Medicines and Medical Devices Bill

Debate between Baroness Jolly and Earl Howe

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Monday 26th October 2020 Grand Committee

[Baroness Jolly (LD) [V]]

With the Northern Ireland component, a time constraint was imposed on the Committee, and people have been looking at ways of solving the problem since our previous meeting. Since 8.30 am I have been in various meetings with various people looking for ways forward. The one described by the noble Earl, Lord Howe, is on the table and has been agreed by all party spokespersons. It was finally agreed at a meeting with the Minister and others at 1.30 pm. Like the noble Baroness, Lady Thornton, I am grateful to the noble Earl for his help in resolving this issue.

[Earl Howe (Con)]

I am grateful to both noble Baronesses for their responses. I think that this provides a basis on which to proceed with our Grand Committee debate today, pending further clarification on the matters that I referred to earlier between now and Wednesday, our next Grand Committee day. I can assure noble Lords that my colleagues and I will endeavour to achieve that clarity, which we will disseminate at the earliest opportunity.

Defence Modernisation Programme

Debate between Baroness Jolly and Earl Howe

Monday 29th January 2018 Lords Chamber

[Earl Howe]

My Lords, I was referring to temporary cuts in some of the training for, for example, the Royal Marines. That is very regrettable, I would be the first to acknowledge, but the service chiefs are clear that these cuts cannot and must not be anything other than temporary. We are not, at the moment, making the kind of reductions to British defence that were widely speculated about at the end of last year. It has never been the Government’s intention to make such cuts. As I said, we are looking to strengthen defence and we will not pursue changes that would be damaging, but that does not mean that we will be looking to preserve every aspect of the department’s current plans. We will be working closely with the service chiefs to explore what changes need to be made to produce the headroom for the kind of modernisation that we want to pursue.

[Baroness Jolly (LD)]

My Lords, the 2015 SDSR called for swingeing cuts to civil servants across the whole department, but of course it is civil servants who can deliver some of the savings that we have talked about this afternoon. Can the Minister update us on how successful the department has been at reducing the number of civil servants?

[Earl Howe]

There has been considerable success in reducing civil servant numbers—for example, arising from our withdrawal from Germany. However, we have always been clear that the last part of the target will remain the most elusive. Unfortunately, I do not have figures in front of me as to how far we have got. It is still very much part of our target, set by the Treasury. We are doing our best to implement those targets, but clearly, as the modernising defence programme goes forward, there may—I am sure there will—be a case for us to have a further conversation with the Treasury about what a whole force concept looks like in the context of the programme that we are undertaking.

Armed Forces (Flexible Working) Bill [HL]

Debate between Baroness Jolly and Earl Howe

3rd reading (Hansard): House of Lords
Wednesday 25th October 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I agree with the noble Lord, Lord Tunnicliffe. I thank the Minister and his team very much for supporting the House and us in our deliberations on the Bill. We are pleased that the Government have accepted the view of the Delegated Powers and Regulatory Reform Committee on parliamentary scrutiny and on the adoption of the affirmative procedure. I worked quite closely on this with the noble Lord, Lord Touhig, and with both spads. We agreed amendments between us: so it is an example where, on occasions, opposition parties can work successfully together, and I wish the noble Lord success in whatever he is doing.

On a personal note, this is my last defence hurrah. I have now moved to health and have come back just for Third Reading. It occurred to me as I was walking into the Chamber that ever since I came into this House I have been either opposite or alongside the noble Earl in my deliberations and those of the House. I thank him very much for his courtesy and consideration; I learned an awful lot from him.

[Earl Howe]

My Lords, I much appreciate the remarks from the Front Benches opposite and reciprocate the warm feelings that have just been expressed by the noble Baroness, Lady Jolly.

I hope that both noble and gallant Lords who spoke will accept that I have listened with care to the arguments they put forward. The Government have taken due note of their concerns about the use of “part-time” in this legislation. We have had debates in Committee and on Report, and the matter was settled by a vote on Report. There is a convention in your Lordships’ House that at Bill Do Now Pass we should not continue the debates of previous stages. Nevertheless, in so far as I have been asked questions by noble and gallant Lords and the noble Lord, Lord West, I undertake to write after the conclusion of this stage of the Bill. Let me make it clear that the service chiefs fully support this legislation. As I said in my opening remarks, the Bill is designed by the services for the services. All three remain involved in the plans to make this a success and I hope that all noble Lords will agree that that is now the imperative.

Armed Forces (Flexible Working) Bill [HL]

Debate between Baroness Jolly and Earl Howe

Report stage (Hansard): House of Lords
Wednesday 11th October 2017 Lords Chamber

[Baroness Jolly]

My Lords, in this group I will speak to Amendment 7. We all want flexible and part-time working to be a success. Therefore it is important to monitor whether these arrangements are helpful in convincing some who may not have ordinarily thought of joining the Armed Forces so to do—I beg your Lordships’ pardon. I am very sorry, I am speaking to the wrong group.

[Earl Howe]

My Lords, I believe that I spoke to an identical amendment as the first in this group in Grand Committee—it was then Amendment 9, I think. I hope that what I am able to say today will reassure the noble Lord completely. The Bill will allow the Defence Council to make regulations to give regular service personnel the right to apply to vary temporarily the terms on which they serve. Specifically, the Bill will allow us to introduce both part-time working and a new form of geographically separated service into the Armed Forces, which together we refer to as “flexible working”.

I am grateful to those noble Lords who have expressed their agreement with the principle that it is fair and appropriate for those regular service personnel who elect in the future to vary the terms on which they serve to see a commensurate variation in the reward that they receive.

I should say up front that nothing in the Bill enables us to do what the noble Lord fears we might do. At present, we envisage that those who work part-time will have their pay proportionately reduced, and those who reduce their liability for separated service will have their x-factor reduced by an appropriate proportion, which we will discuss with the Armed Forces’ Pay Review Body.

As I said in Grand Committee, we have worked—and continue to work—closely with the services to ensure that any reduction in pay, or other benefits, for those who successfully apply to work part-time, or reduce their liability for separated service temporarily, will be, above all else, fair and reasonable to those who work under the new arrangements as well as to those who do not. For reassurance, I will repeat what I said at Second Reading and in Committee: the Bill will not result in any reduction in the basic pay, x-factor or other payments available to regulars who do not take up these new flexible working arrangements. There is a simple reason I can be categorical about that: the Bill deals only with the proposed new types of flexible working. The legislative provisions that govern the pay and conditions of full commitment regulars are contained in different sections of the Armed Forces Act 2006—as the noble Lord will know, having very successfully taken that Act through this House as a Minister in the then Government.

As the noble Lord of course understands, we envisage at present that those who work part-time will have their pay proportionately reduced, and those who reduce their liability for separated service will have their x-factor reduced by an appropriate proportion. As I have said, noble Lords will be aware that the Armed Forces’ Pay Review Body has a responsibility to make recommendations on service pay. It does that through its annual report, which makes recommendations to the Government on an annual Armed Forces pay award, based on a body of evidence gathered from service personnel and their families and the MoD. It also commissions its own analysis and research from other bodies. Accordingly the MoD will engage with the AFPRB and submit a paper of evidence for its consideration on the changes we need to make, in time for the introduction of the measures contained in this Bill from 2019.

I hope there are no lingering concerns that service personnel may be made to work part-time as a savings measure. The regulations under the Bill will make it clear that any application for part-time working or restricted separation must be made by the serviceperson. I am therefore clear that the Ministry of Defence will not be able to impose a change in working pattern on individuals, and that any such change will have to be instigated by the individual. I can reassure the noble Lord, Lord Touhig, that the measures in this Bill will be considered alongside the existing provisions for flexible working that he referred to, so that service men and women will have those options open to them and can accordingly choose the road they go down.

Amendment 6 seeks to protect existing flexible working arrangements. The new flexibilities that this Bill will introduce are part of a series of steps we are taking to modernise the conditions of service we offer to those who serve, and for those who are considering a career in the services. The long-term aim, as I have mentioned, is to improve recruitment and retention in the Armed Forces. We are constantly looking forward and trying to reflect wider best practice in the development of our personnel policies, and we are making good progress. This is the least that our people deserve. In terms of the flexible working options that the Ministry of Defence already provides, such as variable start and finish times, home working and compressed hours, we have over the past two years continued to add to and refine the policies that support them to ensure that they are the best they can be, and we will continue doing so.

As with any HR policy operated within other organisations, it is essential that we have the ability to manage and adjust our flexible working policy to meet the emerging needs of our people and the services. These policies are published in Joint Service Publication 750, a document available to all personnel, to ensure clarity, coherence and transparency for both service personnel and their chain of command. The House can be absolutely assured that we have no intention of withdrawing these existing opportunities for flexible working, which are now well published and in operation in each service. Some have been on offer to our people since 2005 and others have been developed to meet their need for a degree of flexibility in the modern world. To reduce the flexible working options, which is the implied concern in the noble Lord’s amendment, would be a retrograde step given our objective of modernising the Armed Forces offer and would run counter to our aim of increasing the flexibility available to meet our people’s needs.

To be crystal clear, though, to your Lordships, the flexible duties trial that is not part of JSP 750 policy and has been run to help inform the new part-time and geographically restricted service will of course cease when the new arrangements become available to supersede it. However, that is the only exception to what I have laid out. Following these assurances and the circumstances I have outlined, I hope that the noble Lord, Lord Touhig, will feel comfortable in withdrawing his amendment.

--- Later in debate ---

[Baroness Jolly]

My Lords, I apologise to the House for jumping the gun earlier.

We all want to make flexible and part-time working a success, and it is therefore important to monitor whether these arrangements are helpful in convincing some who might not ordinarily have thought of joining the Armed Forces so to do, or in persuading some existing members to remain in the Armed Forces if they were considering leaving. The Armed Forces covenant annual report is the report on the state of the armed services to the nation, so I ask the Minister not to close the door on this level of reporting. It would be helpful if he could assure the House that, in the future, the MoD would consider doing just this.

[Earl Howe]

My Lords, I fully agree with the noble Lord, Lord Touhig, and the noble Baroness about the importance of measuring and reporting on the impact of the changes that will be introduced through this Bill. As I have mentioned a number of times previously, we expect a modest, yet significant, number of our people to take up the new opportunities this Bill will introduce. Therefore, we must ensure that our reporting on this subject is both appropriate and effective for the MoD and Parliament.

