Armed Forces Bill

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 1st March 2016 Grand Committee

[Baroness Gould of Potternewton]

The noble Earl has talked about the question of allegation, which is always a problem. Would he be prepared to say that a comprehensive list should be produced of the number of proven cases within the Armed Forces?

[Earl Howe]

I shall address both points. I shall certainly factor in the last point that my noble friend made about the need to have, where this occurs, a record of a pattern of behaviour to guide the authorities if need be.

In answer to the noble Baroness, Lady Gould, the Service Prosecuting Authority records, for each year, the number of cases referred to it, the number of cases in which charges are preferred and the number of cases where a conviction is secured. The Military Court Service publishes on the internet, on a regular basis, details of every case heard at courts martial, including offences, outcomes and punishments. Therefore, the Ministry of Defence already collects and publishes a range of information about sexual offending within the Armed Forces.

However, I do not want to sound in the least complacent on this. As my honourable friend Mr Lancaster made clear in another place, we recognise that we could improve on what we are currently doing. The MoD is now working to ensure that the necessary policies and procedures can be put in place so that the finished product meets the necessary standards of an official statistic. It is a question of ensuring that any statistics that are published can be relied upon to present a true and consistent picture.

Amendment 5 would impose a legal obligation to publish data about allegations of sexual offences. I am more than a little concerned about that because of the point that I made earlier about unfounded allegations but also because no such obligation is imposed on civilian authorities. One has to ask why the military context should be any different.

Amendment 6 would remove from commanding officers any discretion as to whether to report to the service police allegations of the sexual offences to which the amendment relates. Those offences are sexual assault, exposure, voyeurism and sexual activity in a public lavatory. The amendment would mean that the commanding officer was required, by law, to report to the service police every allegation which would indicate to a reasonable person that one of these offences may have been committed. This obligation would apply regardless of the wishes of the victim.

I do not think that this amendment is necessary and I shall explain why. Commanding officers are under a statutory duty under the Armed Forces Act 2006 to ensure that allegations of any offences, including those covered by the amendment, are handled appropriately. The commanding officer’s duties in this respect are crystal clear. If a commanding officer becomes aware of an allegation or circumstances which would indicate to a reasonable person that any service offence may have been committed by someone under his command, he must ensure that it is investigated “appropriately”. The commanding officer must therefore report an allegation to the service police if this would be appropriate.

However, if a commanding officer becomes aware of an allegation or circumstances which would indicate to a reasonable person that a Schedule 2 offence had or may have been committed, he must report this to the service police. Schedule 2 offences are those inherently serious offences listed in Schedule 2 to the Armed Forces Act 2006. Almost all offences under Part 1 of the Sexual Offences Act 2003 are Schedule 2 offences, including rape, assault by penetration and a large number of other serious sexual offences. This amendment would make sexual assault, exposure, voyeurism and sexual activity in a public lavatory Schedule 2 offences. A commanding officer would therefore have no discretion as to whether to report allegations to the service police.

In considering this issue, it is important to remember that before a commanding officer takes command he has training to teach him how to exercise his powers under the Armed Forces Act 2006, and he has access to legal advice 24 hours a day, seven days a week.

I should also mention that comprehensive guidance on handling serious offences, including sexual offences, has been issued to commanding officers, as has a comprehensive guide for victims of such offences. It is also important to note that there is a specific requirement in the Manual of Service Law that a commanding officer is to take legal advice where the offences covered by this amendment are alleged. The manual makes specific mention of these offences in the section on deciding how to investigate. It also states that there is to be a presumption that the commanding officer should normally ensure that allegations of such offences are reported to the service police.

Gender-based Violence: Screening

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 9th March 2015 Lords Chamber

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government what steps they are taking to improve screenings at healthcare settings, including HIV clinics, to screen for gender-based violence and to provide the necessary support for affected women.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

Routine inquiry of domestic abuse is in place in maternity and mental health services. It will be introduced in maternity services for FGM from April 2015 and for child sexual abuse in some targeted services next year. Accident and emergency departments in England have been sharing data on attendances involving body injuries with their local police forces to help prevent violent crime.

