionate and fair balance. These measures will ensure that if a foundation trust were actively to pursue capital expenditure that is not aligned with local priorities or affordable within local budgets, there is a means to prevent this as soon as possible.
Lord Crisp (CB)
I thank the Minister for that reply. I have one point to make and one question. My point is that an NHS foundation trust may cover an area that is bigger than one ICB, and some of the bigger ones obviously do, so it does not quite work in the way that the Minister talked about. My question, and it is my final question, is: will officials re-engage with NHS Providers on behalf of NHS foundation trusts to discuss this matter further in the light of what we are saying so forcefully to the Government about pragmatic solutions to find a way forward to achieve the right balance and what the Minister has said in his response?
Earl Howe (Con)
I had not quite finished the remarks I was going to make, so perhaps the noble Lord will bear with me. I was trying to say that the measures will ensure that there is certainty for all providers about their capital expenditure. It will also prevent the need unfairly to take planned funding away from other providers, such as NHS trusts, where NHS Improvement and, in future, NHS England, set routine capital expenditure limits just to keep expenditure within system control totals, or national capital limits when a foundation trust exceeds its capital limit. Operational detail of how capital expenditure limits are set is best dealt with, we think, in guidance, where we can ensure flexibility and future-proof the provision, rather than in the Bill.
I hope that those remarks are helpful and will persuade the noble Lord to withdraw his amendment this evening. I say to him, as I did at the start, that I have listened carefully to the points he has made in support of his amendments, and points made by other noble Lords, and I undertake to take these points away for further consideration between now and Report. I am aware that my officials are working closely with NHS Providers on a number of issues, and I very much hope that we can resolve any points of difference to everyone’s satisfaction.
Lord Crisp (CB)
I thank noble Lords who have spoken in support of the amendment, for the very clear message that has been given. I also thank the Minister for that reply and those final remarks about thinking about this further and discussing it as appropriate with NHS Providers. On that basis, I am very happy to withdraw my amendment.
Lord Lansley (Con)
I am sorry to interrupt when the Committee was making such good progress. This clause brings into effect Schedule 10 as an NHS payment scheme, which is to replace the national tariff. Unlike the debates that we have just had about Clauses 39 and 40, I have initiated this stand-part debate not to argue that we should simply take it out but because I simply do not understand yet what the precise differences are that the Government intend between the national tariff and the new payment scheme. I am trying to find out more about it in order that we stand some chance, not least at Report, of seeing whether there is a reason to amend or simply approve what the Government are proposing.
We could have a long debate about this but I am not proposing to do so. If I may, I am going to ask a few questions of my noble friend but do not expect to receive all the answers straight away. These are often things that are easy to put down and send to noble Lords, because we will then have a chance at this stage to think about them before Report.
I can see one obvious difference. In new Section 114A, inserted by Schedule 10, new paragraph (b) includes in the payment scheme provision for payments for public health functions under the NHS Act 2006, which is specifically excluded in the tariff. I can see a difference. Beyond that, I start to lose track of what the differences might be.
The tariff under the 2012 legislation allows not only for payments for episodes of care but for services to be bundled; it allows for year of care budgets; I think it allows for—I cannot see any reason why it does not, and certainly work was done to look at this—outcomes-based pricing; and it allows for local price agreements or national prices. Many of the things which, on the face of it, the new payment scheme is designed to allow, seem already to be allowed. What are the differences?
My first question to my noble friend is this. There is no reference in the new NHS payment scheme to what are effectively national prices, such as the national tariff—if we ignore the word “tariff” and remember that it includes the word “national”. To what extent is the new NHS payment scheme designed to do away with national payments or national prices? In new subsection (3), there is different provision for the same service by reference to different circumstances or areas. We could therefore have regional and local pricing set nationally. That, to me, is an innovation, though I am not sure whether or not it is intended.
Secondly, the national tariff made specific reference to non-discrimination between providers by reference to their status, including, specifically, not paying private providers more than could be paid for a public sector or NHS provider. This new payment scheme refers to different provision for different descriptions of providers. Is it intended that the power should be taken back to pay different amounts to private providers than are paid for public sector providers?
On the payment scheme, there is a very complicated subsection, subsequent to that, that talks about provision of services resulting in
“a fair level of pay for providers of those services”
and refers to differences in costs and services provided. What is intended by that? On differences in services provided, I can see, for example, that if a price is being paid to one provider for a routine service and another provider—which may often be the NHS provider—provides intensive care back-up, the fact that this back-up is available should be reflected in the price they are paid, because, inherently, they have to provide additional resources for it. Is that what is intended? Are other differences likely to result from this?
I then come to my final, and in a way most important, question. I have discussed the point about the Government appearing—the noble Lord told me I was wrong about this—to have abolished the purchaser-provider split. Maybe I was wrong, because here, under the rules that are to be set, we find that they
“may allow or require a price to be agreed between the commissioner and the provider of a service.”
Under all this, the purchaser-provider split has re-emerged, somewhere in Schedule 10. Is that what this means, and is it to be agreed by negotiation or by reference to some other mechanism? One of the fundamental issues about the national tariff was that it was intended to be a negotiated outcome between NHS England and NHS Improvement, on behalf of the commissioners on one side and providers on the other. Who is going to engage in these negotiations and who will be the court of appeal, as it were, in relation to that? What is intended by the Government?
I ask all these questions because we just do not know any of the answers—I certainly do not, but maybe I am missing something. If the Government can share further information about some of these points, that would help me to know whether we want to help speed the clause on its way, or interfere with amendments on Report. I move that the clause does not stand part of the Bill.
Lord Davies of Brixton (Lab)
I wish to address Amendments 201A, 201B and 201C—my name has been left off Amendment 201A for some reason, but I support all three. Indeed, I support the stand-part debate initiated by the noble Lord, Lord Lansley.
I have attended virtually the whole debate in Committee and have been pretty sparing in my contributions, but on this occasion, I am going to make three speeches in one. I have been asked to pass on the thoughts of my noble friend Lord Hendy, who is unable to be here this evening, particularly given the time—though we are meeting a bit earlier than we perhaps expected. The same is true of my noble friend Lady Blower. Both my noble friends have considerable experience in this area and wanted their thoughts to be added to our debates this evening.
My noble friend Lord Hendy tabled these amendments. I have his remarks here; what he says might be of assistance to the noble Lord, Lord Lansley, in that he explains that this Bill, among other things, is designed to facilitate the outsourcing to private contractors of NHS services which are currently carried out in-house. That may not be explicitly stated, but it is clearly one of the underlying aims.
That is the Government’s policy, even though it is firmly opposed by most of the citizens of this island. That said, the purpose of these amendments is to protect NHS workers from the consequences of this policy. Usually when public services are outsourced, the contractor makes profit by reducing the number of staff performing the work formerly done in house and by cutting staff wages, terms and conditions. The TUPE regulations mitigate that process, but usually only by delaying it.
These amendments do not prevent staff reductions consequent on outsourcing beyond the protections in TUPE. In any event, the danger of staff reductions is diminished, bearing in mind that at the end of last year the NHS had 93,000 vacancies and an additional 110,000 staff off sick, half with Covid.
Amendment 201A seeks to prevent cuts to the wages, terms and conditions of NHS staff who are outsourced, and prevent contractors’ staff on worse terms undercutting in-house staff. It does so by requiring that the pricing rules for paying contractors must preserve, then and for the future, NHS staff rates and terms as negotiated between the NHS unions and NHS employers. Payment of those prices will depend on honouring those terms.
I hope the Minister will accept the legitimacy of the need to protect NHS staff in this way, perhaps—my noble friend adds—by better drafted amendments than mine. I am sure the Minister recognises that NHS staff need protection from wage cuts consequent on outsourcing. We must not have a two-tier workforce.
NHS staff are grossly underpaid and the real value of their wages is falling. After years of pay freeze, last year’s miserable 3% wage increase is destroyed by 6% inflation this year. The inadequacy of their terms and conditions is the prime reason for the extraordinarily high level of vacancies—a vacancy rate that increases as more and more work is done by fewer hands. Only heroic dedication by NHS staff prevents the vacancy level becoming a catastrophe.
Amendment 201A also protects against a different kind of two-tier workforce: contractors using the NHS payment scheme to fund salaries above NHS rates to attract certain categories of staff away from NHS posts. The current starting salary for an NHS nurse is £25,655, whereas the equivalent in the private sector is £37,500. No one could begrudge nurses earning whatever they can for their vital work, but NHS funds should not be used to finance a higher rate outside the NHS than within it.
Amendments 201B and 201C are intended to ensure that unions are among the consultees on the likely impact of payment schemes. Obviously, the workforce should be consulted.
My noble friend Lady Blower added her name to all three amendments, and she draws our attention to the fact that my noble friend Lord Hendy is one of our foremost labour lawyers. Some in your Lordships’ House have long experience of trade unions and trade unionism. I therefore hope that they will recognise this quotation:
“Trade unions have been an essential force for social change, without which a semblance of a decent and humane society is impossible under capitalism.”