I am pleased that noble Lords recognise that the long-term aim of providing these new arrangements, alongside a range of other measures, is to modernise the terms of service and, ultimately, improve Armed Forces recruitment and retention. As we have discussed previously, the changes we are introducing do fall within the scope of the Armed Forces covenant. Noble Lords may recall that I said, in Grand Committee, that it was likely that a future report on the Armed Forces covenant would include a section on the introduction of the measures included in this Bill and their effect.

The current wording of Section 343A, inserted by the Armed Forces Act 2011, which places the obligation on the Secretary of State to lay an annual report on the covenant before Parliament, directs him in preparing the report to,

“have regard in particular to … the unique obligations of, and sacrifices made by, the armed forces; … the principle that it is desirable to remove disadvantages arising for service people from membership, or former membership, of the armed forces”.

It also advises the Secretary of State to include,

“such other fields as the Secretary of State may determine”.

We judge that this broad wording is sufficient to deliver the specific outcomes that the noble Lord seeks and, therefore, does not need amending as proposed.

There is a good reason why I am confident in saying that. A look back at the five Armed Forces covenant reports that have been produced since 2011 confirms that they contain a very broad spectrum of information and data on policy developments that have fallen within the covenant’s scope. A good example of that is the Forces Help to Buy scheme, introduced in 2014, under the new employment model. The scheme has featured regularly in annual reports, and the figures for August 2017 show that, since its launch, more than 12,000 of our people have benefited from the scheme, having received some £184 million to help them get on, or stay on, the property ladder.

A key feature of the reporting has been a description of the nature of the policy change being brought in and, where possible, a measure of its impact following introduction. I can undertake that we will take the same approach to reporting on the introduction of the flexible working opportunities from 2019. Those opportunities will, in the long term, improve recruitment and retention in the Armed Forces and, in the near term, our people will see improvements in their terms of service, and they will benefit from the increased level of personal control over their careers that the new flexibilities will bring. We will ensure that we capture the introduction of the policy change in reports on the Armed Forces covenant and, where possible, a measure of the impact following its introduction from 2019 onwards.

For these reasons, we judge—and I hope the noble Lord will draw the same conclusion in light of what I have said—that it is unnecessary to create legislation requiring the Secretary of State to report on the new measures that this Bill will introduce. I hope, following the assurances I have given, that the noble Lord, Lord Touhig, will agree to withdraw his amendment.

Armed Forces (Flexible Working) Bill [HL]

Debate between Baroness Jolly and Earl Howe

Committee: 1st sitting (Hansard): House of Lords
Tuesday 12th September 2017 Grand Committee

[Earl Howe]

My Lords, the introduction of new flexible working measures is designed to attract, recruit and retain people from a more diverse cross-section of society who have the knowledge, skills and experience that we need to deliver operational capability.

Currently, service personnel who have dedicated themselves to public service sometimes struggle to meet their full military commitment—for example, due to a short-term change in personal or family circumstances—and the only option in such circumstances has been to leave the Armed Forces. This represents a loss to the individual and to defence. New flexible working options aim to address this so that in such situations personal circumstances are no longer a barrier to continuing service. We believe that these measures will benefit a small but significant cohort; for example, women and men starting a family, those with caring commitments or those who wish to undertake long-term studies. Moreover, our evidence derived from external reports, comparison with other nations, internal surveys, focus groups and our ongoing flexible duties trial shows that providing our people with modern choices will help us retain highly skilled personnel who might otherwise leave and join organisations which provide these choices. In short, through these new measures we are aiming to modernise the terms of service for the Armed Forces with a view to improving recruitment and retention into the future.

Many other external factors, such as the economic climate, have the strongest influence on recruitment and retention and are likely to mask the impact of these new flexible working arrangements in the short to medium term, and we have to bear that point in mind. Defence is experiencing many of the same skills and recruitment challenges that are being faced nationally. To meet those challenges are proactively as possible, we are modernising the employment offer for our Armed Forces, as I have described. These collectively are being managed under the Armed Forces people programme, which comprises projects including the new joiner offer and enterprise approach. The new joiner offer should support and improve retention by developing a new, more modern and more relevant offer for new joiners that better supports service personnel throughout their career. We also aim to improve retention by better management of critical skills across defence through the enterprise approach project. Changes to enable members of the Armed Forces to work more flexibly originate from the flexible engagement systems project, which forms a further part of the people programme.

These amendments seek to place various obligations on defence to publish reports on the effects of flexible working on the Armed Forces. I am sure the Committee is aware that intake, outflow and strength by rank, trade and specialisation are monitored and managed on a regular basis at service level and centrally by the MoD. The MoD already publishes detailed information and analysis in the UK Armed Forces Monthly Service Personnel Statistics. This publication provides statistics on the number of service personnel by strength, intake and outflow in the UK Armed Forces, and detail is provided for both the full-time Armed Forces and reserves. We carefully monitor information on trade, specialisation and sub-specialisation by rank and service, and routinely release on a regular basis, as part of official statistics publications, a wide range of information on outflow from the UK Armed Forces.

We also publish comprehensive data in the UK Armed Forces Biannual Diversity Statistics. This statistical release presents information relating to the gender, ethnicity, nationality, religion and age of personnel employed by the MoD and meets the department’s obligations under the public sector equality duty to provide information on its workforce in relation to the protected characteristics identified by the Equality Act 2010. Information on numbers of personnel undertaking and returning from maternity and shared parental leave is also provided as part of this publication.

It is important to highlight the evidence from trials and surveys commissioned by the Armed Forces, which indicates that take-up for options that enable service personnel to work more flexibly is likely to be low in the early years of implementation. Furthermore, while the MoD promotes the importance of the Armed Forces being appropriately representative of the diverse society they exist to defend, with operational effectiveness being dependent on inclusion and fairness, we estimate that the overall numbers taking up the new opportunities will be small to begin with. Therefore, assessing any correlative impact that flexible working has on increasing diversity in the Armed Forces is likely to be difficult, particularly in the early stages. This will mean that any detailed evaluation of the impact of flexible working measures on overall recruitment and retention rates, skills retention and outflow, and diversity in the Armed Forces will be difficult to achieve in the early years of operation.

The recording requirements for any pattern of work for our Armed Forces are stipulated in policies and recorded on the joint personnel administration system—JPA. JPA is already used to process applications for existing flexible working options. There is planning in place to enable all instances of part-time working or geographical restriction by personnel to be recorded on JPA when these options are made available. It will be crucial to ensure that all cases of flexible working are properly recorded and monitored to provide personnel and commanding officers with a record of all discussions and agreements. However, since it is estimated that the number of applications is likely to be low in the early stages, collating and reporting information on a monthly basis to provide figures on the number of personnel undertaking flexible working as a proportion of the total of full-time serving members of the Regular Forces would not provide significant or beneficial data.

It is important to emphasise again that the new arrangements are aimed at improving recruitment and retention in the long term, as part of a series of projects being delivered through the Armed Forces people programme. The long-term effects of these collective initiatives should be the measure of how effective the new arrangements are, rather than short-term reporting and figures on take-up.

We judge that formal annual reporting for a small cohort would not add value or provide a real sense of the impact of introducing these new opportunities. However, my department recognises the importance of keeping the delivery and effect of these changes under continuous review, in terms of both the benefits to personnel and the impact on operational capability. We will closely monitor the rates of uptake for new flexible working options by service, rank and specialism and will carefully examine any long-term trends and links to overall retention rates and diversity.

As noble Lords will be aware, the Secretary of State is required to lay an annual report before Parliament each year outlining the Government’s progress in delivering the Armed Forces covenant. The introduction of the new flexible working opportunities falls within the scope of the covenant and we envisage that the introduction of these measures in 2019 will be monitored during the first year of implementation and will be reported on in the covenant annual report and yearly thereafter.

The noble Baroness, Lady Jolly, asked about FAMCAS and AFCAS and drilled down with some further questions. I will write to her on the questions that she asked. I will need to consult the department to understand what further information it would be possible or practical to provide her with, but what information we do have I will be happy to give her. She also asked how flexible working could be introduced within a fixed headcount. The simple answer is that we will manage the levels of flexible working permitted and therefore will be able to ensure that the right levels are maintained to deliver defence outputs. It is envisaged that capacity surrendered to flexible working arrangements will either be within reducible capacity or can otherwise be resourced through other means such as the employment of reserves. Like other organisations with part-time workers, the organisation will change over time to better accommodate flexible working.

I do not believe that it is necessary for the Bill to be amended in this way. I understand that these are largely probing amendments and I hope that the explanations and information I have given to the Committee will be helpful to noble Lords and that they will not press their amendments.

[Baroness Jolly]

My Lords, I am happy to withdraw Amendment 7.

Royal Marines

Debate between Baroness Jolly and Earl Howe

Tuesday 4th April 2017 Lords Chamber

[Baroness Jolly]

To ask Her Majesty’s Government whether they plan to change the size and role of the Royal Marines.

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, the naval service, which includes the Royal Marines, is growing, with 400 more personnel, more ships, new aircraft and submarines. It is only right that the naval service decide the balance of roles within it to ensure that skills are matched to front-line priorities. That is a military judgment which is kept under continuous review and thus is a matter for the First Sea Lord and the other military chiefs to advise on.

[Baroness Jolly (LD)]

My Lords, the House understands that tough decisions are taken in times of austerity, but on the “Today” programme last week the Secretary of State said that if something is no longer needed, it is redundant. This could signal a deliberate move towards a capital-intensive engagement, away from elite personnel—the Royal Marines is a world-renowned flexible amphibious force—all at a time when hybrid warfare is increasingly likely. In this context, can the Minister say whether the Royal Marines are viewed as redundant?

Type 31 Frigate

Debate between Baroness Jolly and Earl Howe

Monday 3rd April 2017 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord. That was indeed a point that came out loud and clear from the recent defence debate we had in your Lordships’ House. However, the UK is leading the way in NATO. Our defence budget is considerably more than 2% at the moment, which is the NATO target. There are, however, other European members of NATO whose defence spending does not even reach 1%. Therefore, I agree that there is a lot of ground to make up with our allies. However, in our case I remind the House that we have a budget over the next 10 years of £178 billion to invest in equipment and support, which is no mean sum.

[Baroness Jolly (LD)]

My Lords, the plans to build the Type 31 frigate are welcome and indeed interesting. However, that does not hide the fact that once the Type 23s are out of service, the size of the fleet will be at a historic low. Would the Minister tell the House what is now determined to be a minimum fleet size and, indeed, configuration, and whether there is any contingency for delays in the Type 31 construction?

[Earl Howe]

My Lords, there are a number of assumptions in the noble Baroness’s question, which I will not be in a position to answer until we publish the national shipbuilding strategy. I do not accept her hypothesis that the size of the fleet in the 2030s will be smaller than it is today. Indeed, it is our ambition to make it larger.