--- Later in debate ---

[Baroness Gould of Potternewton (Lab)]

I thank the Minister for his reply. Currently, there is professional guidance on screening, particularly for domestic violence, for health visitors, school nursing programmes and antenatal clinics. Does he not agree that such guidance should be expanded to HIV clinics, because we know that there is a correlation between women who have HIV and domestic violence, so that they can get the help and support that they need, because they have two problems to sort out for themselves?

[Earl Howe]

I do agree. Sexual health and HIV services are already sensitive to the risk of domestic violence, including gender-based violence, in their routine consultations. One of the most important elements in that is to have an environment and atmosphere that is welcoming, comfortable and calm, so that it engenders a sense of trust. Most sexual health clinics have developed local templates to identify those at risk of domestic violence, with signposting and referral to police and other support services if needed.

HIV: Stigma

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 1st December 2014 Lords Chamber

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government what plans they have to develop a campaign to address HIV stigma along the lines of the “Time to Change” campaign on mental health stigma.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Department of Health funds the Terrence Higgins Trust for the HIV Prevention England programme, which helps to tackle stigma by social marketing programmes and by working closely with HIV voluntary organisations. Implementation of the department’s framework for sexual health improvement, 2013, will help reduce the stigma associated with HIV and sexual health issues. Public Health England is supporting the development of the “People Living with HIV Stigma Index” in the UK.

[Baroness Gould of Potternewton (Lab)]

My Lords, maybe I shall not start by asking the question that might be asked, which is: what is the Minister’s secret? I could ask that in the name of Prince Harry, who wants to know what everybody’s secret is, in order to try to encourage people to be able to say, “Yes, I am HIV positive”. But that is not the question I am going ask the Minister.

I thank the noble Earl for his reply, and yes, there are some activities going on—activities which, I have to admit, are not extremely well funded. It seems to me that the success of the Time to Change campaign, which I am delighted by, shows that anti-stigma campaigns can be, and are, very successful. Does the Minister agree that HIV is the other health condition consistently faced with stigma and discrimination? Why has there not been proper resourcing and funding so that we can have a similar anti-stigma campaign, to ensure that there is prevention and a reduction in the number of people who have HIV?

[Earl Howe]

My Lords, there is certainly still too much stigma, although I believe opinion has moved in the right direction generally. The campaigns in the 1980s played a key part in providing information to the general public about AIDS and later HIV, but for some years it has, I think, been widely accepted that campaigns targeting groups at increased risk of HIV are more effective. That is why, for many years, my department has funded the Terrence Higgins Trust for targeted HIV prevention. HIV Prevention England, the unit set up by the Terrence Higgins Trust, is leading that, and is delivering innovative social marketing campaigns, including some mainstream advertising, on things like condom use and testing. There is also a DH-funded national programme, which has been successfully piloted with Public Health England.

NHS: Out-of-Hours Services

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 29th July 2013 Lords Chamber

[Earl Howe]

My Lords, we are straying a little from the Question before us, but I understand the relevance of the noble Lord’s point to the urgent care pathway generally. We are obviously looking very carefully at the GP contract. I cannot tell him at the moment how far negotiations have reached, because we are only at the start of the process. However, his point about primary care services in A&E departments is well made, and many A&E departments do indeed provide that to ensure safe triage of patients on arrival.

[Baroness Gould of Potternewton]

My Lords, during the process to establish this contract, concerns were raised by many GPs and others which, we are told, were ignored. Can there be a guarantee that this time there will be absolute full concentration and discussion with the relevant bodies, with the GPs and others, who want to be assured that the new contract, whenever it comes, is going to be valid and will work? How are we going to explain this process to the public, who are going to feel very uncertain about the future of 111?