That was not Marx, Engels or any of the great leaders of the TUC, or a general secretary of a major trade union. The quotation is actually from Pope Francis. Given that we all want to live in a decent and humane society, we should all promote the important role of trade unions. This is in part what these amendments would do; they are about fairness and justice for workers.
Lord Stevens of Birmingham (CB)
I shall briefly make two points. First, having looked at this quite carefully, it is good to see that there is nothing in the proposals for the payment scheme that would intrinsically give rise to the concerns just articulated. Secondly, in response to the noble Lord, Lord Lansley, there are very good answers that can be provided, even if not now, to the questions that he poses. One starting point would be to look at the judgment that the Court of Appeal handed down at the end of 2018, which essentially confirmed that what he said is correct. It is just about possible to torture the 2012 tariff system to make it fit for purpose, but an incredibly elaborate set of workarounds is required to do so, with an enormous amount of bureaucracy and that covers only about 60% of the fund flows in the National Health Service. Hence the desire for something more flexible, which this set of clauses enables the NHS to take forward.
Baroness Thornton (Lab)
My Lords, it is very gratifying that so many noble Lords have decided to come in to take part in a debate about NHS finances tonight; I am very grateful for that.
I shall speak briefly to Amendments 199, 200 and 202A in my name. Amendment 199 provides that the Secretary of State must set out rules for determining the price to be paid for NHS services. Amendment 200 ensures that the key policy documents covering NHS services are approved by the Secretary of State. Amendment 202A provides that the rules must be subject to parliamentary scrutiny.
I am very pleased that the complexity of NHS funding was not mentioned in great detail tonight, but there has been speculation about how funding may work and how the various financial responsibilities in and across ICSs may develop. What we think we know is that complex funding approaches, such as payment by results, will become less important. In Clause 70 and the associated Schedule 10, however, the Bill is wonderfully uninformative. It just says, “Out with the old”—the national tariff—“and in with the new”, the NHS payment scheme. I am again with the noble Lord, Lord Lansley, in saying that these questions need to be answered, because they will affect the regulations, procurement rules and so on.
The payment scheme—actually, I am not going to talk about the history of the NHS payment scheme at this time of night, but, unless the Minister can justify it and answer the questions posed by the noble Lord, Lord Lansley, this part of the Bill should be quietly dropped. We seem to have something that works, so why replace it with something that we do not know very much about?
Lord Kamall (Con)
I thank the noble Baroness and echo her gratitude to all the noble Lords who have turned up for this group of amendments.
Before I turn to specific amendments, it may be helpful to make a few general points about the new payment scheme and explain why this clause should stand part of the Bill. For many years, the national tariff improved access to services and drove up quality across the NHS. The new scheme will build on that success. NHS England will continue to make rules determining the price paid to a provider, by a commissioner, for healthcare services for the NHS, or for public health services commissioned on behalf of the Secretary of State. Also, expanding the powers to enable NHS England to set prices for public health services, such as maternity screening, will allow for seamless funding streams for different care episodes.
However, we need to update the NHS pricing systems to reflect the move towards a more integrated system focused on prevention, joint working and more care delivered in the community. This will support a move from a “payment by activity” approach, towards an approach that promotes integration and early intervention, while discouraging perverse incentives for patients to be treated in acute settings. It will allow flexibility over the current pricing scheme, and allow rules to set prices, formulas and factors that must be considered when determining the prices paid. I assure noble Lords that, when developing the scheme, NHS England will continue to consult any persons that it considers relevant, which will include ICBs, NHS trusts and foundation trusts, as well as trade unions and representative groups. I share the sentiments of the noble Lord, Lord Davies, about the valuable role that trade unions play in a free society.
I turn briefly to the points made by my noble friend Lord Lansley. On regional variation, the NHS payment scheme will encourage commissioners and providers within an integrated board area to work together to agree prices that are in line with the rules set out in the scheme. To date, only one provider has applied successfully for local modification, and closer working within ICBs should remove the need for disputes. On paying different providers differently, there may be scenarios where it is appropriate to pay non-NHS providers different prices from those paid to NHS providers, to take into account differences, different starting costs or a different range of services provided. There may also be cases where the financial regimes of different providers make it appropriate to set different prices or pricing rules. When setting any prices, NHS England will aim to ensure that prices paid represent a fair level of pay for the providers of those services, as well as fair pay between providers of similar services. We will not introduce competition on price rather than quality. We hope that these changes will increase the flexibility and reduce transactional bureaucracy at the ICP level.
I must disagree with the proposal in Amendment 199. While the Secretary of State will remain responsible for setting out overall funding for NHS England, NHS England, alongside Monitor, has set the rules successfully since 2013. I cannot see the benefit of this duty being transferred to the Secretary of State, beyond separating it further from those making operational decisions in the system. Following that logic, we must also reject Amendment 202A. However, I assure noble Lords that the payment scheme will be published in the usual way, and your Lordships will of course be able to table Questions, secure debates, hold us accountable and ensure that the mechanism is scrutinised.
I turn to Amendments 201B and 201C. As part of the broad consultation duties, we expect NHS England to work closely with trade unions and staff representative bodies, such as the Social Partnership Forum, NHS Providers, the Healthcare Financial Management Association and all the royal colleges, when developing the national tariff.
On Amendment 200, I assure your Lordships that the NHS payment scheme will be published by NHS England following consultation. The Secretary of State will also have the general power to require NHS England to share the NHS payment scheme before publication, not to publish a payment scheme without approval, and to share the contents of the scheme should that be necessary.
On Amendment 201A, in setting the rules for the payment scheme, NHS England will of course want commissioners to consider staff pay, pensions and terms and conditions. NHS England will continue to take account of cost growth arising from uplifts to Agenda for Change. New Section 114C makes it clear that, before publishing the payment scheme, NHS England must consult any person that it thinks appropriate. Again, in practice we expect this to include representative bodies and trade unions. NHS England must also provide an impact assessment of the proposed scheme.
I hope I can reassure noble Lords that the department and NHS England remain committed to Agenda for Change. Independent providers will remain free to develop and adopt the terms and conditions of employment, including pay, that best help them attract and keep the staff they need. However, we expect that good employers would set wage rates that reflected the skills of their staff.
On Amendment 202, it is right that the commissioners and providers of NHS services should be able to make representations and, if they feel it necessary, object to pricing mechanisms set by NHS England in the payment scheme. That is why we have retained the duties to consult commissioners and providers. We have also retained the ability for ICBs and providers to make representations and to formally object in response to consultations on the NHS payment scheme, as they can with the national tariff.
The current prescribed thresholds are set by the National Health Service (Licensing and Pricing) (Amendment) Regulations 2015, and the current objection thresholds since 2015 have been set at 66%. My department consulted on these thresholds in 2015 and it remains the Government’s view that they are proportionate, preventing the delay of future payment scheme publications and giving the NHS the certainty that it needs to plan for future financial years.
If I have not answered all the questions from my noble friend Lord Lansley and others, I ask noble Lords to remind me and I will write to them. This has been a very important discussion—as we can see by the attendance—and I hope I have given enough reassurance to noble Lords for them not to move their amendments and have explained why the clause should stand part of the Bill.
Lord Lansley (Con)
My Lords, I am most grateful for the Minister’s response to that short debate and for the other contributions. I shall certainly look at the Court of Appeal judgment—was it the Court of Appeal? —and try to work through precisely where the problems are. There are two ways of dealings with this issue. One is to scrap the national tariff and put in a new payment scheme. The other is to start with the national tariff and ask what the problems are and how we are going to deal with them, and I would quite like to work that through.
We may come back to this because there is an issue about how far the payment scheme is a national payment scheme and how far it becomes a local and varied one. That is a very interesting question, as is the way in which discrimination between providers may be implemented and for what purposes.
For the moment, though, I am very grateful to my noble friend for his response and for his promise to follow up on issues.
Baroness Meacher
“(1AA) The regulations must make provision—(a) for anyone with a diagnosis of terminal illness to be offered a conversation about their holistic needs, wishes and preferences for the end of their life, including addressing support for their mental and physical health and wellbeing, financial and practical support, and support for their social relationships,(b) that, where that individual lacks capacity for such a conversation, it is offered to another relevant person, and(c) that for the purposes of section 12ZB a relevant authority must have regard to the needs and preferences recorded in such conversations in making decisions about the procurement of services.”Member’s explanatory statement
This amendment ensures that the scope of the regulations as to patient choice includes those at the end of life.
Baroness Meacher (CB)
My Lords, in moving Amendment 203, I declare my interest as chair of Dignity in Dying, the sister organisation of Compassion in Dying. This amendment is supported by Marie Curie, Together for Short Lives, Hospice UK, Sue Ryder and the Alzheimer’s Society, as well as Compassion in Dying, a national charity which enables people to prepare for the end of life. I thank them all for their support and their briefing. I apologise—I have cut my speech to the bone in light of the late hour.
The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)
I now call the noble Baroness, Lady Brinton, to speak remotely.