Defence: Industrial Strategy

Debate between Baroness Jolly and Earl Howe

Monday 27th February 2017 Lords Chamber

[Earl Howe]

My Lords, I do not think we need to get too hung up on the word “strategy” as opposed to “policy”. The key questions, it seems to me, are how we can make UK industry more competitive, how we can drive innovation, how we can drive skills and, as I have said, how best to ensure that industry can engage productively with government and that government itself is a more intelligent customer. These are the questions we should address and I am sure they are the ones industry wants us to address.

[Baroness Jolly (LD)]

My Lords, what are the considerations when making decisions about the maintenance and growth of the supply chain, particularly on issues such as the availability of British skilled workers, the current defence industrial locations in the UK and the impact on local economies of buying overseas?

[Earl Howe]

In the industry consultation that we carried out, a number of areas were highlighted, all of which we are looking at in the refresh exercise. They included how we make our processes more straightforward for non-traditional suppliers, the improved use of early market engagement, and communicating our approach more clearly to industry at an early stage. Those things will all play into the issues that the noble Baroness recited.

Trident Missile Test

Debate between Baroness Jolly and Earl Howe

Monday 23rd January 2017 Lords Chamber

[Earl Howe]

My Lords, I am very grateful to my noble friend, who has immense experience of these matters. I say again that this was a successful operation. There are very few matters that cannot be discussed openly in Parliament or outside it, but this is one of them. Noble Lords will, I hope, appreciate that it is appropriate and right for government to maintain secrecy on detailed matters relating to our nuclear deterrent.

[Baroness Jolly (LD)]

My Lords, we on these Benches support the use of a deterrent, and the whole point of a deterrent is that people do not know, blow-by-blow, what happens when and how and where. However, it has been argued today that it could be a waste of taxpayer resources to have a nuclear deterrent, which depends on credibility for its deterrent effect, if there are doubts about its effectiveness. Does the Minister agree that the confusion surrounding this test will erode public trust in the credibility of the nuclear deterrent? Would the Government agree to make sure that Parliament and the public are kept updated on non-sensitive information?

[Earl Howe]

My Lords, I can only repeat that we have absolute confidence in the operation of our independent nuclear deterrent capability and that the effectiveness of the Trident nuclear system—should we ever need to employ it—is absolutely assured. I would add only that I often reflect on the importance of not believing everything one reads in the press. This is a classic example of the application of that principle.

Royal Navy: Frigates

Debate between Baroness Jolly and Earl Howe

Thursday 8th December 2016 Lords Chamber

[Baroness Jolly (LD)]

My Lords, Sir John Parker has called for disciplined governance processes in the design and specification of the new frigates. Will the Minister therefore tell the House why we should feel confident now, when there has been such a history of failure?

[Earl Howe]

My Lords, we will be replying to Sir John’s report in due course. However, he has identified a renaissance in shipbuilding that is emerging in a range of regional companies where he has found an entrepreneurial attitude and an enthusiasm to embrace change. We should be encouraged by that. We need to bottom out those assumptions but we certainly respect the conclusions that Sir John has drawn.

Multilateral Disarmament

Debate between Baroness Jolly and Earl Howe

Monday 28th November 2016 Lords Chamber

[Earl Howe]

My Lords, that is clearly a constant concern and the noble Lord is right to raise it. Against that background, the UK continues to push for the early start of negotiations, without preconditions, on a fissile material cut-off treaty in the Conference on Disarmament. We supported a Canadian-backed resolution at the United Nations first committee on that topic, in October. In this country we have a voluntary moratorium on the production of fissile material for nuclear weapons or other explosive devices. We have not produced fissile material for nuclear weapons since 1995.

[Baroness Jolly (LD)]

My Lords, in 1968 the UK signed the nuclear non-proliferation treaty and, as the noble Earl said, a lot of progress has been made since then. President Reagan met with President Gorbachev in Helsinki in 1986, and that resulted in the Intermediate-Range Nuclear Forces Treaty. What encouragement will the Government give to President-elect Trump to talk to his friend President Putin to kick-start multilateral talks on further reduction, in time for the 50th anniversary of the NPT in 2018?

[Earl Howe]

I hope the noble Baroness will be glad to know that at the appropriate time we will convey to President-elect Trump the importance of the nuclear non-proliferation treaty. We should not underestimate the role it has played for almost five decades in helping to limit proliferation and provide a framework for disarmament and the peaceful uses of nuclear energy. Nearly all United Nations member states are signed up to it—that is a tremendously important point in its favour. That treaty should form the basis on which we make progress in this area.

Royal Navy: Harpoon Anti-ship Missiles

Debate between Baroness Jolly and Earl Howe

Wednesday 23rd November 2016 Lords Chamber

[Earl Howe]

The noble Lord, Lord West, painted a picture of a dysfunctional Royal Navy. I repudiate that picture entirely. It is a Royal Navy that can be proud of the investment that is being placed in it. One of the proudest features are the carriers that the noble Lord, Lord West, was instrumental in commissioning.

[Baroness Jolly (LD)]

My Lords, all our Type 23 frigates and half our Type 45s carry the Harpoon missile. Will the Minister tell the House the effect of the inevitable loss of capability and can he reassure the House that we will not be putting these ships and their crews at extra risk during this period?

[Earl Howe]

It is important to understand the context in which a weapon such as Harpoon would be used. Harpoon would be likely to be used only in open ocean against frigates and above in a state-on-state conflict when our naval assets would most likely be operating within a coalition task group with a range of offensive systems at its disposal. There are ways other than Harpoon of delivering that offensive capability.

Strategic Defence and Security Review

Debate between Baroness Jolly and Earl Howe

Monday 21st November 2016 Lords Chamber

[Earl Howe]

My Lords, I am sure that my noble friend’s request will not have fallen on deaf ears as regards the usual channels. I am happy to speak to him afterwards about the possibility of a debate on these matters. We are not complacent about Russian capabilities, the political changes in the United States or Brexit. We remain, however, fully committed to NATO and our European partners, with whom we will deter threats across a wide spectrum in order to protect our people. We have a readiness action plan that we have developed with NATO. That gives NATO the tools needed to respond to short-notice, or indeed no-notice, incidents in order to protect alliance territory.

[Baroness Jolly (LD)]

My Lords, our defence is supported by a skilled Civil Service. Will the Minister confirm whether the SDSR commitment to reduce MoD staff by 30% by 2020 is still on track and what proportion the Government anticipate will be carrying out the same role but with a new employer?

[Earl Howe]

It is too early for me to answer the last part of the noble Baroness’s question, but I acknowledge that the last few percentage points in that 30% target are challenging—there is no doubt about that. At the same time, what we are impressing on our people is that to the extent that they are able to save money from a reduction in the Civil Service headcount, all that money is to be ploughed back into the defence budget under the efficiency agreement with the Treasury.

Defence Contracts: British Steel

Debate between Baroness Jolly and Earl Howe

Monday 21st November 2016 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is right: we have to acknowledge that the steel industry is currently dealing with very challenging global economic conditions. It is a global problem that I would maintain requires a global solution. We set up the Steel Council to work with all key stakeholders to explore actions that industry and government can take further to support the UK steel sector, but our aim is to leave no stone unturned. We have been addressing the asks of industry as I outlined in my earlier reply.

[Baroness Jolly (LD)]

My Lords, this is an issue of value for British taxpayers’ money and of our own industrial capability and capacity. What proportion of defence contracts is expected to be delivered by British suppliers and contractors? Are there any restrictions on using suppliers that are not British?

[Earl Howe]

My Lords, we have a policy to build our warships in British yards. Defence requirements for steel in that context are usually sourced by our prime contractors, taking into account—as the noble Baroness rightly said—value for money, quality and the time factor. We remain engaged with our prime contractors to ensure their support in implementing our policy guidance on steel procurement. That emphasises the importance of pre-market engagement activities to facilitate access to supply-chain opportunities for UK suppliers.

Defence Estate

Debate between Baroness Jolly and Earl Howe

Monday 7th November 2016 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I thank the Minister for repeating the Statement. The MoD’s aim is to reduce waste from overcapacity or inefficient use of facilities. That has to be welcomed, but as yet we have not seen the list of estates—if it has been released, I have not yet seen it. We welcome the general thrust of what the MoD wishes to achieve, but, as with all things, the devil is in the detail. The opportunity to improve accommodation for service personnel is long overdue, and their families will welcome that investment.

Times have changed. The noble Lord, Lord Touhig, referred to golf courses and pitch and putts, and I have to confess that over 40 years ago, the father of our best man was known as SHAGO—Security, Horse and Golf Officer—for one of the golf courses and Navy bases near Portsmouth. But several serious issues arise from the Statement.

There are the revenues from the sales, the impact on local communities and the opportunity to rationalise the functions of our Armed Forces geographically. Is this just a short-term attempt to plug the gap in defence accounts? We get capital from this money only once, so why is now the time to sell? Are there buyers for these sites? Will the income from the sales go into MoD or Treasury coffers?

In the Statement the Minister said:

“I can confirm MoD has firm plans to achieve its target to release sufficient land to build up to 55,000 houses in this Parliament”.

This makes no mention of whether the houses are affordable homes, for which there is a very clear need; whether it is housing that will benefit the local communities, meeting their needs; or whether the houses will be expected to have green standards—all of which is the least that a community should expect, given that it will feel it is losing quite a lot. Has any impact assessment been done of the effect on local communities of losing jobs? There is no point in building houses in these places if there are no jobs to attract people.

I ask the House to excuse me: I am not going to refer to the Army or RAF issues as I have not had time to do the research. I know rather more about the Navy, so I would be grateful if the Minister could clarify some issues surrounding the Devonport naval base and the area around it. Would he confirm that the Trafalgar class submarine will move from Devonport to Faslane? Will he comment on whether the rehousing of the Royal Marines from Royal Marines Stonehouse to Royal Marines Tamar is a possibility? The closure and sale of Stonehouse was announced in the previous Statement amid much local sorrow and anguish but it was not clear, and I do not think it is clear yet, where the Marines and their capability and functions will move.

[Earl Howe]

My Lords, I am grateful to both noble Lords for their questions and comments. The noble Lord, Lord Touhig, began with a statement with which I wholly agree. This programme has been built around the needs of the Armed Forces; that is the first requirement that we should always consider. I hope the fact that the Chief of the Defence Staff has put his name to the document alongside that of the Secretary of State demonstrates that the strategy is based closely on advice from front-line command. This is about enabling an infrastructure that better supports military capability and the needs of a modern fighting force. That is its starting point. It will see the defence estate consolidated into fewer centres of gravity and specialisation, with better support capability.