[Earl Howe]

My Lords, I can give the noble Baroness that reassurance, because we want local commissioners and doctors involved in the process to be confident in the service that they are commissioning. We did not ignore the warnings from Dr Buckman and others in the BMA. Indeed, on the strength of that we allowed a six-month extension to those providers who felt they needed it to ensure that they were confident in providing a good service. Only two providers took us up on that, which seemed to indicate that our confidence in the service was not misplaced.

Public Health England Advisory Board Membership

Debate between Baroness Gould of Potternewton and Earl Howe

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

I do not think that women necessarily have exclusive expertise in the field of vaccination. However, I take the noble Baroness’s point. It is something that we are closely bearing in mind in the context of the forthcoming appointments that I mentioned in my Answer.

[Baroness Gould of Potternewton]

My Lords, may I follow up on the question asked by my noble friend on the Front Bench? I have two specific points. First, if the Government have a diversity policy, why was such an appointment not made in the first place? Secondly, when are the adverts that we understand will extend the board going to go out? Are they going to look specifically for more women and more ethnic minority members?

[Earl Howe]

The advertisements will go out, I understand, in September, with a view to making the appointments by the end of the year. As regards the gender balance, the noble Baroness may like to know that within Public Health England itself there are almost twice as many women and men across the workforce, and in senior roles there are more women than men. I hope noble Lords will understand that Public Health England itself has no gender bias. The key thing is that appointments are made in accordance with the published criteria on merit. It is our aspiration to have gender balance, but the criteria must be related to those issues.

South London Healthcare NHS Trust

Debate between Baroness Gould of Potternewton and Earl Howe

Thursday 31st January 2013 Lords Chamber

[Earl Howe]

I am grateful to my noble friend and agree with all that she has said. In making this very difficult decision, my right honourable friend’s primary concern has been to protect outcomes for local patients. Indeed, the logic behind these proposals comes from the clinicians themselves, who came together from across London—way before the TSA was appointed—to develop a series of standards for certain conditions. These are based on the simple principle that a critical mass of highly qualified specialist consultants in one place, on a 24/7 basis, available to see patients within one hour and backed up by the latest medical equipment, will give patients better outcomes. At present, no south-east London hospital meets all the emergency or maternity clinical quality standards. Achieving those standards will mean accommodating acute in-patient care across fewer sites. The result will be that people in south-east London will continue to have much better access to A&E and specialist maternity units than the majority of the population in England, and the prediction is that up to 100 lives a year will be saved by this rearrangement of services. My noble friend has raised a very important point because this is about better patient outcomes.

[Baroness Gould of Potternewton]

My Lords, I want to ask the Minister about the next stages and what happens now. I was interested in the paragraph that says:

“It is important to be clear that my acceptance of these recommendations is conditional on Monitor approving the proposals relating to foundation trusts and on my Department negotiating an appropriate level of transitional funding with organisations such as Kings Partners”.

What is the actual process by which Monitor will now do this? When is it likely to report? When is it likely that the transitional funding will be agreed? What is the process if neither of those things is agreed?

[Earl Howe]

My Lords, the noble Baroness asks some extremely pertinent questions. Matthew Kershaw, the TSA, expects to start a new job as chief executive of Brighton and Sussex University Hospitals NHS Trust in the spring. That will happen before South London Healthcare NHS Trust is dissolved. As we move into the implementation phase, my right honourable friend will use powers in the 2006 Act to appoint a new TSA to provide the management role normally performed by the board of directors. That takes care of the mechanics of management, and the person appointed will of course have to have the necessary skills and experience to lead the trust. The TSA worked closely with both foundation trusts and Lewisham Healthcare NHS Trust to develop his proposals. The trusts are eager for the mergers to go ahead to realise the benefits that I have described. All three trusts are now working towards having signed heads of terms in place that agree the principles of the transaction and set the basis for the final deal.

Looking forward, the organisational changes will almost certainly not occur until somewhere between June and October. Having said that, the trust managers will immediately start making the necessary operational efficiency improvements, as indeed I know they are keen to do. The actual transfers of emergency maternity and paediatric services to other sites is planned to happen in late 2015. That will not be immediate, because it is necessary to spend the funds that I have mentioned to expand the capacity of these other acute centres.