Baroness Brinton (LD) [V]
My Lords, there are two amendments in this group, both dealing with end-of-life arrangements, and I support both of them. Amendment 203 in the name of the noble Baroness, Lady Meacher, would put on the face of the Bill an extremely important provision—that of giving anyone with an end-of-life diagnosis the right to a conversation about their needs, how and where they want to die, and how they can be given the support they need to achieve that. This is long overdue. Our excellent palliative care and end-of-life healthcare clinicians and professionals carry out an invisible yet vital service to people. But unfortunately, it is not universal.
Why, oh why, as a nation, do we hate to talk about dying? I have seen both the best and worst in practice. Indeed, very recently, a friend in hospital who was told that he had a few weeks left wanted to go home to die. No one at the hospital used the phrases “end-of-life care” or “palliative care” or even talked about hospices. They thought he was not close enough to death to get to that stage. Instead, there were discussions about setting up the right domiciliary care, or possibly a care home through the council. This amendment would ensure that when the diagnosis of end of life is made, that conversation will happen for all patients. That is very welcome. It is too late for my friend, who died while he was still in hospital.
Amendment 297 in the name of the noble Lord, Lord Forsyth, sets out the requirement for the Secretary of State to lay a Bill before Parliament to permit terminally ill and mentally competent patients to end their own lives with medical assistance. I offer my deepest sympathies to the noble Lord, Lord Forsyth, on the death of his father. I look forward to hearing his speech on this amendment, and I apologise that, due to the remote contribution rules, I have to comment on it before he speaks.
Both the Private Member’s Bill brought by the noble Baroness, Lady Meacher, and before it the Private Member’s Bill brought by the noble and learned Lord, Lord Falconer of Thoroton, had exceptionally sensitive and thoughtful debates in your Lordships’ House, but neither has progressed any further. We know that public views have changed—like those of the noble Lord, Lord Forsyth—in light of sad family experiences of death where pain and trauma were not controlled and where, for too many people, access to palliative care and end-of-life care was just a lottery.
I have spoken in the debates on both those Private Members’ Bills in favour of assisted dying and remain firmly committed to campaigning for it, but that is not what tonight’s debate is about. If accepted, Amendment 297 would not immediately change the law on assisted dying. It would merely require Ministers to bring forward draft legislation, not even to campaign in its favour.
Government is well placed to draft the legislation, encourage a wider public debate through consultation and bring together voices and views from right across our society in a way that perhaps the polarised debate between individual MPs and Peers on such a complex issue always makes difficult. Government can and should maintain their neutrality on assisted dying, but they can guarantee sufficient time for the consideration of the legislation.
It is worth noting that in those jurisdictions where assisted dying has been made legal, there have not been the disastrous consequences predicted by opponents. Instead, those laws continue to receive huge popular support many years after legalisation. In no jurisdiction has any law been passed on assisted dying and subsequently repealed, demonstrating perhaps that the fears of opponents to assisted dying have not come to pass.
The Crown Prosecution Service has recently opened a consultation on the introduction of a prosecution policy for homicides that can be categorised as mercy killings or suicide pacts. The prosecution guidelines, if approved, would add clarity to the law in the same way as the prosecution policy on assisted suicide adopted over a decade ago. While this is helpful, it does not change the law, and it cannot protect dying people with a legal choice of how to end their life, nor can it protect their families, as decisions would be made by the CPS only after the death of the person. I have seen a family friend have to go through the trauma of a police investigation after her husband took his own life. He deliberately chose a day when she was 100 miles away to protect her. It still took months for the police to make their decision and, frankly, it was cruel.
What we need above all is a commitment to a public consultation and parliamentary time for a wider debate on assisted dying. Amendment 297 provides that. It does not change the law on assisted dying. Tonight is not the right time for that, but I think the country is ready for that debate. Both these amendments are vital in their own way, and I hope that the Minister will be able to respond favourably.
The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)
My Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite her to speak.
Baroness Campbell of Surbiton (CB) [V]
My Lords, I wish to oppose the two amendments in this group. Amendment 203 extends the scope of regulations on patient choice under the National Health Service Act to require particular services to be provided at the end of life. It is, I am afraid, clear from the speech made by the noble Baroness, Lady Meacher, on Amendments 47 and 52 in Committee that this is to include the right to assisted dying. It is directly linked to Amendment 297 in the name of the noble Lord, Lord Forsyth.
I am afraid I do believe that these two amendments are an attempt to hijack the Bill to promote a change in the law on assisted dying. I do not feel tonight is the time to discuss the merits or otherwise of assisted dying. By no stretch of the imagination is assisted dying within the scope of this Bill. There is a separate Private Member’s Bill already before this House, awaiting detailed scrutiny. That is the right vehicle to debate this issue and that is where it should be debated—not here, not tonight and certainly not at this late hour.
Moreover, Amendment 297 seeks to force the Government’s hand into requiring it to prepare a draft Bill on a subject that has not yet been agreed by Parliament. To date, the Government have, studiously and quite properly, taken a neutral stance. This amendment could be seen as a deliberate manipulation of the parliamentary process to provoke a viewpoint that is known to be contentious, and to force the pace of further scrutiny before Parliament, and before parliamentary time has been made for it.
Given the existing pressures on the Bill before us, these tactics are, I believe, truly not worthy of your Lordships’ House, so I hope that the Minister agrees with me that the amendments should be rejected and withdrawn. This is not the place to have this debate.
Lord Forsyth of Drumlean (Con)
We have just listened to very powerful speeches by the noble Baronesses, Lady Campbell and Lady Brinton.
I would like to begin with an apology to all Members whose email inboxes have exploded over the last 48 hours. If it is any consolation, so did mine. I got the same emails, all of which were identical and came from the same email address, info@righttolife.org.uk. They began:
“Dear Lord Forsyth, I am making contact on an urgent matter. As you probably know, Lord Forsyth has tabled an assisted dying amendment to the Health and Care Bill, and this amendment will be debated next week. I am asking that you please oppose this dangerous amendment”.
The first point I would like to make is that it is very late at night, so I am going to keep my remarks brief. Contrary to what the noble Baroness, Lady Campbell, said, this has got nothing to do with the amendment of the noble Baroness, Lady Meacher. The reason that they are grouped together is because I asked for them to be grouped together; otherwise, it would have come up on a Friday when I could not be here. There is no common link in the terms of these being about assisted dying, and the noble Baroness, Lady Meacher, has explained why her amendment is not about that.
My amendment is not actually about the merits of assisted dying. It is true that I have changed my mind on this matter as a result of not just my own experience with my father but also because all the time that I opposed it I have felt a bit of a hypocrite, because if ever I was, for example, to contract motor neurone disease, I would want the right to assisted dying. I felt it was rather hypocritical to vote against something that I would want for myself. But I persuaded myself that I was doing so because there were certain protections that were needed. That is all I am going to say about that—and I was not going to say anything at all—because the noble Baroness, Lady Brinton, raised it. It is an unusual position to be proposing an amendment when it has already been opposed, before you have even spoken to it.
Baroness Bennett of Manor Castle (GP)
My Lords, the Green group is operating on the lark and owl system —appropriately enough, you might say. My noble friend Lady Jones of Moulsecoomb attached her name to Amendment 203 in the name of the noble Baroness, Lady Meacher. I am going to be brief, as I am aware of the pressures. I find it very hard to see why anyone would resist Amendment 203. It is about providing appropriate structures and law to ensure that people’s views are heard and respected.
When I looked at this, I thought of the very old feminist slogan, “the personal is political”. What could be more personal or political than a person having control over the nature of their own death, being able to express their wishes and ensuring that they are heard and recorded.
It is worth saying that I was not able to take part in an earlier debate about the funding for palliative care. We should see much better investment in palliative care in the UK; we should not see volunteers rattling fundraising buckets for hospices to meet their basic needs. But that goes along with the right of individuals to be in control, knowing that they will be heard and listened to, and their wishes acted on. That would allow them to be in a situation of much less fear.
I also want, very briefly, to offer the Green group’s support for Amendment 297. Support for assisted dying is Green Party policy. I want to reflect back to October last year, when the Private Member’s Bill was being debated. There was a very respectful, silent crowd outside, holding up signs saying “Choice, Compassion, Dignity”. I ask people considering this to make sure that those people can be heard in this House and this can be debated.
As the noble Lord, Lord Forsyth, said, it is not about a change in the law; it is about a guarantee of parliamentary consideration, as the courts have requested. It might surprise the noble Lord to know that I preceded him on this. I am trying to remember the details—I was not aware that any fuss had been made about this procedure, but it was either in the Agriculture Bill or the Environment Bill that I put down an amendment in this form. I would not consider myself a procedural innovator, so this is something that has been done many times before.
I want to make one final point. It is perhaps not of legal significance, but, in a way, it is a legal issue. Assisted dying is already available to people in our society—to people who have the funds, the knowledge and the remaining health to get to Dignitas, in Switzerland. This is very much an equalities issue around a right that some people have and some people do not. There is also the fact that, to be guaranteed to be fit to travel, some people are now dying before they need to because we have that inequality.
Baroness Hayter of Kentish Town (Lab)
My Lords, I have added my name to Amendment 297 from the noble Lord, Lord Forsyth. He has made the case, so there is not much more to say. At the core of that amendment, in proposed new subsection (2)(b), all we are asking is
“to enable Parliament to consider the issue.”