He asked about golf courses, which I can cover quite quickly. The department currently has 11 operational golf courses, five of which are contained in today’s announcement: Molesworth, Abercorn, Condor, Henlow and North Luffenham. While we do not resent our personnel enjoying the odd round of golf, there is perhaps a happy limit to the number of courses that it is proper for the ministry to maintain.

The noble Lord asked an important question about disposal receipts and whether they would be reinvested into defence. I can give him that assurance. It is not a statement that was included in the words that I repeated, but it applies as much to these disposals as those that we have previously announced.

The noble Lord asked how much would be raised. In the nature of this programme, that is not a question that I can answer because we are looking at a disposal programme over the next 25 years. These are sites that we are now signalling our intention to dispose of, but many of them will in fact not be sold for a number of years, for reasons that I will come on to. But I can say that the disposals will contribute significantly towards the MoD’s £1 billion target for land release sales, as set out in last year’s spending review. The money raised will be reinvested in the defence estate, where it is most needed. The strategy will also generate savings of more than £140 million in running costs over 10 years, rising to nearly £3 billion by 2040. Again, all that can be reinvested in defence.

The noble Lord asked how many service families would be required to move. We are closely reviewing how to offer service personnel more choice in their accommodation options in future, and by consolidating the defence estate around capability in regional clusters we are able to provide additional stability to service personnel. We recognise the vital contribution made by the families of our personnel and it is our intention to provide better employment opportunities, particularly spousal employment opportunities, for those who often make great personal sacrifices to support the careers of the men and women of our Armed Forces.

The noble Lord asked about regular reviews of this programme, perhaps every five years. I hope I can reassure him even more firmly than that: where plans are required to change we will inform our personnel and we will update Parliament every year on our progress. This is a matter of continual review, not just review every five years. The annual update that we give to Parliament will include updates to reprovision on a rolling five-year basis.

The noble Baroness, Lady Jolly, asked why now was the time to sell. As I have indicated, we do not anticipate selling these sites now or even next year, but some will be disposed of in this Parliament and some in the next Parliament and the Parliament after that. The key point here is that this is an imperative. We have to grip this. The estate is too large, the cost of maintaining it is spread too thinly and we need to configure the estate, as the Statement makes clear, in accordance with the needs of the Armed Forces and their capabilities.

The noble Baroness asked about affordable homes and green standards. Those are discussions that will need to be had with the relevant local authorities as time goes forward. The whole issue of the disruption to local communities, and indeed the enhancement to some local communities, along with the jobs that will be lost and created will be part of those discussions. Again, though, the important point is that we are giving ourselves enough time to have those discussions with local authorities, and I hope that they will welcome that.

On Devonport and the removal of submarines to Faslane, I can confirm that the plan is to base all our submarines in due course at Faslane. I will have to get back to her about the other question she asked about the rehousing of the Royal Marines, if she will allow.

Counter-Daesh: Quarterly Update

Debate between Baroness Jolly and Earl Howe

Tuesday 24th May 2016 Lords Chamber

[Earl Howe]

My Lords, I am very grateful to the noble Lord for his comments and questions. He asked a number of the latter, the first of which was about access by Daesh to oil. We have no evidence that Governments in the region are buying Daesh oil, with the exception of the Assad regime. Regional countries, including Turkey, have increased their efforts to counter smuggling. The majority of Daesh oil is sold internally, within Daesh-held territory. There is no doubt that our international efforts, including sanctions, have made it harder for Daesh to trade oil. Our military effort with coalition partners has successfully targeted Daesh oil facilities and infrastructure. We have destroyed or damaged over 1,200 oil infrastructure targets and reduced Daesh oil production by around 30%.

Broadly, the military operation has enabled us to drive Daesh out of territory from which it takes tax revenues. We are militarily degrading its ability to earn revenue from oil and we are using international sanctions to cut it off from external sources of revenue. The issue of countering Daesh finances is regularly raised at meetings with officials and Ministers around the region, including at the recent Coalition Counter-ISIL Finance Group, the Financial Action Task Force meeting in Paris in February, and the Chatham House counterterrorism funding conference on 8 February.

I mentioned Turkey a second ago. We regularly engage the Turks on the issue of Daesh’s finances. I say again: there is no evidence that Turkey is purchasing Daesh oil. In fact, Turkey has taken very active steps to tackle oil-smuggling across its border with Syria, including by greatly increasing the number of border guards. The Turks have reported that 79 million litres of smuggled oil were intercepted in 2014. In the period January to October 2015, that had dropped to 1.22 million litres. So it appears that they are making a very considerable difference.

The noble Lord asked about our support for fighters in the region. Subject to parliamentary approval, the MoD is planning to provide the Kurdistan Regional Government of Iraq with more than £1 million worth of ammunition to equip the Peshmerga. The UK is providing significant support to the Kurdish Peshmerga to assist them in the fight against Daesh. We have already provided them with more than 50 tonnes of non-lethal support, 40 heavy machine guns, nearly half a million rounds of ammunition, and £600,000 worth of military equipment. To date, we have trained more than 3,300 Kurdish Peshmerga.

As regards the negotiations to bring about a peace in Syria, UN Special Envoy de Mistura has conducted three rounds of talks with the parties in Geneva, and this pattern is set to continue. We never expected the UN-brokered negotiations to deliver instant results. We are clear, however, that a negotiated political settlement is the only way to end the conflict, and we are working with our international partners to help to create conditions on the ground that are conducive to negotiations continuing. In its statement of 17 May, the ISSG reaffirmed its determination,

“to strengthen the Cessation of Hostilities”,

and,

“to ensure full and sustained humanitarian access”,

so that the parties can return to negotiations to reach agreement on political transition. We hope the parties will resume negotiations soon.

[Baroness Jolly (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. I join him and the noble Lord, Lord Touhig, in commending the work of our service men and women. This was echoed in yesterday’s debate.

There must be absolute clarity about what Syria and Iraq would look like post-Daesh and about what post-conflict strategy, including an exit strategy, will give the best chance of avoiding a power vacuum. It might seem optimistic to think of Syria post-crisis, but what stage has been reached in determining what needs to be done? Is there any sort of embryonic Marshall plan? As the Minister said, clearly Kurds are at risk in Syria and Iraq. He has outlined some of the steps that the Government have taken in training, but will he indicate what support has been given by Turkey?

Finally, the battle against Daesh in Syria and Iraq is ongoing, but will the Minister give us some indication of the work that is being done against Daesh here in the UK? At the beginning of the Statement, he highlighted the events in Brussels. Brussels is down the road. I would be really quite interested to hear what progress we are making in beating Daesh in the UK.

[Earl Howe]

My Lords, I thank the noble Baroness for her very relevant questions. She asked about the post-settlement strategy in Syria. It is perhaps too early for me to give her substantive information on that. Clearly, the priority is to achieve that settlement. We are actively supporting the negotiations through our participation in the ISSG, including in the ISSG task forces on the cessation of hostilities and humanitarian access, and our engagement with the opposition. The Foreign Secretary has attended all four meetings of the ISSG and a ministerial meeting of the United Nations Security Council on 18 December, at which UN Security Council Resolution 2254 was passed. We are also offering technical advice, including on strategy and diplomatic handling, and logistical support to the opposition negotiating team, alongside our international partners. However, I can tell her, as I am sure she knows, that as and when a settlement is achieved, the UK has promised a further £1 billion to assist in the reconstruction of Syria.

As regards Turkey, there is no doubt that Turkey is making a critical contribution to the international campaign against Daesh. It is a key member of the global coalition and co-chair of the foreign terrorist fighters working group, and it is making a really strong contribution to stopping extremists from reaching Iraq and Syria. The Turks have detained more than 2,500 Daesh suspects. We should remember too that Turkey has itself been a victims of Daesh attacks in Ankara, Istanbul and elsewhere. It is also housing 2.7 million refugees. We should pay tribute to the efforts that the Turks have made in this very difficult area.

The noble Baroness asked about the effort at home. We are continuing the Prevent strategy, which has undoubtedly made a difference. Thousands of people in the UK have been safeguarded from targeting by extremists and terrorist recruiters, which incidentally includes those at risk from far-right and neo-Nazi extremism as well as those vulnerable to Islamist extremism. In the last year, we have considerably increased our programme of Prevent activity through our network of Prevent professionals, working with more than 2,790 different institutions and engaging nearly 50,000 individuals during last year. Although to some the Prevent name has acquired a slightly pejorative ring to it, nevertheless it is the right thing to be doing to protect those most vulnerable.

Yemen

Debate between Baroness Jolly and Earl Howe

Wednesday 11th May 2016 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. Yemen’s is now one of the most serious humanitarian crises in the world. Of the world’s population in need of humanitarian aid, one-fifth lives in Yemen, totalling 21 million people. Aid is being co-ordinated through the United Nations, as my noble friend is aware, and is being delivered through UN agencies and NGOs. The UK is the fourth-largest donor, I am pleased to say, and we have more than doubled our commitment to Yemen over the past financial year to £85 million. But there is much more to be done, including ensuring the flow of commercial goods into Yemen and access for humanitarian agencies.

[Baroness Jolly (LD)]

My Lords, I welcome the talks taking place in Kuwait, but what involvement are we having in these talks and what involvement might we have in keeping any peace?

[Earl Howe]

My Lords, it is too soon to say what involvement we might have, should a peace agreement be reached. The talks are facilitated, as I mentioned, by the United Nations, and we are working closely with it to encourage the parties to engage in good faith without preconditions and to respect the ceasefire which began on 10 April.

Army: Helicopter Pilots

Debate between Baroness Jolly and Earl Howe

Wednesday 23rd March 2016 Lords Chamber

[Earl Howe]

My Lords, I take the noble Lord’s point about common sense. At the same time, he will realise that this is public money; it cannot simply be written off in bulk. Having said that, each debt will be dealt with individually and recovered over a long period. Recovery from serving personnel commenced in January, less those that have submitted an objection to recovery, and we have not seen anyone cite this issue as the reason for leaving the Army Air Corps since that recovery process started.

[Baroness Jolly (LD)]

My Lords, we are where we are as a result of human error. In just over a week, the new employment model commences for the Armed Forces. Why should we be confident that the transfer will be error free?