[Baroness Gould of Potternewton]

I am sorry to interrupt the noble Earl, but will he actually answer the question about Monitor and the transitional funding arrangements?

Health: HIV Strategy for England

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Baroness Gould of Potternewton]

My Lords, is the Minister aware of a recent study undertaken on behalf of the British HIV Association on the relationship between women with HIV and domestic violence, which shows that half the women interviewed have shared a lifetime of what is called intimate partner violence—IPV? In the light of that evidence, can the Minister indicate what action is being taken by government to raise awareness of this very serious level of violence against women with HIV and, secondly, whether there will be any routine screening to find out the level of IPV among these women? Furthermore, does he agree that if we had a national strategy for HIV, surely issues such as this and things such as unemployment, as well as other areas, could be taken into account?

[Earl Howe]

My Lords, the noble Baroness raises an extremely important issue about violence against women. There is a great deal of activity in my department designed to bear down on that and I should be happy to write to her about it. On the issue that she specifically alluded to at the end of her question, we think that, as most HIV is transmissible sexually, it makes much more sense to build that dimension into a sexual health strategy which embraces not only HIV but all transmissible sexual conditions.

Abortion

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 4th December 2012 Lords Chamber

[Baroness Gould of Potternewton]

My Lords, the Minister has answered part of my question, but I shall question him a little further. First, I make the point that of course the law must be maintained at all time. Some of the arguments demonstrate attempts not to keep to the 1967 Act. Is it not therefore important that we stress what it says and maintain in absolute the Act as it stands? Any attempt to water down that Act would return us to the days of backstreet abortions and the deaths that followed them. Does the Minister agree—he mentioned this in his last point—that we should maintain proper, available contraceptive services for all ages? A lot of PCTs are not giving contraceptive services to the over-24s, which is why the abortion rate has gone up in that age group. Does he agree that there should be open access to contraceptive services for all ages and by all methods?

[Earl Howe]

My Lords, I agree with the thrust of the noble Baroness’s two points. In particular, I agree that there should be no departure from the terms of the 1967 Act, which is why the CMO took the trouble to write to all clinics and hospitals, as I mentioned earlier, to remind them of the provisions of the Abortion Act and in so doing to remind them that sex-selective abortions are illegal.

I must correct what I said earlier. I hope I did not give the wrong impression about repeat abortions. My briefing states that in 2011, 36% of women undergoing abortions had had one or more previous abortion. That proportion has in fact risen from 31% since 2001. Twenty-six per cent of abortions to women aged under 25 were repeat abortions, which is quite a high percentage.

Abortion

Debate between Baroness Gould of Potternewton and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

I fully agree with my noble friend.

[Baroness Gould of Potternewton]

My Lords, further to the Minister’s reply, some time ago the Government set up a parliamentary committee, of which I was a member, to look at counselling for abortion. For some time we have had no idea whether that will go ahead. Can the Minister tell us whether the consultation planned at that time will go ahead? Further, can he indicate the outcome of the review of abortion services conducted by the Care Quality Commission?

[Earl Howe]

My Lords, the department is currently considering the best way to make progress with pregnancy options counselling in the context of improvements to sexual health as a whole. As regards the noble Baroness’s second point, the Care Quality Commission looked into the allegations that were made about the pre-signing of HSA 1 forms and found that a number of trusts were non-compliant. The CQC is working closely with these trusts to ensure future compliance, but we are awaiting the conclusions of the investigations by other agencies, including the police, the GMC and the Nursing and Midwifery Council.

NHS: Public Information and Advice

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 12th June 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend is absolutely correct to highlight the importance of preventing obesity, particularly obesity in the young. He will be reassured to know that the Change4Life Campaign, which we have continued from the previous Government, will include this as a major focus into the future.