That is really all we ask.
We know, as has been said, that the public want change. I believe that the House, at its full strength, wants change. The courts have said that it is not for them, judges, the Crown Prosecution Service, the Law Commission or anyone else to decide. It is the role of Parliament to take a decision of this importance.
By failing to allow a full debate and a decision in Parliament, as the noble Lord, Lord Forsyth, has just said, the Government are effectively siding with those who want no change. That is not a neutral position: it is allowing no change by forbidding those who want to put the issue to Parliament from being able to do that. That is done partly through the number of wrecking amendments that we have seen. I know that the Chief Whip has lots of other demands on his time, but my judgment is that, even if he did not, he would not give time for this—for what would be necessary, given the number of wrecking amendments.
All the Government are doing is accepting, as the noble Baroness, Lady Bennett, has just said, that people with money can go to Switzerland. More importantly, there are no safeguards. Those who oppose assisted dying say that it exposes people to pressure from their families. The whole point of having safeguards is that you will have to go and get permission before it happens, and someone has to test that. At the moment, you can go to Switzerland and there is no check—there is not even a check for whether you are dying. There is no check on whether you are of fit mind; there is no check on whether you are under pressure from a family member. You can just go, if you have the money, but there are no checks. The Government are allowing that to continue: our citizens are able, if they have the money, without any safeguards, to go quite legally to that country and end their lives when they are facing the end of life anyway. That really is not how this country ought to be.
What is important is that we allow Parliament to decide. I can only think that those who have turned up wanting to oppose this are actually afraid that Parliament will decide that it wants change. I often do not like things that Parliament does—unsurprisingly, sitting where I do, on this side of the House—but we are a democratic country and we should let Parliament take the decision on this.
Lord Warner (CB)
My Lords, I support the amendment in the name of the noble Lord, Lord Forsyth. This is an unusual position for me; I do not remember in 22 years ever having supported an amendment tabled by the noble Lord. I am beginning my third decade in this House supporting change in the law. Who knows? I may have reached my fourth decade before we have got there.
During this time, I have watched many parts of the English-speaking world use their Parliaments to debate these issues and change their laws. This has now happened in Canada, New Zealand, five Australian states and 10 states in America and the District of Columbia. These changes have not been rushed through; they have been measured, considered and debated, and the populations have been consulted in the way described by the noble Lord, Lord Forsyth. It cannot be said to be right, if we live in a democracy, if the only way forward on an issue that is of great personal concern to many people is having to rely on Private Members’ Bills, which can be treated to wrecking amendments which make it almost impossible to progress a discussion and debate this issue. In the statesman-like way that the noble Lord, Lord Forsyth, has set this out, we should be impressed by the need to facilitate this debate within Parliament, as other countries have managed to do both in the English-speaking world and across Europe. Even countries such as Spain, with strong religious traditions, have allowed this debate to take place and changed their law as a consequence.
At the end of the day, this issue comes down to being a matter of personal choice. It is right that Parliament should be able to debate that issue of personal choice and facilitate the exercising of it by many people who are terminally ill if they wish to do so. They are not forcing anybody else down that path—it is a personal choice; it is a personal decision. Changing the law does not mandate anybody to do this; it is left to the individual, within the safeguards provided for in the legislation, to exercise that personal choice.
I have also added my name to Amendment 203 in the name of the noble Baroness, Lady Meacher. She makes it clear in that amendment that end-of-life issues are a matter of personal choice. We make many speeches in this House about patient choice, so why is it wrong to have more patient choice at the end of life when we have a lot of patient choice during it? We need to focus much more on patient choice. I support Amendment 203 as well as Amendment 297.
Baroness Young of Old Scone (Lab)
My Lords, I think I am about to score a historic double whammy. I thought that I had stayed tonight to let some momentous words cross my lips that I never thought would do so—that is, I agree with everything that the noble Lord, Lord Forsyth has said—but, and I never thought I would say this, I also agree with every word that the noble Lord, Lord Warner, has said. How is that for a double whammy?
I do not want to delay the Committee, because it is late, but let me touch briefly on Amendment 203 in the name of the noble Baroness, Lady Meacher. I sat on the Commission on Assisted Dying, and we heard endlessly and quite heartrendingly from medical professionals, patients and relatives of those who had already passed away about the inadequacies of the discussion about choices at the end of life. At the moment, the legislation makes it almost impossible for healthcare professionals to open up that sort of conversation—we are not talking necessarily about assisted dying; we are talking about any sort of choices at the end of life. The amendment in the name of the noble Baroness is therefore much needed.
However, for heaven’s sake, on Amendment 297, the whole process of Private Members’ Bills is doomed to failure for something as important as this, which has been tackled by legislatures across the world. Yet we are frozen in this grand old Duke of York scenario, where we march up to the top of the hill at Second Reading on a Private Member’s Bill, then absolutely sod all happens after that and we all march back down again. We cannot continue to do that on a five-yearly basis for ever. This is not asking the Government to nail their colours to any particular side of the debate but simply to open up parliamentary time. I very much commend the noble Lord, Lord Forsyth—good grief— on his foresight in seeing this opportunity.
Lord Mackay of Clashfern (Con)
My Lords, your Lordships will know that I have known my noble friend Lord Forsyth as a noble friend and as a friend for many years. I know also that he is extremely good at putting forward a case—whether the case is well founded or not does not seem to matter too much.
We have a procedure in this House, which was established a long time ago, which says that government time is to be used for Bills presented by members of the Government. That is the rule generally. However, there is also a procedure for dealing with Private Members’ Bills. It has been used many times, and it has been used in connection with assisted dying during the present Session. We had a full day of discussion of the merits of that matter—exactly the merits of this matter; the arguments for and against are not for tonight. We are not here to argue for that amount of time; it took a whole day with quite brief statements being made to express different views about this matter.
The Government are a member of those procedures; they are a party to the procedures that deal with Private Members’ Bills. The Government are there so that they can be asked in the course of the proceedings to help. From time to time, they decide that what is in issue is so important generally that it should be given government time. That is the procedure that has been laid down, and as far as I know in this case so far, the Government have not been asked to give time. They said at the end of the debate just two or three weeks ago that they were neutral and waiting for a decision from Parliament. It is Parliament that takes a decision; a Private Member’s Bill is a proceeding in Parliament. It is not just Parliament dealing with government Bills—Parliament deals with Private Members’ Bills also, as well as other kinds of Bills, such as hybrid Bills.
However, this Bill was in Parliament in the Private Member’s Bill system, which is the system that exists just now. If my noble friend, with his skill, wants to suggest a different sort of procedure for Members’ Bills, he can go about it, but to try to break out of the present system a new system for this sort of Private Member’s Bill will produce a complete wreck of the present procedure when no new procedure is being introduced. The Government have from time to time given time for a Bill to be taken forward, which has reached the statute book. That is the procedure which is available now, and it is the proper procedure to ask for.
This procedure is about trying to put an amendment into a health Bill, which has no mention of this, to amend the law on assisted suicide. That is the essence of this—the heading in the amendment is “Assisted dying”—which would mean an unnecessary amendment to the law relating to assisted suicide in his country. There is no question about that. There is nothing about that in the Long Title of the Bill. This Bill is not the proper machinery for raising this matter. It is not my responsibility or an option to deal with the merits of the case. I made a speech in the debate two or three weeks ago towards the end. I think my noble friend was not able to be present, if I remember rightly.
Lord Forsyth of Drumlean (Con)
I was able to be there, but as we got only three minutes to debate it, I did not think it was possible to deal with the very complex issues in that time. My noble and learned friend is making the case against the amendment that it requires the Government to produce a Bill. It does not. It requires them to produce a draft Bill. If my amendment had said that the Government should bring forward their own Bill, then my noble and learned friend would be quite right, but I would not have been able to table such an amendment because it would have been out of order for the reasons he has given.
Lord Mackay of Clashfern (Con)
Exactly. A draft Bill is preliminary to a Bill; it is not there for the purpose of not being considered. A draft Bill is for making a proposal the subject of an ordinary parliamentary Bill, which has the same authority as a government Bill. All Bills are produced in draft; some are considered in draft in pre-legislative scrutiny. A Bill has to be in draft at some stage, but the object of producing this Bill is not that it should remain in draft but that it should be considered. The amendment does not say how long it should be allowed, but that is another matter. The point is that there is already a procedure by which government help can be obtained if it is asked for in the proper situation of Private Members’ Bills.
I think it is wrong in principle to consider the merits of this matter tonight. Some remarks have been made about that, and I refrain from making any remarks about it because I do not think that that is what is needed here. I submit that it is a view well founded on the rules that Private Members’ Bills are drafted by the private Member, are submitted and then are subject to procedure in the Private Members’ Bills system, including if the Government think it is right that they give additional time.
It is also questionable whether this Motion is in order, since the matter has already been discussed in this Session. There is a question about whether having have a separate procedure raising the issue in much the same form as it was considered some weeks ago is in proper order.