[Earl Howe]

My Lords, the pay system that is now in place is mature, and people have got used to using it. There is far less scope for error, although I cannot obviously give a guarantee that no errors will ever occur. More generally, running in parallel to this is a five-year tri-service review of flying retention pay, which is currently being staffed and should put in place a sustainable and more retention-positive remunerative package for the air crew of all three armed services.

Syria

Debate between Baroness Jolly and Earl Howe

Tuesday 15th March 2016 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness. As the Statement makes clear, we have issued a cautious welcome to the Russian announcement. But it remains to be seen, over the coming days, how that announcement will convert into practical action— and, if so, what action. The noble Baroness is quite right that we have seen the predominance of Russian air strikes directed against targets other than Daesh. To that extent, we welcome Russia’s announcement of the withdrawal of its air forces. It is, however, fair to say that, since the ceasefire was announced some days ago, we have seen an adherence to it, as regards the moderate Syrian opposition, by Russian forces. We shall, of course, monitor the ceasefire very closely and there are various systems in place to do this. To the extent that we are aware of violations, we shall make sure to raise those in the appropriate quarters, not least in Geneva as the talks proceed.

As regards the RAF, we do not see the Russian announcement as affecting the objectives that the RAF has been given or the extent of its operations over both Iraq and Syria. What the Russian action may do, however, is make that situation slightly less complicated than it has been hitherto in terms of the crowded airspace that we have seen.

War crimes have been very much in our sights since the start of the Syrian hostilities. While they are not the prime focus of the negotiations in Geneva—there are other hurdles to get over before we reach that point—the noble Baroness can be sure that the issue will not be off our list of actions.

[Baroness Jolly (LD)]

My Lords, I thank the Minister for repeating the Answer and welcome the promising news of aid convoys. Russia has confirmed that it will still be operating from its naval and air bases in Syria, so might air operations still be anticipated against opposition forces?

[Earl Howe]

This is the very question that we are wrestling with. It is too early, frankly, to say what the Russians will be leaving behind in the way of assets. As the noble Baroness rightly points out, the Russians still have their naval base at Tartus and the Hmeimim air base, with a significant air defence network in place, and, no doubt, protective forces for all those installations. Whether the Russians will be in a position to resume air activities and strikes at will is something that we shall need to assess as the picture becomes clearer.

Refugees and Migrants: Royal Navy and NATO Interception in Mediterranean

Debate between Baroness Jolly and Earl Howe

Monday 7th March 2016 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord, Lord Touhig, for his questions. The principal role of “Mounts Bay” will be to gather information and provide it, for example, to the Turkish coastguards to help them intercept migrant boats in their territorial waters and return those boats to Turkey. That can happen straightaway. In cases where RFA “Mounts Bay” needs to come to the rescue of a migrant boat in distress, we are working with the relevant authorities in order to get to a position where we can carry out returns.

The noble Lord is absolutely right to talk about the origins of this crisis. We believe we need to take a tougher approach in order to stem the flow of migrants into the EU. While the NATO deployment is currently a support and surveillance mission—it is important to emphasise that: it is not a search and rescue mission—we are considering the practicalities and legalities of returning any rescued migrants to Turkey. These are complex considerations, particularly given the various territorial waters. Discussions are ongoing today at the EU-Turkey summit, and Parliament will be updated in due course.

We are not alone in the efforts that we are contributing. The NATO operation is under German command. The German command ship FGS “Bonn” is already in the area. It will be supported not only by “Mounts Bay” but by a Canadian escort, the HMCS “Fredericton”; a Turkish escort, the TCG “Barbaros”; and a Greek escort ship, the HS “Salamis”. The key thing will be to spot the migrant boats as soon as possible after they leave the Turkish shore, and preferably before they do so. That, of course, is the role of the Wildcat helicopter and the other helicopters in the area. I shall need to write to the noble Lord on some of his detailed questions about the exact location of the other British ships that I mentioned.

[Baroness Jolly (LD)]

My Lords, we welcome the inclusion of RFA “Mounts Bay” in the NATO maritime task force, and that of the Wildcat helicopter. Will the Minister tell the House, for the operation as a whole, what arrangements have been made for NATO ships to dock in Turkish ports should the need arise, and for the safe onward passage of migrants after the processing of their claims for asylum?

[Earl Howe]

My Lords, if it became necessary for our ships to dock in a Turkish port for any overriding reason, I have no doubt that the Turkish authorities would allow us to do that—but not to disembark anyone that we may have picked up en route; it would be purely for the servicing of those ships. But I do not anticipate that that will be necessary. As regards asylum claims, it is important to understand that migrants cannot make claims for asylum in the UK on UK-flagged vessels outside UK territorial waters—lest that should be a concern of the noble Baroness. If we do pick up any migrants—again, I stress that that is not our primary role—we would take them to Greece in the first instance.

Armed Forces Bill

Debate between Baroness Jolly and Earl Howe

Tuesday 1st March 2016 Grand Committee

[Baroness Jolly]

My Lords, I am happy to support the amendment. Future Reserves 2020 relies upon a significant build-up of our Reserve Forces, and at a pace. Employers and reservists have both rights and responsibilities. I am sure that noble Lords would agree that a wise would-be reservist would talk their plans through with their employer, but they need not. The first the employer could hear about them is the receipt of a letter from the MoD. Similarly this can happen at the change of a job. When you apply for a job you are not under any obligation to tell your would-be employer that you are a reservist, which probably chimes with the point just made by the noble Lord, Lord Empey. It is therefore really important that there should be no discrimination. Noble Lords might wonder whether an employer would feel anxious and somewhat disappointed about the lack of confidence that the employee has in him that he has not been told, but clearly there are many reasons here. Also, what employees do in their own time is very much their own business.

There are ways around this on a temporary basis. A reservist employee can ask for a waiver from the MoD lasting a year not to tell the employer, but that aside, there is evidence of discrimination by employers. There is no protection against such discrimination in employment in the normal course of events. This probing amendment seeks to draw out from the Minister the various issues around how this might be handled and ask whether we are aware of the scale of the problem. But as with Amendment 5, recording and publishing the information gives the Government and indeed the public the opportunity to measure progress year on year and creates a fairer environment for reservists in which they are to work.

[Earl Howe]

My Lords, I am most grateful to the noble Lord for raising this issue and I understand entirely why he felt it appropriate to do so. Nevertheless, I am not convinced at the moment that it is necessary or appropriate to set out a requirement in the Armed Forces Bill for commanding officers to collect and for the Ministry of Defence to publish the kinds of data that he has referred to.

We fully recognise and value the contribution of reservists and the need to ensure that their interests are properly protected. Part of that is making sure that their reserve service does not negatively affect their employment prospects. I completely accept that principle. But that is precisely why there is protection in place to ensure that reservists are not dismissed as a result of any duties or liabilities that they have to undertake; for example, as a result of being mobilised. This protection is provided by the Reserve Forces (Safeguard of Employment) Act 1985, Section 1 of which gives a reservist who is called out for reserve service the right to apply to his or her former employer to be reinstated after they return from mobilised service. In addition, Section 17 of the 1985 Act makes it a criminal offence for an employer to dismiss an employee solely or mainly by reason of any duties or liabilities that may arise as a result of being called out.

Further, Section 48 of the Defence Reform Act 2014 amended the Employment Rights Act 1996 to remove the current two-year qualifying period for claims of unfair dismissal where the reason for dismissal is or is primarily because the individual is a reservist. However, we are not aware of any cases having been brought as a result of this change. In addition, as proposed in the Reserves in the Future Force 2020: Valuable and Valued White Paper, we have established a website that allows reservists to alert the Ministry of Defence if they believe that they have been disadvantaged in employment as a result of their reserve service. These cases are of course investigated if the complainant agrees. There have been only 13 contacts from reservists since we established the website in July 2013. Those are the facts as they currently stand.

The amendment proposed by the noble Lord seeks to place a legal duty on commanding officers to collect statistics on how many reservists have reported employment discrimination on account of their reserve service and for the Ministry of Defence to collect and publish statistics on the number of complaints regarding discrimination. There are more than 300 reserve units in the UK. Given the very low incidence of reported complaints, I submit that a requirement of that kind would be disproportionate and burdensome.

However, there is another difficulty with the proposed amendment—it may be unnecessary for me to point this out, but I hope that noble Lords will forgive me for doing so. It refers to “discrimination” in the context of employment, but it is important to be clear that, despite the protections that I have referred to for reservists in the civilian workplace, being a reservist is not a “protected” characteristic under the Equality Act 2010, unlike characteristics such as age, disability, race, religion or belief, sex or sexual orientation. I would like to make a further point. It does not follow that an allegation of discrimination means that an individual has been discriminated against. One need only think of a simple example, such as someone who says that they have not been promoted because of their reservist status and that that needs investigation. Clearly when an allegation like that is made, it is quite a complex situation. While on the face of it the amendment appears simple, I suggest that there are significant difficulties below the surface.

Our approach, which I hope that noble Lords will agree with, is to develop open relationships with employers and to encourage and support reservists in their individual relationships with their employers. We encourage reservists to raise employer issues with their chain of command and to resolve issues through the improved relationship management process that we have put in place. I would like to think that those processes have borne fruit, in the light of the very small number of contacts with the website that I referred to earlier. Good relationships with employers are absolutely central to the Government’s programme for the Reserve Forces, but I believe that our resources in this area are better spent in strengthening these relationships than in creating and fuelling a reporting process.

The improved relationship with employers is increasingly evident from the number signing the Armed Forces covenant and the very strong examples of those employers up and down the country who have been recognised for their support to our Armed Forces. The issue raised by my noble friend Lord Attlee is slightly different, as I am sure he recognises, and I undertake to write to him about it.

I hope that the Committee will understand why I cannot support the proposal that the Bill should be amended. For that reason I hope that the noble Lord will agree to withdraw the amendment.

Armed Forces: Future Force 2020

Debate between Baroness Jolly and Earl Howe

Thursday 25th February 2016 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. Of course, at the moment we have a much more flexible set of arrangements to integrate regulars and reserves than we did in the past. We can call up reservists at very short notice. Cyber is, once again, a good example. It is a discipline that often allows lateral entry at a more senior rank than would be the norm for general applicants on first joining. Indeed, the Royal Marines have a cyber specialisation to provide the maritime element of the joint cyber unit. That specialisation is formed from qualified practitioners recruited from industry and academia.

[Baroness Jolly (LD)]

My Lords, we all recognise that cyber poses a great threat to our security. Will the noble Lord tell the House how many cyber experts and trainees have been recruited to the Reserve and Regular Forces, and whether their recruitment is on target?