[Baroness Gould of Potternewton]

My Lords, in light of the fact that the Minister talked about having a review, have the Government given any reconsideration to the need for a specific national prevention campaign designed to reduce the number of HIV infections? Does he accept that there is a necessity to reduce the increasing level of transmission, not only because it is spreading into non-high-risk groups but also because of the cost of treatment, which is extremely costly indeed? It seems to me that there is no question that the long-term savings would be substantial compared to the cost of a national campaign. Can the Minister also clarify the future of the two current targeted HIV campaigns?

[Earl Howe]

My Lords, I share the noble Baroness’s concern. She has highlighted a major area on which Public Health England and local authorities will wish to focus going forward. This is the great advantage of the architecture that we have put in place, with health and well-being boards responsible for determining local needs and the way in which to address them. Public health awareness campaigns have their place but they are not the total answer. The noble Baroness has drawn attention to the importance of having sufficient treatment facilities, and access to them, available. So, with the support of Public Health England at a national level, local authorities should be addressing sexual health as one of their key areas.

Health: Clinical Commissioning Groups

Debate between Baroness Gould of Potternewton and Earl Howe

Thursday 26th April 2012 Lords Chamber

[Earl Howe]

My Lords, I do not accept that. CCGs will be subject to rigorous safeguards that prevent conflicts of interest affecting their commissioning decisions. Each CCG has to maintain registers of interest. They must have a governing body with lay members on it and other non-GP clinicians who will oversee the arrangements for governance. Each CCG must make arrangements set out in their constitution to manage conflicts and potential conflicts of interest. And the NHS Commissioning Board, as part of its overseeing role, will be responsible for making sure that every CCG has arrangements to manage potential conflicts of interest. So we do not see these problems arising in practice.

[Baroness Gould of Potternewton]

I should like to probe the Minister a little further in response to that. While he says that CCGs have to have a register of interest, how are they going to be monitored to make sure that actually happens? How will the register be kept up to date so that conflicts of interest cannot arise in the future? And what actions might be taken when a conflict of interest is proved?

[Earl Howe]

My Lords, the watchword in this context is transparency in that the governing body of a clinical commissioning group will usually meet in public. There will be provision for the health and well-being board of a local authority to challenge decisions made by the clinical commissioning group in its annual commissioning plans. In general, if anyone has a concern about a conflict of interest, or indeed a perceived one, it is open to them to refer the matter, first to the CCG and, secondly, to the NHS Commissioning Board itself.

Health: Stroke Care

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My Lords, not for the first time, we learn from Newcastle how to treat patients.

[Baroness Gould of Potternewton]

I, too, refer to the debate that we had recently on stroke. The Minister greatly praised the work of an organisation called Connect. I declare an interest as my daughter is a director of it. It is a third-sector organisation which works across the country but mainly in rural areas. Connect and many other third-sector organisations are worried that, in light of the squeeze on local authority and NHS budgets, their funding will cease and this wonderful and vital work will be lost.

[Earl Howe]

My Lords, we are well aware of the issue raised by the noble Baroness. Indeed, it was raised during the listening exercise last year. PCT commissioners are identifying all their clinical contracts as part of a stocktaking exercise and over the next year will be using the information collected to identify those contracts that are due to transfer to the new commissioning organisations next year. We will work with both providers and commissioners to ensure that there is a smooth transition and continuity of care for patients and service users.

Health and Social Care Bill

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 13th December 2011 Lords Chamber

[Baroness Gould of Potternewton]

The difference between sexual health and most of public health is that sexual health provision crosses local government boundaries, otherwise you will restrict any form of open access, which is absolutely essential in providing proper and effective treatment and care for people who need sexual health services. That has to be taken into account. Identifying sexual health provision just in terms of local government areas will make all the work that has been carried out over the past few years to provide better services disappear rapidly.