But my main point is about the procedure for dealing with Private Members’ Bills in our Parliament—we are not in the Scottish Parliament at the moment, and there may be some question as to whether my noble friend would like to be—and we have to apply the rules in this Parliament. In my submission, applying the rules of this Parliament, if we want help from the Government, it is to be asked for in the Private Members’ Bill procedures and the Government may, for all I know, be prepared to do something along the lines that my noble friend has suggested.
Lord Moylan (Con)
My Lords, I wish primarily to speak to the amendment standing in the name of the noble Baroness, Lady Meacher, but, before I do so, may I just reply, without any hint of rancour, to the comments made by the noble Baroness, Lady Hayter? She repeatedly described the amendments tabled to the Assisted Dying Bill as “wrecking amendments”. Certainly, my amendments are not intended to be wrecking amendments; the Bill raises very important consequences for the National Health Service, and my amendments are primarily about the effect on the relationship between doctors and patients. These are important considerations, and to call them wrecking amendments is a little unfair. I say that without any rancour at all.
Baroness Wheatcroft (CB)
I support both these amendments. I have listened to the noble Lord, Lord Moylan. In answer to his points on Amendment 203, it is highly relevant that organisations such as Marie Curie want this legislation in the Bill. Marie Curie’s nurses work tirelessly to make the end of life as gentle and congenial as possible for so many patients, but if they believe that this would help them, I would certainly support the amendment.
I agree with the noble Baroness, Lady Brinton, that in this country people are too frightened to talk about dying, and that is what we are talking about tonight—and for some it will be painful. Nevertheless, dying is a subject that nurses and those in hospitals should be empowered to feel comfortable discussing with their patients, and Amendment 203 should help with that.
It is with some trepidation that I venture to support Amendment 297, having heard the noble and learned Lord—
Baroness Wheatcroft (CB)
Yes, Lord Mackay. Your Lordships can see how nervous it makes me feel! I think that, in this particular situation, private Members’ Bills have failed, and the Government show absolutely no intention of moving on something that is so crucial to so many people. Although you have to be wary of opinion polls, it seems perfectly clear that opinion in this country has moved and that a majority of people would like not to have assisted dying made mandatory but to have the choice at the end of life of how they say farewell.
Like others, my inbox has been inundated, and I have tried to reply to one or two of those who have been opposed to the proposal from the noble Lord, Lord Forsyth. One doctor, Dr Whitehouse, a palliative care doctor, wrote to tell me that nobody had come to him whom he could not help, and it was very important that everybody should treasure their short remaining time, and palliative care would do that and assisted dying should be resisted. I wrote back to him a week ago through email—he gave me his email address—and said that I wanted to know more. I am a firm believer in palliative care; it works wonders, and it has improved hugely over the years, but I do not believe that it works in every case. I asked him whether it worked, for instance, with motor neurone disease, or whether it could cope with the incontinence which makes the end of life such a discomfort and an indignity for so many people—or did the help that could be provided mean only understanding and care, which does not necessarily deal with the indignity at all? Noble Lords will not be surprised to learn that I have not heard back from Dr Whitehouse, and neither do I expect to.
This matter polarises people, but the amendment is asking merely that Parliament should have the chance to debate a matter that is crucial to parliamentary Members and, more importantly, the constituents who vote for them. I support both amendments.
Baroness Finlay of Llandaff (CB)
My Lords, I declare all my interests in palliative care and as a director of Living Well Dying Well and vice-president of Marie Curie and of Hospice UK. I have two amendments in this group. I do not intend to lay out all the arguments against the amendment proposed by the noble Lord, Lord Forsyth. Indeed, the noble Lord was right that we had only three-minute speeches when we debated the Bill proposed by the noble Baroness, Lady Meacher. However, I remind the Committee that the Bill put forward in the other place by Rob Marris MP actually failed—it was voted out—and it was one that came high in the ballot, so if it had been voted in it would have progressed quite well.
Personally, I do not think this is the place for us to debate assisted dying, which would need a change in the criminal law. The procedural issues have been clearly explained by the noble and learned Lord, Lord Mackay of Clashfern. The noble Lord, Lord Forsyth, spoke about the right to die. I remind him that everybody is going to die—it is an inalienable right. What he is talking about is licensing some people to provide lethal drugs to others, against a set of criteria. I remind him that three-quarters of people in my branch of the profession—specialist palliative medicine—who look after these patients all the time, not only do not want the law to change but do not want anything to do with it in the event it changes.
The claim has been made that palliative care is not a panacea. Assisted dying is not a universal panacea either. There is a 6.9% complication rate in Oregon, which is experimenting with the fourth drug cocktail in seven years. I remind the Committee, because I have made a plea for specialist palliative care, that it is estimated that 118,000 patients each year in the UK cannot access specialist palliative care. That is why I have an amendment tabled to the Bill, which I hope the Government will look favourably on. Areas where assisted dying has happened rank low on end-of-life care compared to the UK. Areas with assisted dying have dropped in the rankings for palliative care since 2015 compared to areas which did not change the law.
Amendment 203 is well intentioned and builds on all the moves for advanced care planning that are spearheaded by specialist palliative care. I know it was drafted originally with Marie Curie’s help, because it initially discussed with me whether I would table it, but I did not and did not sign it for two reasons. First, it is imperative that such conversations begin early, are part of ongoing care and do not become a tick-box exercise which says, “Conversation offered—tick”. That risks all the dangers of what happened with the Liverpool care pathway. Sadly, I have seen all too often a patient being told, “But that’s what you said you wanted”, when their needs have changed. Much research on advanced care planning has been done by my colleagues in my team in Wales. This has now informed some of the moves that are happening. Having open conversations is something that patients want, and the clinicians trained in communication skills want to provide those openings and do.
The second reason that I was concerned about this is that excellent draft guidance on advanced care planning has been developed by NHS England and NHS Improvement, and is near to being published; I had the privilege of being consulted on the final draft. It sets out core principles that such planning must always be a voluntary process and that every effort must be made to help someone express their views and preferences. The person is central to developing and agreeing their advanced care plan with agreed outcomes that are shared in partnership with relevant professionals. They have a record of the shareable plan and are encouraged to review and revise it so that they can change their mind at any time. In addition, anyone involved can speak up if they feel that the principles are not being followed.
The very sensitive approach set out in the guidance recognises that people have different levels of preparedness for such conversations; that their perception of their illness evolves over time; and that, in the crisis of being given a diagnosis or told of disease recurrence, the views that a person expresses may subsequently change as they reframe their experience. The first step is to start with an exploration of how much the person wants to be involved, what matters to them, and the pace and language that matches the person, as well as that they are listened to and understood.
The amendment asks for a “relevant authority” to
“have regard to the needs and preferences recorded … in making decisions about the procurement of services.”
I hope that the Government can see that, by providing specialist palliative care as a core service, the type of bureaucratic delays that would be involved in procuring services would be completely replaced by a rapidly responsive specialist service that can address the person’s needs in all domains. The amendment also uses the term “relevant person”. If it were used as in the Mental Capacity (Amendment) Act, that person could turn out to be the care home manager, who may actually have competing interests and therefore is inappropriate.
A comprehensive survey of over 2,000 people by Cardiff University’s Marie Curie research department reported that people listed their top priorities towards the end of life as timely access to care at 84%, and being surrounded by loved ones at 62%. Being home was a priority for only 24%.
This is a well-intentioned amendment but it has now been replaced by the extensive consideration of the consultation and production of comprehensive guidance.
Lord Flight (Con)
My Lords, I support the amendment of the noble Lord, Lord Forsyth, but was asked at short notice by my noble friend Lord Suri to present his contribution. He makes the point that we humans look after animals and other living creatures with the highest levels of care—
Lord Ashton of Hyde (Con)
The normal convention in this House is that if a Member is not present at the beginning and end of a debate, they should not speak. It is not right to read out someone else’s speech.
The Lord Bishop of Carlisle
My Lords, I recognise and respect the integrity and passion that underlie Amendment 297. However, I rise to agree wholeheartedly and briefly with those noble Lords and noble and learned Lords who have already expressed their significant reservations about it.
There are two problems in particular with that amendment. The first has to do with the many contentious arguments for and against any legislation permitting assisted dying, some of which have already been mentioned. Tempting though it is to rehearse some more of those, I am conscious not only of the time but of the fact that they have already been presented recently and at length, as we have been reminded by the noble and learned Lord, Lord Mackay, at Second Reading of the Assisted Dying Bill here in your Lordships’ House. The ongoing process of that Bill, however slow it may be, should not be undermined. We have also been assured that this is not primarily what Amendment 297 is all about. I might add that the terminology of that amendment is unhelpfully vague. “Vague” is a word that has already been used more than once in the debate today. For instance, we might ask exactly what is meant by “terminally ill” or “medical assistance”.
The second problem, which has already been persuasively argued, concerns the attempted use of this Health and Care Bill potentially, if not directly, to change the law on assisted dying. The proper place for any amendment of this kind should be Committee on the Assisted Dying Bill, not Committee on this Bill, which would be subverted were this amendment to be accepted.