[Earl Howe]

I am afraid that I cannot give the noble Baroness the precise figures. Broadly, recruitment to the reserves is on target, but I will have to get back to her on the specific numbers associated with cyber.

Vanguard Submarine Replacement

Debate between Baroness Jolly and Earl Howe

Wednesday 10th February 2016 Lords Chamber

[Earl Howe]

My Lords, to state the obvious, a nuclear deterrent requires nuclear warheads. The Government were elected on a manifesto commitment to retain a nuclear deterrent, so having anything less than a nuclear warhead in our submarines would not offer a credible deterrent.

[Baroness Jolly (LD)]

My Lords, without doubt, there is a shortage of engineers to cope with the nuclear programme. Whenever it starts is relatively academic. What action is the MoD taking to recruit, incentivise and train young men and women to be the nuclear engineers of the future?

[Earl Howe]

My Lords, extensive work is going on across government to incentivise people to enter the engineering profession. The noble Baroness is quite right. We are working not only within government but with industry to ensure that the attractiveness of engineering, in the nuclear field in particular, can be shared and that people who enter the profession can look forward to a rewarding career throughout their lives.

Syria: Brimstone Missiles

Debate between Baroness Jolly and Earl Howe

Wednesday 3rd February 2016 Lords Chamber

[Earl Howe]

The noble Lord is right that airpower alone will not defeat Daesh. Indeed, military action alone will not defeat Daesh. We have to counter its ideology as well and cut off its sources of finance. We have set our face against putting British troops on the ground in Iraq or Syria. Prime Minister Abadi of Iraq has made it very clear that he wishes the action on the ground to be pursued by Iraqi armed forces, not western troops, and we respect that.

[Baroness Jolly (LD)]

My Lords, the Minister spoke earlier of careful planning. Can he tell the House how many time strikes have been called off as a result of that planning to prevent civilian losses or casualties?

[Earl Howe]

My Lords, the noble Baroness makes an extremely important point. There have been many occasions—I cannot give her a precise number—when a strike mission has been called off because it has been deemed too risky to the civilian population. We always err on the side of caution in that respect.

Mental Health Services: Serving Military Personnel

Debate between Baroness Jolly and Earl Howe

Thursday 14th January 2016 Lords Chamber

[Earl Howe]

My noble friend hits on an extremely important point, which is why, in 2003, the Ministry of Defence commissioned the King’s Centre for Military Health Research, which is part of King’s College London, to conduct a long-term research study following a cohort of more than 20,000 members of the Armed Forces. That study continues with the same cohort. In so doing, comparative information is emerging about the performance of other armed services around the world. We can take credit for the fact that the incidence of mental illness in our own armed services compares very favourably indeed with that of some other armed services around the world.

[Baroness Jolly (LD)]

My Lords, men and women seeking this sort of support require anonymity and are anxious about that, as, indeed, they are about quality. Therefore, will the Minister explain to the House whether anonymity is protected, how this service is regulated and when it was last quality tested?

[Earl Howe]

The noble Baroness is quite right that anonymity is important to many people and, of course, record-keeping is scrupulously observed in that sense. At the same time, some people feel that it is important to identify mental illness when it occurs. That is why peer support among a unit, for example, features very large, particularly when armed services personnel are on deployment. Anonymity in that sort of instance is difficult to achieve by the very nature of the support that we wish to see personnel give to their peers.

War Pensions: Uprating

Debate between Baroness Jolly and Earl Howe

Monday 11th January 2016 Lords Chamber

[Earl Howe]

My Lords, it is important to make it clear that despite its name, a war disablement pension is not a state pension but a form of compensation for disablement and/or injuries caused by service to the country. It is tax free and payable in addition to the state retirement pension. Payments are set at a higher rate than similar disability benefits and most war pensioners who have reached retirement age will be in receipt of both pensions.

[Baroness Jolly (LD)]

My Lords, the war pensions scheme includes allowances related to employment, so the annual uprating should be related to earnings inflation and not price inflation. Will the Minister tell the House what it would cost the Treasury to link the war pensions scheme to earnings and not to inflation?

[Earl Howe]

My Lords, I know that the Royal British Legion has come up with its own calculation. To answer the noble Baroness’s question, I am not aware that the Treasury has done so. However, the principles should be clear here. Under the Armed Forces compensation scheme and the war pensions scheme which preceded it, an injured service man or woman is assessed on their level of disability, and based on that assessment they are compensated for their deemed loss of earnings in civilian employment. After that, the guiding principle is that the real-terms purchasing power of the annual payment should be maintained, and it is therefore indexed to the consumer prices index, which, as I said, is the index applied by the DWP to all disability benefits.

Syria and Iraq: ISIS

Debate between Baroness Jolly and Earl Howe

Tuesday 8th December 2015 Lords Chamber

[Earl Howe]

My Lords, as my noble friend will be aware, we are veering slightly off Iraq and Syria, but I can tell him that the presence of Daesh in Libya is causing us considerable concern and is the focus of attention across the coalition. Beyond that, I cannot say more at this stage.

[Baroness Jolly (LD)]

My Lords, it would help if we could restrict the flow of ammunition to Daesh. We know that it is using ammunition produced by our allies and coalition partners. What steps are the Government taking to ensure that the supply chain is being broken?

[Earl Howe]

A number of measures are being taken to ensure that smuggling of equipment and ammunition is blocked. The Syrian moderate opposition forces have been quite successful in blocking those routes, particularly between Turkey and Syria. More widely, there is an international effort to close down the sources of finance that Daesh has as its disposal. A lot of that work, I am proud to say, is being led by the United Kingdom.

National Security Strategy and Strategic Defence and Security Review 2015

Debate between Baroness Jolly and Earl Howe

Monday 23rd November 2015 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I thank the Minister very much for the briefing that I received, along with colleagues from the Labour Party, earlier today. I am sure that the final form of this document was a result of the events in Paris and, as with all reports, the devil is in the detail. The debate next week in the name of the noble Earl, Lord Attlee, will give us all more time to analyse that very detail.

This strategy points to a more forensic and measured analysis than its predecessor, which is welcome, and it is appropriate to the times we find ourselves in. I will concentrate my remarks on the interconnection between defence and the world, our alliances, personnel and cyber. It is a complete coincidence that the noble Lord, Lord Touhig, has covered much of the same detail. On Syria, my leader has made it clear that he is not a pacifist or a unilateralist, and he is concerned for security of the nation. He will be outlining the conditions under which we would support military action in the next few days.

It is pleasing that the Government see our defence and security as requiring such a strong commitment to our allies and to international efforts. There are few issues that we face that can be addressed without co-operation, from climate change to transnational terrorism to state aggression. It is the strength gained from working with our allies and like-minded states, in particular within the United Nations, NATO and, of course, the EU, that will allow us to overcome and address these issues.

Our soft power capabilities—the British Council, international aid, the BBC World Service and our diplomatic representation—are valuable assets for spreading British values. A recognition of their contribution to our security and defence is an important addition to the SDSR. Will the Minister confirm that there will be no cuts to the budgets of either the World Service or the British Council? I am sure the extension of deep country expertise to a wider span of areas that are vital to our security and prosperity will be welcomed at the FCO, but will the Minister point to how this dovetails with the possible cuts in the FCO’s budget, which officials have said may,

“imperil the UK’s diplomatic capacity”,

if they go ahead?

Moving on to personnel, today I will focus on the Royal Navy and get into the detail of the other services in next week’s debate. Last week I was delighted to visit, with parliamentary colleagues, the two carriers, “Queen Elizabeth” and “Prince of Wales”, in Rosyth. They are an awesome sight and a tribute to British engineering and co-operation between manufacturers. While I welcome their addition to the fleet over the next couple of years, they bring with them a challenge. Will the Minister confirm that there are plans to ensure that there will be sufficient personnel with the right specialities to run the carriers with the Astute-class submarines, destroyers, frigates and support ship configuration? In particular, what action is being taken to ensure that there will be engineers at all levels of seniority and speciality?

As a member of the AFPS, I have visited service personnel in their workplaces, met families in their homes and spoken to senior officers and other ranks. I have to tell your Lordships that morale is not universally high. There is concern about salaries and allowances. Will the Minister confirm the rumours that the annual increment system will change, as will overseas allowances, as a result of MoD cuts? I welcome the move to support a service woman or man to buy their own home. A supported family is critical to the well-being of a serving member of Her Majesty’s Armed Forces. Will the Minister confirm that the covenant will continue and, more importantly, that its implementation is being monitored by the MoD?

On cyber, it is important that cyber intelligence is shared, as many of our systems are shared with our allies and our partners. I am concerned about defensive cyber. Cyber threatens systems and, by its nature, much of today’s warfare consists of systems of systems, with millions of lines of code, all interconnected and interrelated. It is great that we are working with our partners and allies on this, but adding to the connectivity is a multiplier of risk. So I welcome the joint cyber group, but there is an urgent need for recruitment and training. Will the Minister tell us how quickly we can gear up for this joint cyber group as the need is immediate?

I should not finish without a nod in the direction of how the SDSR is to be paid for. I am aware that the Chancellor will unveil the CSR on Wednesday. The Liberal Democrat Benches welcome the commitment to 2% of GDP, but that is another issue where the devil is in the detail. Will the Minister tell the House what sort of efficiencies the MoD is expected to make—apart from selling land and property—that will have no impact on the smooth running of the department? If we are to believe today’s Financial Times, it will be paid for from the welfare budget and from cuts to police and in grants to businesses.

[Earl Howe]

My Lords, I thank the noble Lord and the noble Baroness for their comments and questions. I particularly welcome many of the comments made by the noble Lord, Lord Touhig. It was regrettable that he felt it necessary to conclude his speech as he did, on a note of dissent. Nevertheless, taking his comments in the round, there is much to unite us, rather than the opposite. The noble Lord asked me a number of questions, as did the noble Baroness, and I will get through as many of the answers as I can.

First, on the Royal Navy, I would put it to the House—once noble Lords have had an opportunity to read the document, which is in the Printed Paper Office—that the Navy has benefited very considerably from the review. Full crewing of aircraft carriers, new offshore patrol vessels, new fleet solid support ships, 400 extra personnel, and a faster buy of F35 Lightning, to allow the carriers to embark up to 24 operational aircraft, are just examples of that. As for manning, the reorganisation of manpower within the Navy will ensure that sufficient people are trained and available to man and operate both Queen Elizabeth carriers. The requirement for each carrier is, I understand, a crew of 733 sailors. The planned retirement of HMS “Ocean” in 2018, combined with a rationalisation and reprioritisation of personnel across the naval service, plus the uplift of 400 extra personnel, which I mentioned, will ensure that sufficient people are trained and available to man and operate both carriers.