[Earl Howe]

My Lords, I appreciate those points and I was coming to some words of comfort for the noble Baroness. Not only could Monitor provide technical advice to Public Health England, provided that that was resourced and managed through the framework agreements and the memorandum of understanding between the two organisations, which would be a given, but Public Health England and local authorities could develop their own tariff, if that is what they wanted to do. I understand the noble Baroness’s concern about the underfunding of sexual health services and that the mandate may not set out enough on that score. Her amendment is clearly a way of ensuring that public health services—particularly this type of service—have an agreed cost attached to them that cannot be varied by local authorities, unless they adhere to the rules around variation. I understand all that. However, what the noble Baroness proposes would significantly increase the remit of Monitor and the NHS Commissioning Board and cut across the roles of local authorities and Public Health England. I will, of course, reflect on what she said, but there are probably mechanisms to deliver the kinds of objectives that she is aiming for.

Also on the subject of sexual health services, my noble friend Lady Tonge made some important points. I completely agree with the importance of the issue she raised. It would probably be best if she allowed me to write to her in response.

My noble friend Lord Clement-Jones proposed in his Amendment 292ZA that Monitor should include variations to prices for individuals who experience disadvantage or who have complex needs. While I am sympathetic to his intention, this is already provided for in the broad provisions in Clauses 114(4) and 117(1). In addition, the inclusion of “must” rather than “may” would not provide Monitor with flexibility on when to specify variations and rules.

I move on to the amendment of the noble Lord, Lord Davies of Stamford, who argued the case for competition on price, and I listened with interest to what he had to say. Let me explain what we are seeking to achieve. Overall, we want a system of fixed prices, set locally or nationally, that would ensure that competition was based on quality and patient choice, not on price. Only in specific circumstances could the prices determined by the tariff be varied. These flexibilities would not allow price competition but would rather, as I have indicated, prevent cherry-picking, allow innovation and secure continued access to services. Put simply, the flexibilities would be allowed only where the effect was to improve the efficiency or quality of services provided.

The Government made amendments to the Bill in another place to make clear that the tariff would not be a maximum price. That is vital to avoid perverse incentives for providers to cut costs at the expense of quality. That is entirely different from the competitive tendering scenario to which the noble Lord, Lord Davies, referred. In that scenario, whereby services would be outside the tariff, it is quite reasonable to evaluate bids in terms of best value, not the cheapest price. Guidance published by the previous Government made that clear. I think that we are closer together than perhaps the noble Lord appreciates, but I am grateful to him for what he said. However, he will know that it was the firm view of the NHS Future Forum that competition should be based essentially on quality rather than on price alone. There is of course a danger that we have a race to the bottom if we go too far down that road.

My noble friend Lord Clement-Jones in his Amendment 294M made some telling points. While I am sympathetic to some of them, I can reassure him that agreements for local modification of tariff prices under Clause 122 are intended not to introduce price competition but to sustain the provision of essential services. For example, a local modification may be necessary to sustain provision of A&E or maternity services in a less populated area. It would be inappropriate to remunerate all providers of an essential service at a modified tariff rate without assessing their circumstances on an individual basis.

The noble Baroness, Lady Finlay, in her Amendment 294BZA proposed that it be explicit that Monitor, in establishing the national tariff, have regard to differences in costs of patients incurred by providers and differences between services provided. Clause 116 makes clear that when developing the draft tariff for consultation, both the NHS Commissioning Board and Monitor should have regard to the differences in costs of patients incurred by providers and differences between services provided. However, that amendment raises a valid point around whether Monitor should have regard to these differences when publishing, as well as when drawing up, the national tariff. I can tell the noble Baroness that this issue will be given consideration to determine whether further clarity is necessary in this area.

I now return to Amendment 292ZA, tabled by my noble friend Lord Clement-Jones. He raised the issue of cherry-picking, which we define as something that occurs when providers undertake only the more simple interventions for less complex patients but are paid an inflated price, based on higher average costs. I hope that my noble friend would agree with that definition. Under the proposals in the Bill, Monitor would ensure that the price paid to providers was accurate and reflective of the services delivered. A comprehensive tariff with more reflective prices will prevent cherry-picking. In particular, Monitor and the board would need to consider among other factors the impact of variations in the range of services provided by different providers and the differing needs of the patients treated. My noble friend again asked why the Competition Commission should be used, and again my answer is similar to the one I gave him earlier. The commission is an expert independent body with experience in considering matters such as this—unlike the OFT.