With regard to Amendment 203 in this group, whether or not it is deliberately linked, it is evidently concerned to address the holistic needs of those approaching the end of their lives, and that includes, of course, talking about death. That is something that we would all wish to encourage. However, there is again an issue of vagueness in the amendment, as in Amendment 297. For example,
“wishes and preferences for the end of their life”
could include almost anything, from repeated albeit futile chemotherapy, through bucket list wishes, to assisted suicide. Who decides, and how, that someone lacks capacity for engaging in a conversation about their holistic needs? Who is a “relevant person”, as we have just been reminded by the noble Baroness, Lady Finlay? Then, in proposed new paragraph (c), what does
“having regard to the needs and preferences recorded in such conversations”
actually entail?
Most of what is proposed in the amendment is already covered in End of Life Care for Adults: Service Delivery, NICE guideline NG142, which was published on 16 October 2019. Perhaps it would be simpler just to require healthcare professionals to meet the requirements of that guideline, which would address the heart of the amendment’s stated, and laudable, objective.
Lord Carlile of Berriew (CB)
My Lords, it is a real pleasure to follow the right reverend Prelate and, given the similarity between his see and my name, I hope I may be able to slipstream some of his authority.
I entirely agree with the noble and learned Lord, Lord Mackay of Clashfern, and the noble Lord, Lord Moylan, that this is not a debate in which we should be having Second Reading discussions about the principle of assisted dying, and I shall absolutely not do so.
I start by saying a few words about Amendment 203. I was greatly relieved when my noble friend Lady Meacher immediately revealed it to be only a probing amendment, because I had taken the trouble of reading proposed new paragraph (b). This is not the occasion for me to indulge or deploy my inner Rumpole or Henry Cecil by telling your Lordships stories of frauds committed on families by greedy relatives and the like—although there are many to be found in the annals of the criminal courts, even from the time when I practised in north Wales. However, the words “another relevant person” are an absolute recipe for undue influence and ostensible but completely fraudulent carers. I am very surprised that my noble friend, for whom I have enormous respect, thought it right to present such a vague piece of drafting to the House on this occasion.
I am very concerned in relation to both Amendment 203 and Amendment 297 about parliamentary procedure and statutory integrity. I have huge regard for the noble Lord, Lord Forsyth, who is one of our very greatest debaters in this House, and so I listened to him with great care. It has been an unusual occasion to hear him relying on a Liberal Democrat Peer in Scotland and the Scottish Parliament. I am not sure that I have heard him deploy that juxtaposition before—and I am pleased to see that he sees the funny side of that himself. However, I beg him, before Report, to consider whether he has got his concept right or wrong, for I would say that, conceptually, what he proposes is wrong.
I do not want to repeat what was said so clearly by the noble and learned Lord, Lord Mackay, and the noble Lord, Lord Moylan—it does not need to be repeated, and I would diminish it if I tried to—but there are a couple of points to add. One was alluded to very graphically by the noble Lord, Lord Moylan. If, as a rule, one could table an amendment simply saying that the Government—or anyone else, for that matter, as the noble Lord suggested—should present a draft Bill to Parliament, it would be impossible to control. Reference was made to the 200 amendments tabled to the absolutely extant Bill of the noble Baroness, Lady Meacher—it is a living Bill and it can still be debated. It is extremely unfair to suggest, as one noble Baroness did, that those were wrecking amendments. Some of them may be, but the great majority of them are substantive amendments seeking to safeguard vulnerable people. That is one of the things that the private Members’ procedure is for. When a private Member presents a Bill to Parliament—and many have passed; it is not a futile gesture—it has to withstand the same parliamentary scrutiny that we give to the Government when they present Bills before Parliament, such as the police Bill, debates on which a number of us here have been taking part in recently.
Furthermore, let us suppose that the clause from the noble Lord, Lord Forsyth, was passed and that within the 12 months that followed the Government decided not to present a draft Bill to Parliament. I do not believe—though I may be disabused of this by greater judicial minds than mine—that the court would have the power, other than possibly to advise, to order the Government to present such a Bill to Parliament, because that would be a breach of the separation of powers. I do not believe that any judge, other than in a nightmare, would see themselves doing that.
Lord Carlile of Berriew (CB)
I will give way at the end of this sentence. It seems to me that what the noble Lord, Lord Forsyth, is proposing is simply not going to be effective, so what on earth is the point of presenting it?
Lord Forsyth of Drumlean (Con)
I rise with some trepidation to take on the noble Lord, Lord Carlile, but could he just reference the point that I made that my amendment does not seek for the Government to produce a Bill? It is a draft Bill. There is no compulsion on the Government to give it time or anything else, and therefore no notion that one would go to the courts. What I am trying to do here is break the logjam. It is completely disingenuous to suggest that we have a Bill before us; we all know that that Bill is going absolutely nowhere, like all its predecessors.
Lord Carlile of Berriew (CB)
The noble Lord is trespassing on the old Social Democratic Party by using words like disingenuous. I will give him an example: some years ago, I chaired a Joint Select Committee of both Houses of Parliament dealing with the draft Mental Health Bill. That particular Bill was never enacted after our year of meetings and the report that we produced, but there was not a single person or NGO—including some that have been mentioned today—that did not believe that it was a parliamentary Bill. A Bill is a Bill is a Bill. In this Parliament we have draft Bills but not half Bills. That is my answer to the noble Lord.
I do not want to take up more time. I finish by saying that I think this is a completely misconceived proposal, both procedurally and, were we to come to it, on the merits.
Baroness Smith of Newnham (LD)
My Lords, I shall speak to both amendments but I shall speak first to Amendment 203, which, on the face of it, I am minded to support.
My reason for that—I hope this is not seen as a Second Reading speech—is that two years ago, just before Christmas, my mother contacted me and said she thought she had terminal cancer. She was taken to hospital two weeks before Christmas and died on Boxing Day, not of terminal cancer but of end-of-life COPD. I had no idea that she had end-of-life COPD, although I knew she had COPD. On Christmas morning, I was summoned to the hospital, and a junior doctor asked me what I wanted to do: “Your mother’s been a bit unconscious. What do you want us to do? Do you want us to wake her up? Do you want us to do anything?” That is not really the best conversation to have. The next morning, Boxing Day, I had almost exactly the same telephone call: “Please come to the hospital, your mother is very ill.” I said that I had had the same conversation yesterday. However, on this occasion I was summoned in and met a doctor who spoke to me with compassion. My father and I agreed that my mother should not be resuscitated. I had never had that conversation with her, but, when I went through her things, I discovered that she had completed a form that said: “End-of-life COPD. When in doubt, do not resuscitate.”
So, in many ways the amendment in the name of the noble Baroness, Lady Meacher, is very attractive because it is surely right that, towards the end of their lives, people talk about what is appropriate.
Baroness Meacher (CB)
It might help the Committee if I make clear that, as I understand it, all our Fridays are taken up, because people are talking so long on all these Bills that we are having to use Fridays for government business, and also there are lots of Private Members’ Bills with Second Readings to come. So my understanding is that we have done what we can do with my Bill.
Baroness Smith of Newnham (LD)
My Lords, perhaps the Minister, in replying, can tell the Committee whether he will talk to the usual channels, especially since I note that the Chief Whip and the Deputy Leader are both in their places, about whether time could be made available for further discussion of the Bill that is extant. Because whatever the merits or demerits of assisted dying, this is not the Bill for such an amendment.
Lord Ashton of Hyde (Con)
My Lords, the noble Baroness, Lady Grey-Thompson, has been trying to get in for a while.
Baroness Grey-Thompson (CB)
My Lords, I want to react very briefly to one comment that has been made in debate tonight, which is the issue flagged by my noble friend Lady Wheatcroft. It is something that is continually raised in the wider debate on assisted dying and it is the issue of incontinence being seen as so inherently tragic that people should use it as a reason to want to end their lives. It is considered an important subject; we have an all-party group on it.
Personally, I find it really difficult because I am incontinent and I have never once felt undignified by it. I cannot believe that I am the only person in the House, or, indeed, in the Chamber tonight, who is incontinent and I will happily discuss the many solutions for sorting out this problem. What I see is that people are scared to talk about it, because they think it is something that we should never discuss. I have many solutions for this. I intermittently catheterise; I use indwelling catheters; I have lots of options available to me if those do not work—medication and lots of options on surgery. There is nothing undignified about being incontinent if we support it properly.
Lord Aberdare (CB)
My Lords, both these amendments reflect a desire to give people a greater say over the final weeks of their lives. As a strong believer in patient choice, which is, after all, a very central part of this Bill, I am greatly attracted by and supportive of my noble friend’s Amendment 203.
As several noble Lords have said, we are not very good at thinking about, planning for and managing death, despite Benjamin Franklin’s observation that it is one of only two certainties in this world, along with taxes. This amendment would give people diagnosed with a terminal illness the possibility of some degree of agency in their final days. That seems to me a wonderful idea, but it does of course raise questions about who such discussions would be with, and what qualifications might be needed by the people offering them. So, while I support the amendment, I would want to know more about the practicalities of delivering it, hopefully without having to create a whole new regulated profession of mortality consultants. I hope therefore that the Minister will respond positively to my noble friend’s suggestion of discussions on how the amendment might work; I will be interested to hear his response.