We will maintain our fleet of 19 frigates and destroyers. There has been no moving away from that commitment. We will also design and build a new class of lighter flexible general purpose frigates, as was mentioned in the Statement. I am sure that many noble Lords will welcome the fact that we are now committed to reintroducing maritime patrol aircraft. We will purchase nine Boeing P-8 maritime patrol aircraft—that includes the aircraft we need in the envelope—advanced high-altitude surveillance aircraft, and 138 F35s over the lifetime of the programme. The MPAs will be based at Lossiemouth; that is considered to be the ideal location for the most common maritime patrol areas. Further details will emerge in due course. It is likely that there will be 400 additional personnel for Lossiemouth, to ensure that the MPA capability can be properly serviced.

On the F35, we will bring forward the purchase of nine front-line aircraft, which will allow the second F35 Lightning squadron to stand up in 2023. That is about a 60% increase in front-line aircraft numbers by 2023, compared with our previous plan. We are buying our current tranche of 48 F35 aircraft earlier than originally planned, to maximise our carrier strike capability in the early 2020s. As I have said, we are committed to a total through-life buy of 138 F35 aircraft. Decisions on the precise details of subsequent tranches will be taken at the appropriate time.

I am conscious of the clock, so I will get through as many questions as I can. When will the strike brigades be ready? The fielding of the strike brigades will start from 2018, delivering an initial operating capability by 2021, and moving towards a full operating capability from 2025.

The £1.9 billion that we have set aside for cyber is a national-level investment towards implementing the new national cybersecurity plan. I am advised that I have more time than I thought, which is good. The national cybersecurity plan will include a new national cybercentre, a stronger active defence programme, more funding for training of the UK’s next generation of experts in digital skills, a stronger regulatory framework, a stronger cyber sector, and funding for the national offensive cyber programme.

In September 2013, during the coalition Government, the Defence Secretary announced that, as the noble Baroness mentioned, Britain would build both defensive and offensive capabilities, including a strike capability to operate in cyberspace as part of our full spectrum military capability. The national offensive cyber programme is a partnership between the Ministry of Defence and GCHQ, harnessing the skills and talents of both organisations. As for the deterrence of cyberattacks, it is our aim to make ourselves a difficult target, so that doing us damage in cyberspace is neither cheap nor easy. We hope to build global norms in that regard, so that those who do not follow them suffer the consequences.

On the 2% commitment, I hope noble Lords will accept my assurance that we follow the NATO guidelines as to what constitutes defence expenditure. Like other NATO member states, we make periodic updates to how we categorise defence spending—for example, to reflect changes in the machinery of government—but all updates remain, and will continue to be, fully in accordance with NATO guidelines.

I shall briefly cover the question that the noble Baroness asked me about pay and allowances. It is not our intention to remove incremental pay or annual pay increases for those serving. We have reviewed military allowances: the vast majority will not change, but we are making minor changes to a few of them, and removing commitment bonuses. Commitment bonuses were designed as a retention tool, but we have no evidence that they influenced people’s decisions on whether to stay or leave. The Chief of the Defence Staff recommended that we remove them, so we will phase them out.

The remaining questions I will write on—but on the subject of the British Council, the SDSR refers to it by saying that we will continue to invest in it. It does not give a figure, and I think we will have to wait for the spending review announcement to know what that will be.

Royal Navy

Debate between Baroness Jolly and Earl Howe

Thursday 5th November 2015 Lords Chamber

[Earl Howe]

My Lords, as the noble Lord is only too well aware with his enormous experience, the normal operational cycle of every ship involves them entering different readiness levels depending on their programmes and departmental planning requirements. He is right that the Type 45 has experienced some equipment reliability issues, including with the power and propulsion systems, but I am glad to tell him that most of them have now been remedied and work is continuing to resolve the remaining issues. Notwithstanding the issues that I have referred to, the Type 45 class remains operational and has certainly demonstrated its capability in the time that it has been in service.

[Baroness Jolly (LD)]

How many personnel are required on board these ships to fulfil those committed tasks? What gives the Minister confidence that there are enough skilled men and women to ensure that all ships and boats have their full complement?

Syria: Military Involvement by Canada

Debate between Baroness Jolly and Earl Howe

Wednesday 28th October 2015 Lords Chamber

[Earl Howe]

My Lords, I agree that the facts in Syria have changed by reason of the Russian intervention. That is undeniable. What has not changed is that ISIL represents a direct threat to this country as much as ever it did, if not more, and it is very much in our national interests to see that threat eliminated. However, I take the noble Baroness’s point that ultimately the end of this conflict can be reached only by political means, and we are engaging as strenuously as we can through diplomatic and political circles to see that satisfactory conclusion.

[Baroness Jolly (LD)]

My Lords, I note the Minister’s response to my noble friend’s Question. We support our troops in the advice and training role in Iraq. However, I am concerned to learn that American trainers have been involved in combat and there have been casualties. Will the Minister clarify the position with our trainers? How many are there? Has their role changed to replicate the US model, and have there been any casualties?

[Earl Howe]

My Lords, I am not aware of any casualties among those of our personnel who are engaged in the training of moderate Syrian forces. Both we and the United States agree that we need to continue to support the moderate opposition in Syria. We acknowledge that the training programme has faced some challenges. The noble Baroness may be aware that only the training element of the programme is currently paused. We will continue to enable the efforts of the moderate opposition in its fight against ISIL and focus on equipping. That will allow us to reinforce the progress already made in countering ISIL.

Syria and Iraq: Airspace

Debate between Baroness Jolly and Earl Howe

Thursday 22nd October 2015 Lords Chamber

[Earl Howe]

My Lords, the United States is not making the MoU public, so I cannot go into a huge amount of detail on its content, other than what the US has publicly released, which is that the MoU is aimed at minimising the risk of in-flight incidents between coalition and Russian aircraft and includes specific safety protocols for aircrews to follow. The US and Russia will be forming a working group to discuss any implementation issues, which will no doubt include those raised by my noble friend.

[Baroness Jolly (LD)]

My Lords, what evidence do the Government have to allow them to be confident about the safety of our missions into Syria and Iraq, given the proliferation of armed and surveillance drones over these territories? Will the Minister also tell the House what discussions the coalition has had about this particular issue?

[Earl Howe]

I have already referred to the memorandum of understanding, which, as I have said, is a major step forward in terms of avoiding unwanted incidents over Syrian airspace. The protocols to which I referred include maintaining professional airmanship at all times, the use of specific communication frequencies, and the establishment of a communication line on the ground. But it is worth noting that, by and large, the reconnaissance effort that the coalition is putting in is directed to the east of Syria, whereas the Russian action is largely in the west of that country.

Armed Forces Act (Continuation) Order 2015

Debate between Baroness Jolly and Earl Howe

Monday 7th September 2015 Grand Committee

[Baroness Jolly (LD)]

I thank the Minister for his explanation of the order and note that his speech is somewhat familiar, as I delivered it myself last year. These things do not change an awful lot so I shall not take long.

The order reflects the constitutional requirement under the Bill of Rights that the Armed Forces may not be maintained except with the consent of Parliament. The noble Lord, Lord Rosser, has repeated some of the points and questions that I probably failed to answer last year around this whole issue of what happens should we not agree. But I would like to highlight an area that had its own legislation passed earlier this year—the Armed Forces (Service Complaints and Financial Assistance) Act 2015—in particular, complaints, which are covered in this order.

The 2014 continuation order covered the old complaints system. The 2015 legislation to set up the new Service Complaints Ombudsman amended the Armed Forces Act 2006. Will the Minister confirm that this continuation order incorporates the service complaints paragraphs of that Act? The ombudsman set up in the Act will have stronger powers than the current commissioner to investigate any maladministration in the handling of a service complaint. Will the Minister also confirm that as the Act goes live in 2016, the system set up is on track to meet the change in legislation?

I note, too, my responses last year with regard to the letter from noble Lord, Lord Tunnicliffe, to the department, and Mr Morrison’s response on the 2014 order. Can the Minister confirm whether he believes that the Explanatory Memorandum of this year reflects the contents of Mr Morrison’s letter? Will the noble Earl also confirm that next year we will be debating a 2016 Armed Forces Act, which we expect to, as it is done every five years, and does the Minister have any inkling of that timetable?

As the Minister has highlighted, we have the opportunity in next week’s debate on role and capabilities of the UK Armed Forces to explore in more detail issues of a more specific nature, and I hope that the Minister will accept the point made in last year’s debate, which the noble Lord, Lord Rosser, repeated today, that a general debate is useful. The issue could helpfully be swept up in the debate next week and the Minister could respond to areas that are defence related but are only tangentially connected with role and capability. In the mean time, I am happy to agree to the continuation order.

[Earl Howe]

My Lords, I am grateful to the noble Lord, Lord Rosser, and the noble Baroness, Lady Jolly, for their comments and questions. I shall address them in turn.

The noble Lord, Lord Rosser, devoted his remarks to questions around the hypothesis that were this order not to be approved, the effect on the Armed Forces would be to render them, in practice, completely ineffective. I can confirm that. The practical effect of not renewing the Act would be that the Armed Forces as we know them would cease to exist because, among the many important provisions in the Act, the key provisions are perhaps the duty to obey lawful commands and the mechanism for enforcing that duty. Without these, the Armed Forces would be unable to continue as disciplined forces. They would continue to owe allegiance to Her Majesty but to deploy the Armed Forces in practice or in theatre would be rendered almost impossible because the system of obeying duties would fall away.

Syria: UK Military Involvement

Debate between Baroness Jolly and Earl Howe

Tuesday 21st July 2015 Lords Chamber

[Earl Howe]

My Lords, currently there is no doubt that ISIL represents the greater threat.

[Baroness Jolly]

My Lords, in the Syria Statement yesterday, the Secretary of State’s words were carefully chosen. At the moment, our actions could be construed as the West versus Islam, so could the Minister see any likelihood of future pilots being embedded in Middle Eastern partners’ forces? Would any ministerial permission therefore need to be sought?

[Earl Howe]

My Lords, exchange of personnel is a regular feature of our Armed Forces, as the noble Baroness will be aware, and this has been the case for many years. I asked for figures relating to our personnel embedded with the forces of other nations, but that statistic is more difficult to come by than might be initially supposed. However, if I can enlighten the noble Baroness, and indeed the House, I would be happy to do so once the information has been gathered.