I now turn to Amendment 294AA, tabled by the noble Lord, Lord Warner. It would duplicate what is already stated in this clause, whereby Monitor must send a notice to other persons as it considers appropriate, which may include other clinical groups. Clause 59(8) makes explicit that Monitor must obtain appropriate clinical advice to enable it effectively to discharge its functions. Clause 116(1)(c) provides that Monitor must notify other appropriate persons of the proposed national tariff, which may include other clinical groups. Monitor must publish its consultation containing the draft tariff.

As regards Amendment 294BA, the share of supply percentage that triggers a reference to the Competition Commission will be considered in secondary legislation and agreed through the affirmative resolution procedure. The share of supply percentage would ensure that providers of a service made up of only a few providers would still be able to object to a proposed national tariff and therefore trigger a reference for independent adjudication.

Health: HIV/AIDS

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 5th September 2011 Lords Chamber

[Earl Howe]

The noble Lord is right to draw attention to the rising incidence of other sexually transmitted diseases. I draw the House’s attention in particular to the large numbers of cases of chlamydia and herpes, where he is perfectly correct in saying that the statistics are rising. In other areas, the statistics are stabilising—but he is generally right in the point that he makes. The data show that in 2010 there was a 1 per cent decrease in all diagnoses, but within that there are areas on which we undoubtedly have to concentrate.

[Baroness Gould of Potternewton]

My Lords, I am sure that the Minister appreciates how important it is to have early testing. What efforts will the Government make to ensure that GPs and other primary care professionals routinely offer HIV testing to all new patients, particularly in high prevalence areas? More than that, is any action being taken to give the new GPs and other new professionals the confidence, skills and ability to be able to offer that test?

[Earl Howe]

The noble Baroness with her experience makes a central point here. We absolutely agree that increasing the offer and uptake of HIV testing in a variety of healthcare settings is important to reduce undiagnosed HIV. We welcome the BHIVA professional guidelines in this area, which have been extremely helpful. The sooner a person with HIV is diagnosed, the sooner they can benefit from treatment and also make any behavioural changes to prevent transmission. It is those behavioural changes that count most strongly.

The department funded pilots to support the implementation of recommendations from the BHIVA, and those were extremely successful. In the coming days, we will consider carefully the report that is due to be published by the Health Protection Agency to see how we can take forward its findings in this area.

Public Health

Debate between Baroness Gould of Potternewton and Earl Howe

Tuesday 30th November 2010 Lords Chamber

[Earl Howe]

My noble friend takes me back to happy days watching “Dr Finlay’s Casebook”. I seem to remember that Dr Snoddie always had an encounter with Mistress Niven, who came down with all manner of complaints and ailments that the redoubtable duo usually diagnosed and dealt with.

My noble friend is correct. We have to ensure that we have the right people trained at the right level to deliver this service and that we do not get bogged down in managerial bureaucracy. Health and well-being boards will be a vehicle for public health, social care, the GP consortia, when they are formed, and the patient organisations, such as HealthWatch, to come around the same table, so to speak—maybe literally—in order to look at the broader health needs of an area and decide on priorities. I see that as powerfully playing into the public health agenda. This will be far from being a process that is bogged down in bureaucracy.

[Baroness Gould of Potternewton]

My Lords, I welcome this document as well as the concept of cross-party working on public health services. I particularly welcome, as the Minister might expect me to say, the references in the document to improving sexual health.

I have a number of questions. On the directors of public health, the Minister talked about them being at the right level. What level is that expected to be within the framework of local government? Unless they have a high status within local government then, unfortunately, they might not be able to influence some of the things that they might want to influence. I have another question regarding the directors. In working with GP consortia, what if there is a difference of view that needs to be resolved? Who takes the final decision? Who has the final say in respect of that?