On Amendment 297, which I also support, I make only two brief points. First, I very much agree with what everybody has said that tonight is not the time to be discussing the merits of assisted dying; that is not what this amendment is about. Many Members on both sides of the argument have made it clear that Parliament needs to decide this issue, and the amendment from the noble Lord, Lord Forsyth, seeks to find a way of making that possible. I feel the same sort of alarm as my noble friend Lady Wheatcroft in finding myself on the opposite side to that of the noble and learned Lord, Lord Mackay, but, with the greatest respect, I think he himself said we were waiting for a decision from Parliament before the Government could act on this. In that case, there has to be some way or process for making such a decision happen. That is exactly what the noble Lord, Lord Forsyth, is trying to produce with this amendment. No doubt there are ways of improving how that is done, maybe by giving more time to my noble friend Lady Meacher’s Bill. This responsibility is Parliament’s to resolve, and I cannot believe that, in this great Parliament, we cannot find a way of doing it.
Baroness Fraser of Craigmaddie (Con)
My Lords, I rise partly because my noble friend Lord Forsyth referred to me earlier and partly because I wanted to clarify what is happening in the Scottish Parliament. There is not actually a Bill in front of the Scottish Parliament. The Orkney MSP, Liam McArthur, carried out a consultation which was very wide-ranging and closed only at the very end of December. Liam McArthur has reported that the submissions to his consultation were wide-ranging and unprecedented, and I look forward with great interest to reading some of them. You can look some of them up. I commend the Scottish Partnership for Palliative Care’s website; its submission is published there. The Neurological Alliance of Scotland also published a submission—I declare an interest because I am a trustee of the latter.
Both those submissions illustrate that this is a very complicated issue, as noble Lords have acknowledged, and there are many things that need evening out before we even get to potentially having draft legislation—a Bill or whatever it is; I am still learning parliamentary procedure. I find it interesting that my noble friend Lord Forsyth mentions that there might be a majority for assisted dying in the Scottish Parliament. I remind him that there is currently a majority for independence in the Scottish Parliament, but that does not mean that the people of Scotland want independence.
In my short time in this House, I have seen many amendments that may have been worthy in their own right but were in the wrong place in the wrong Bill. I think Amendment 297 in the name of my noble friend—I feel very nervous suggesting this to such an esteemed colleague—may possibly be the wrong amendment in the wrong Bill.
Baroness Walmsley (LD)
My Lords, I rise to speak on my own behalf; I am not representing anybody. The substantive issue is a conscience issue. I do, however, support the amendment in the name of the noble Lord, Lord Forsyth, because I think it is a discussion whose time has come. I am very impressed and pleased that noble Lords have resisted the temptation to discuss the substantive issue this evening, because all of us here understand—unfortunately, many outside do not—that this amendment is not about the substantive issue.
However, I am somewhat disappointed that the noble and learned Lord, Lord Mackay of Clashfern, wishes to knock it out on a procedural point. I think it is much more important than that. The noble and learned Lord is a wily old politician, and he knows very well that if you want to defeat something, it is often a very good idea to try to get rid of it on a procedural point. He suggested that we should use the Private Member’s Bill procedure. He has been in this House long enough to know that very few Private Members’ Bills are taken up by the Government and given time, and if they are not given time, they are going nowhere. But it is clear that this country wishes to discuss the matter and have Parliament decide on it.
The noble Lord, Lord Moylan, suggested that we cannot put anything in the Bill that the Government do not want to do. I remind him that every time we defeat the Government on an amendment, we are asking them to do something they do not want to do—and we did it 14 times last week on the policing Bill.
I have one other point. The right reverend Prelate the Bishop of Carlisle talked about vagueness. I think the noble Lord, Lord Forsyth, has been deliberately vague, because it is for the draft Bill to be specific. That is important because we need something very specific to discuss, with specific powers and safeguards that Parliament has put in. Without that, we would have all the fear that we have around the country, much of which has been expressed in our inboxes in these last few weeks. People are afraid of what might be in the Bill and what Parliament might pass, and only if we have a specific set of proposals in front of us can we amend it to put in the proper safeguards. Parliament can then decide, and people can take their view about it. I think that will take away a lot of the fears of people who believe that there will be no safeguards, because I am convinced that this Parliament would put in proper safeguards. If it did not, a lot of noble Lords would suggest some that jolly well should be there, and rightly so. For those reasons, I hope the Minister will consider the amendment in the name of the noble Lord, Lord Forsyth.
On the amendment in the name of the noble Baroness, Lady Meacher, again, I am so glad that she said it is a probing amendment, because other noble Lords have suggested that the drafting would need to be changed to avoid some unintended consequences. I am quite sure that the noble Baroness would do that if it was more than a probing amendment. She is asking for something that patients need: choice at the end of life. I hear what the noble Baroness, Lady Finlay, said about what is already in place. She is an expert on this. It could well be that a conversation needs to be had about whether there needs to be anything further in legislation to strengthen the availability of what the noble Baroness, Lady Finlay, talked about, which sounds absolutely excellent. So I am not expressing a definite opinion on that amendment.
I hope the Minister will consider the amendment in the name of the noble Lord, Lord Forsyth, because we, as practical politicians, know that in the real world—in this Parliament—the Bill brought forward by the noble Baroness, Lady Meacher, is not going anywhere, but we need to have the discussion.
Baroness Stroud (Con)
My Lords, I believe it is really important to understand what Amendment 297 does and does not do. It is my understanding that this amendment instructs the Secretary of State—not Parliament—to lay before Parliament a draft Bill that would permit terminally ill, mentally competent adults legally to end their own lives with medical assistance. I listened carefully to my noble friend’s speech on the matter just before Christmas, and I hugely empathise with his own personal journey. But it is important for us to understand what this amendment actually does and does not do.
Lord Bethell (Con)
My Lords, I would like to speak in support of Amendment 297 from my noble friend Lord Forsyth and specifically address the issue of timing that the amendment refers to:
“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill,”
and so on. I feel competent to address this point because I was asked myself, when I was Minister, whether the Government should support a debate with a Government-supported Bill on this issue. There were five conclusions that I reached during my thoughts on the matter.
The first was that a Private Member’s Bill, however worthy, was just not going to get across the Table. It was like a soggy piece of spaghetti—very difficult to push across. This issue is very complex, and a large amount of consultation is needed, quite rightly on such a delicate issue, that only a Government can engage in. PMBs may be all right for cosmetic fillers, but not for assisted dying.
Secondly, on soundings with the professions, there was clearly a massive change in the sentiments of the medical professions, and the appetite and desire for reform was profound, among both the membership and the leadership. That was something we had to take account of.
Thirdly, reform in like-minded countries such as Canada, New Zealand and even Ireland had changed the international context for this issue. We cannot duck the fact that Britain is actually behind the curve on this matter.
Fourthly, public opinion has moved a long way on this. The noble Baroness, Lady Wheatcroft, referred to this.
Lastly, there was a large amount of interest, privately, among parliamentary colleagues in engaging on this subject, particularly among those who were not necessarily highly focused on the issue.
My conclusion was that the time was right to have this debate. My message to the Minister is that it is right that the inconsistencies and delicacies of this issue are tackled by the Government and soon. In the phrase of TS Eliot in “The Waste Land”:
“HURRY UP PLEASE ITS TIME”.
Lord McCrea of Magherafelt and Cookstown (DUP)
My Lords, I rise to make just a short contribution. I listened carefully to the words of the noble Lord, Lord Forsyth, for whom I have great personal respect. I watched him in another place and saw his great ability in debate, and I have no doubt whatever that he has much to contribute to the debates here in this House and will do so in the future. However, I have to say that I profoundly disagree with him in this case.
The noble Lord said that he had changed his mind on assisted suicide. He mentioned personal circumstances within the family and then he said that he thought about his own personal circumstances if he were in that position. I do not believe that that is the best way to bring legislation forward, based on your own personal circumstances; you are therefore bringing legislation in for the whole country to meet your own personal circumstances. I have empathy with him and understand the personal circumstances he has had to face.
I say to the noble Lord that I come from a different perspective. I have personal experience of the awful pain of the suicide of a loved one. I know what it is for a family member to come to their wits’ end because of their personal circumstances, where cancer had ravaged the whole family circle, even taking a little child of four, and they could not face life any more. Were they terminally ill? I tell your Lordships, they had died within because of their circumstances. Were they mentally competent to make a decision? They made a decision, and I am sad to say that the rest of the family circle has had to live with that awful pain within their hearts.
This is not an easy situation. I understand that we say that we are not talking about the particulars of a Bill, but this amendment says:
“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill to permit terminally ill, mentally competent adults legally to end their own lives with medical assistance.”
That is certainly assisted suicide. I heard other noble Lords saying that this was simply asking for parliamentary time to have a debate. We had a long debate in this House on the Bill in the name of the noble Baroness, Lady Meacher, which is in fact progressing.
I notice that the noble Lord is shaking his head. I have to ask this question. Numerous Private Members’ Bills are going through this House and are progressing, perhaps at a slow speed. Why is this one different from the others? Do we ask the Government simply to pick this one out and forget about all the rest, or are we saying that they should do it in a timely fashion? Let the Government give this special time to those that are already in that process, and when it comes to the Bill in the name of the noble Baroness, Lady Meacher, time can be given for that to progress and to provide a Bill.