How is it going to be determined whether an area qualifies for the new health premiums? With regard to ring-fenced budgeting, the aid support grant lost its ring-fencing. Does that mean that it will be in the public health ring-fenced budget or not?

When the independent advisory group on sexual health, of which I was chair, was abolished, we were told that a new sexual health organisation would be established. What will be the process for that and when is it likely to happen?

[Earl Howe]

My Lords, the noble Baroness asked me a number of questions there. I may not be able to answer all of them now, but I will certainly write on those that I cannot.

As I mentioned earlier, it is important to recognise that in part the status of directors of public health will be confirmed by virtue of not simply being appointed locally, but also by being appointed from the centre by Public Health England. That will confer an added status to them. With the dual accountability that I referred to, primary accountability would be to their employer, the local authority, but the Secretary of State would have a backstop power to dismiss directors of public health on the basis of a failure to discharge local authority responsibilities in the area of health protection. Again, while one does not want to dwell on that power, it signifies that this is a person who will be there very much as the representative of the Secretary of State.

The noble Baroness asked what happens if there is a difference of view. Differences of view will arise but the important point to emphasise here is that we want to see them sorted out at a local level wherever possible. That will not always be possible but it should be the aim that health and well-being boards and consortia should decide, in the light of the joint strategic needs assessment and other factors, what the priorities are locally and how the budget is to be spent. It has to be that way: second-guessing from the centre is bound to lead to perverse consequences. However, there will be mechanisms available to ensure that the NHS commissioning board will have a role in trying to resolve these issues and the noble Baroness will see, when we publish the health and social care Bill, that the Secretary of State will have a backstop power in extremis.

She asked about the health premium. We will be publishing a document for discussion on this. We want to hear the views of everybody as to how this should work. Clearly, if a health premium is paid it has to reflect a measure of genuine progress in reducing health inequalities, while recognising that some areas start off with the handicap of having particularly deprived communities to work with and that the task is thereby more difficult. It is important that the department receives the views of interested parties to see how this is going to work.

On sexual health, we are looking to see what more can be done to increase the awareness of risks, prevent infection and promote access to screening and treatment. The consultation documents, which will be issued shortly, will set out the proposed funding and commissioning routes for public health services, including how comprehensive sexual health services might best be commissioned. I hope the noble Baroness will feed into that.

Health: Cancer

Debate between Baroness Gould of Potternewton and Earl Howe

Monday 21st June 2010 Lords Chamber

[Earl Howe]

My noble friend is absolutely correct. It is now generally agreed that the most important reasons for the lower survival rates in England compared with other European countries are: low public awareness of the signs and symptoms of cancer, delays in people presenting to their doctors, and patients having more advanced disease at the time of diagnosis. We are looking very carefully at how best to achieve earlier diagnosis. There are some key messages on the NHS Choices website and the national awareness and early diagnosis initiative has been under way since 2008. As for my noble friend’s second question, on the blood test, the newspaper reports in recent days have been extremely exciting in terms of the potential. However, it is clear that researchers will have to demonstrate improved clinical outcomes for patients before any large-scale rollout can be applied.

[Baroness Gould of Potternewton]

My Lords, given the Minister’s reply, does he agree that targeted screening remains the best way to prevent growth of oral cancer? Given the success of the previous Government in cutting the overall rates of cancer deaths, is he prepared to guarantee that the current investment and screening programme will continue?

[Earl Howe]

The noble Baroness is quite right that screening plays a very important part in the detection of cancer. However, it is not universally applicable to every cancer. In terms of oral cancer, which was the particular subject of my noble friend’s Question, there are difficulties. For example, there is considerable uncertainty about how the disease progresses—its natural history—and we cannot predict which lesions will be malignant and which will not. We need clear guidelines—for dentists, for example—and we do not have those. There is also no clear evidence base for the management of malignant lesions when we find them. However, the National Screening Committee will review its position again in about three years’ time and will no doubt take all the current evidence into account.