Over these past two years this whole nation has been fighting to save life, not take it. We have spent billions of pounds in trying to do that and I pay tribute to the health service for all its efforts. An assisted suicide law, however well intended, would alter society’s attitude towards the elderly, the seriously ill and the disabled, sending a message that assisted suicide is an option that they ought to consider. Society should not allow a double standard in allowing some people an assisted suicide while we do all we can to prevent young people and other vulnerable groups committing suicide—
Lord Warner (CB)
I am sorry to interrupt the noble Lord but is he aware that in all the countries I cited in my speech, parliaments played a facilitating role in changing the law and consulting their citizens on these kinds of changes? Is it not a bit strange that so many English-speaking and non-English-speaking democracies that we all respect managed to go down that path with the help and facilitation of their own parliaments?
Lord McCrea of Magherafelt and Cookstown (DUP)
My Lords, there is a process that the noble and learned Lord, Lord Mackay, outlined tonight for how this issue could proceed. I believe we should bow to his legal and learned knowledge concerning this matter.
I think society should give everything financially and provide palliative care to those who are in need at the end of life. I trust and pray that this House will send a clear message that we will do everything to ensure people live with decency and honour rather than telling them that we will help them to die.
Baroness Merron (Lab)
My Lords, this debate has probably exposed more that is not resolved rather than what is resolved. Having listened very closely to the passionate, informed and often personal contributions from noble Lords this evening, I feel there was some inevitability that that is where this debate would lie.
I want to touch on the two amendments before us. I am grateful to the noble Baroness, Lady Meacher, for clarifying that Amendment 203 is a probing amendment. I am reminded of when we debated these issues in the previous group where your Lordships’ House had great regard for ensuring that a patient’s final wishes should be respected as a kindness. This allows respect and dignity but is also practical in respect of reducing unplanned hospital admissions and other interventions.
There may well be merit in further consideration of the sentiments in the noble Baroness’s amendment that patients should have the opportunity for meaningful conversation about what matters most to them at the end of their life. Of course, the noble Lord, Lord Carlile, is also right about ensuring protection for those who are more vulnerable, and I am sure that, in the course of further discussions, those considerations will be made.
With regard to Amendment 297 put forward by the noble Lord, Lord Forsyth, obviously your Lordships’ House has heard, as I have, the depth and range of concerns and opinions across this issue. Such an important legislative change as proposed in this amendment would need to be its own topic, in its own Bill. I do not feel that any steps towards such a monumental change should be added via an amendment to a Bill that concerns itself entirely with other matters, as does this Bill.
In conclusion, whatever the views of noble Lords on assisted dying and however strongly held those views are, I believe that your Lordships’ House should do justice to it but that this Bill does not provide that opportunity.
Lord Kamall (Con)
My Lords, this has been a fascinating discussion and debate. I recall watching the debate on the Private Member’s Bill of the noble Baroness, Lady Meacher, a few weeks ago; I remember thinking that that was Parliament at its best. The arguments on both sides are fascinating—thank goodness I was not the Minister responding.
I thank my noble friend Lord Forsyth for assuring me today that we were not going to re-open the whole issue but talk only about the merits of the noble Lord’s amendment. Before I turn to his amendment, I will start with Amendment 203 tabled by the noble Baroness, Lady Meacher.
It is incredibly important that everyone at the end of their life, whether or not they have been diagnosed with a terminal illness, has the opportunity to discuss their needs, wishes and preferences for future care, so that these can be taken fully into account. There is ongoing work across the health and care system, as the noble Baroness, Lady Finlay, alluded to, to support this aim, including a commitment within the NHS Long Term Plan to provide more personalised care at end of life, and a recently updated quality statement from NICE on advanced care planning. In addition, we have established the ministerial oversight group on Do Not Attempt Cardiopulmonary Resuscitation, following the CQC’s review of this during the Covid-19 pandemic. This group is developing a set of universal principles for advance care planning to further support health and care professionals in having appropriate and timely discussions with individuals at the end of life. We believe that patient choice is a powerful tool for improving patients’ experience of care, and we intend to ensure that effective provisions to promote patient choice remain. However, I do not feel it is appropriate to specify the level of detail included in Amendment 203 in the Bill, and I hope the noble Baroness, Lady Meacher, will consider withdrawing her amendment.
Let us now turn to the amendment that has been much discussed. As many noble Lords have rightly said, it is a long-standing position that any change to the law on assisted dying is a matter for Parliament to decide, rather than one for government policy. Assisted dying remains a matter of individual conscience, on which there are deeply held and very sincere views on all sides. Sometimes these are informed by one’s own experience of family members; other times, these are informed by one’s faith. You can rationalise it, or argue, but people have very strong feelings on both sides.
Noble Lords are aware of the Private Member’s Bill of the noble Baroness, Lady Meacher, on this subject, and we look forward to further debate in Committee when parliamentary time allows. I will commit to discussing this with the Chief Whip, given the request that was made. But as this matter is so important and is a matter of conscience, we cannot take a partisan position. If the will of Parliament is that the law on assisted suicide should change, the Government would not stand in the way of such change but would seek to ensure that the law could be enforced in the way that Parliament intended.
Lord Forsyth of Drumlean (Con)
I am most grateful to my noble friend. Could he just clarify what he said? Did he say that there was a possibility that time would be made available for the Bill of the noble Baroness, Lady Meacher?
Lord Kamall (Con)
I am afraid that I cannot give that guarantee. I will commit to speak to the Chief Whip about whether time could be made available.
Lord Kamall (Con)
I was not expecting that reaction.
On Amendment 297, it would not be appropriate to include a commitment to bring forward new primary legislation in the Bill. Future Bills and the use of parliamentary time are decisions that are rightly made via other avenues. As I said, I will commit to speak to the Chief Whip—he is not very far from me at the moment.
A number of noble Lords spoke about definitions. It seems that tonight we have challenged the definition of “neutral”. I was told that if I did not support this amendment, it would not be a neutral position. Given that those who spoke in favour of the amendment tend on the whole to be in favour of assisted dying, would it be a neutral position if I supported it? Therefore, have we now got a subjective understanding of neutrality or, as I said in my PhD viva, a subjective view of objectivity?
For all these reasons, I ask the noble Lord to consider not moving his amendment, but I fully expect him to come back to it in future.
Baroness Meacher (CB)
My Lords, I thank the noble Lord, Lord Forsyth, for tabling his amendment. I was asked by other noble Lords to make it absolutely clear, and I have no problem with this, that I fully and strongly support his amendment. I did not speak to it because of time.
I thank a lot of noble Lords for being very good this evening about not addressing the great issue of assisted dying, because that would have been entirely inappropriate. Many noble Lords have been careful not to do that, so I am grateful to them. I am also grateful to the many noble Lords who have made clear their support in particular for Amendment 297. I was very clear about my own amendment; it is a probing amendment. I thank the Minister for his response and the Chief Whip for placing this at the very end of the day so that we did not spend 12 hours on it—I think we can all be grateful for that. I thank all noble Lords here tonight. I beg leave to withdraw the amendment.
Lord Forsyth of Drumlean (Con)
My Lords, it is late. Tempted as I am to respond to all the arguments that have been put—I have some extensive notes here—I want to make just two points.
First, on the procedural arguments that have been put, if the amendment was not in order, it would not have been allowed to be put on the Marshalled List. Had the clerks advised me that there was any constitutional or procedural problem with the amendment, of course I would not have tabled it—a tradition which I hope will be maintained in this House. All these arguments about procedure—people can think it is not the right thing to do, but ultimately it is for the House to decide. I am most grateful to my noble friend the Minister; I suspect the Chief Whip will not be as accommodating as he might have hoped when he has his conversation with him.
The Minister made the point that many of the people who supported my amendment had a particular view on this issue, but it is important to point out that all those who sought procedural reasons for why it would be inappropriate also have a particular point of view. That is why we need a proper debate.
On the Private Member’s Bill of the noble Baroness, Lady Meacher, the most disingenuous argument has been that which says, “Well, we’ve got a Bill before us”, when there is not time even for a Committee stage and there are some 200 amendments. It is well-trodden path.
I shall not say any more other than that if I wanted to summarise succinctly, I would probably have said everything that the noble Baroness, Lady Walmsley, said. Not only is this the first occasion that I have praised the Scottish Parliament to the skies but it is the first occasion that I have relied on a Liberal to put into words what I feel about an issue. The Committee should also take notice of what my noble friend Lord Bethell, who was the Minister, had to say. He said that he would like to have done this as a Minister. I do not know whether my noble friend wants to change places with him again so that he can come back and make it happen. It is wonderful how when one is no longer in government one is able to say all kinds of things one was not able to say in government.
On the basis that I believe that this matter needs to be decided by the House, I shall consider the points that have been made and come back to it on Report, but I think that I will want at that stage to test the opinion of the House.
Lord Ashton of Hyde (Con)
My Lords, I have got up twice today to ask people to be succinct. Front Benches and Back Benches have been very good at that, so I want to say thank you very much. I am very grateful.