Armed Forces: Airborne Maritime Patrol

Debate between Baroness Jolly and Earl Howe

Thursday 4th June 2015 Lords Chamber

[Earl Howe]

My Lords, I think that the noble and gallant Lord will accept that we must not leap ahead of ourselves too much. However, I can tell him that the capabilities required from a future maritime patrol aircraft have been studied by the MoD over the past two and a half years. The study has received representations from a number of defence industrial organisations, which have allowed us to understand better the nature of the platforms in existence, as well as the timeframe in which novel technologies are likely to mature.

[Baroness Jolly (LD)]

My Lords, given the Minister’s response just now, can he reassure the House in the mean time how we will be able to meet our international obligations on search and rescue—for example, were an aircraft to crash in the furthermost corner of our sector of the Atlantic?

[Earl Howe]

My Lords, a range of other military aircraft provide search and rescue radar capability to the Armed Forces. We have the E-3D Sentry system, which admittedly is optimised for the air-to-air role, but its radar has a maritime search mode. C-130 Hercules aircraft are fitted with radar systems that, combined with visual search, provide basic maritime search capabilities. RAF Sea King helicopters, and Royal Navy Merlin and Lynx helicopters all possess short-range surface search radar for use in maritime search operations.

NHS: Out-of-Hours Services

Debate between Baroness Jolly and Earl Howe

Monday 29th July 2013 Lords Chamber

[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.

[Baroness Jolly]

My Lords, this is an issue around commissioning. As we have heard, CCGs can now commission NHS 111. Can my noble friend tell the House what support CCGs are likely to receive in commissioning these new services, and from whom?

[Earl Howe]

CCGs, where relevant, are receiving support from local area teams of NHS England.

Cigarette Packaging

Debate between Baroness Jolly and Earl Howe

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

The noble Baroness gives me the opportunity to make clear that plain packaging of tobacco is very much still in our sights; we have not decided to reject that option. I am sure that the psychology of marketing is one very important area that we will continue to focus on.

[Baroness Jolly]

My Lords, what better adviser is there for the Department of Health or indeed the Prime Minister than Cancer Research UK, whose only interest is preventing children starting to smoke? When did my noble friend’s department last speak to that organisation about tobacco packaging?

[Earl Howe]

My Lords, I cannot tell my noble friend about the dates on which the department spoke to Cancer Research UK; I can tell her that we have very regular dealings with Cancer Research UK. CRUK made a submission to the consultation on the plain packaging of tobacco. I can feed back to my noble friend with specific details.

NHS: Accident and Emergency Services

Debate between Baroness Jolly and Earl Howe

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

As the noble Lord will be aware, the latter issue is currently being scrutinised by the Independent Reconfiguration Panel, so it would be wrong of me to comment on that. On the question of reconfigurations generally, we are clear that this is a matter for local decisions by doctors, nurses and all those with a stake in the system. It is not for Ministers to issue edicts from the top. We are clear that any reconfiguration of A&E services has to take into account the capacity of the system to absorb any closures of A&E and the capacity of community services to step in where that is appropriate.

[Baroness Jolly]

My Lords, there is emerging evidence that younger people are using A&E as their first point of contact with the health service rather than their GP or out-of-hours services. Are there any plans to run local campaigns to remind people that accident and emergency units are just that? They are for accidents and emergencies and not coughs and colds.

[Earl Howe]

My noble friend is exactly right. In the work that we are doing on NHS 111, we are seeking to promote to members of the public the advice to phone before they do anything else. If they phone NHS 111, they will be signposted to the correct area of the health service.

NHS: Foundation Trusts

Debate between Baroness Jolly and Earl Howe

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, I am sure the noble Lord is aware that the provision for reviewing NHS mergers on competition grounds is not at all new. Responsibility for reviewing NHS mergers has moved from one independent body—the Co-operation and Competition Panel—to another, the OFT. This is a continuation of the approach that has been in place since 2009. In all these decisions what matters is what is in the interests of patients. The competition authorities will continue to review whether the potential benefits of a merger outweigh the potential costs to patients.

[Baroness Jolly]

My Lords, would my noble friend confirm whether any of those trusts yet to achieve foundation trust status were planning to merge with any on today’s Bruce Keogh list?

[Earl Howe]

I am not aware of any on Sir Bruce Keogh’s list which were planning to merge but, if I may, I will write to my noble friend with further details if that needs clarifying.

NHS: Keogh Review

Debate between Baroness Jolly and Earl Howe

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

We will see the Chief Inspector of Hospitals picking up the baton, as it were, from Sir Bruce Keogh, whose way of working in this exercise has been very instructive. His judgments were based on talking, not just to a few people in the trust, but to patients, a wide range of staff and, in some instances, people outside the trust. I am sure that Sir Mike Richards, the new chief inspector, will want to learn from that. It will be up to the CQC to decide whether this will be institutionalised. Its methodology is evolving. The hospital aggregate rating system will have a role to play in systematising the evaluation of performance and in any future instances of very poor care we will no doubt see a level of transparency from the CQC which we have, perhaps, not had before. However, I would not want to commit the CQC to reporting annually to Parliament in a particular way. It will report annually to Parliament but it is largely up to it how it does it.

[Baroness Jolly]

My Lords, we welcome the drive to improve quality in these trusts and across the NHS, based on the eight ambitions for improvement held in the report. In the Statement read by the Minister, the Secretary of State said:

“In some cases, trust boards were shockingly unaware of problems discovered by the review teams”.

Surely the boards were in receipt of data on quality. If not, why not? If so, why was action not taken? What attention is being paid to issues of trust board governance and its support and development?

[Earl Howe]

We will now see follow-up action by the CQC, not least in the area of trust governance where the quality of that governance has been called into question by Sir Bruce. That will be done rapidly. It is by no means the case that governance is defective in every trust, but question marks have been placed on some and it is important that assessments are made, not just by the CQC, but by the Trust Development Authority and Monitor as the two bodies responsible for overseeing the provider section. It may be that the CQC will be asked to carry out further work, but we are looking, for the time being, to the TDA and Monitor to do that.

Health: Prescription Drugs

Debate between Baroness Jolly and Earl Howe

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My Lords, of course I will revisit that Answer, and I will come back to the noble Baroness if I find cause to correct what I have said. However, I agree with her that the risks associated with long-term use of tranquillisers have been well recognised for many years. There are several authoritative sources for guidance for prescribers on this issue. I believe that that guidance is having an effect because, as I said, the prescribing rate has considerably diminished of late. There is no shortage of guidance out there. There is the national formulary, which already describes the importance of gradual withdrawal from benzodiazepines, and there is a wide variety of other impartial and trustworthy information resources to support prescribing.

[Baroness Jolly]

My Lords, GP training is important but for a user the crucial thing is the availability of the services. Will my noble friend tell the House whether services for those addicted to prescription drugs are readily available within each CCG area and where one might find details of such services?

[Earl Howe]

My noble friend will be encouraged to know that Public Health England has published a commissioning guide for the NHS and local authorities which sets out its expectation that support should be available in every area for people with a dependency on prescription or over-the-counter medicines. Local authorities are now, as she is aware, responsible for commissioning services to support people to recover from dependence in line with local need. Most of the support available for people who are addicted to prescription drugs is with their GP and not in services treating those addicted to illegal drugs, but there is a range of services available.

Public Health England Advisory Board Membership

Debate between Baroness Jolly and Earl Howe

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

My Lords, absolutely not. The noble Baroness to whom the noble Baroness refers is, in everybody’s eyes, a highly qualified person. It would be inappropriate in any case for me to comment on individual candidates, successful or unsuccessful. However, I can confirm, and I emphasise this strongly, that the recruitment campaign was managed in a way that completely complied with the principles of the Commissioner for Public Appointments’ code of practice. It was open and transparent, and appointments were made on merit against published criteria for the role.

[Baroness Jolly]

My Lords, will my noble friend explain what action is being taken to grow tomorrow’s female and minority leaders in health?

[Earl Howe]

My Lords, across the field of health it is difficult for me to give a generic answer, but the NHS Leadership Academy, which is now starting its work, will ensure that women with promise for leadership will be encouraged to come forward in a variety of roles, not just clinical but managerial. I hope that we will see the fruits of that work over the coming months.

Health: Diabetes

Debate between Baroness Jolly and Earl Howe

Wednesday 3rd July 2013 Lords Chamber

[Baroness Jolly]

My Lords, the House has heard that eye screening is critical for those with diabetes. As the national screening programmes are now commissioned by NHS England on behalf of Public Health England, and while diagnostic and treatment services are commissioned by clinical commissioning groups, will my noble friend tell the House what challenges these arrangements pose to the patient when trying to assess quality?

[Earl Howe]

The key thing here is for NHS England, Public Health England and local commissioners to work closely together, which is indeed what they are doing, so that the patient experiences a seamless service. Essentially, the new commissioning arrangements for national screening programmes enable effective commissioning and oversight of the whole screening pathway, alongside integrating those with the diagnostic and treatment services. To ensure a quality service, local programmes are assured by NHS screening programmes’ quality assurance teams and services are measured against 19 standards.

NHS: Mid-Staffordshire NHS Trust

Debate between Baroness Jolly and Earl Howe

Monday 24th June 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord raises a very current issue. As he will remember, we have introduced a contractual duty to raise concerns. We have issued guidance to NHS organisations on that subject. We have also strengthened the NHS constitution to support staff in the NHS and in social care on how to raise concerns. There is a free helpline to enable them to do that. We are considering in the context of the Care Bill the whole issue of the duty of candour. I feel sure that the noble Lord will make a valid contribution to that debate.

[Baroness Jolly]

My Lords, communication of complex issues is a vital part of any press department’s role. Will my noble friend the Minister tell the House how large the press teams within the Department of Health and NHS England are, how much they cost the taxpayer and how their effectiveness is managed?

[Earl Howe]

My Lords, the latest figure that I have for the cost of the Department of Health’s media centre is for 2011-12 and is £2.57 million. I will write to my noble friend as soon as I have more recent figures. She may be interested to know that the names and contact details of each of the department’s press officers are published on the GOV.UK website. Currently, 28 Department of Health press officers are listed there. I do not have to hand the details of the number of press officers employed by NHS England, but, again, I shall write to my noble friend with that information. In the department and in NHS England, internal line management arrangements are in place to measure performance.

Health: Children's Heart Services

Debate between Baroness Jolly and Earl Howe

Wednesday 12th June 2013 Lords Chamber

[Earl Howe]

I hope that my noble friend will be reassured by the IRP’s recognition that the location and geography of these centres and where they are in the country are material factors in this equation. At the same time, I think it would be wrong to give the impression that one can establish a centre of expertise of this kind in every city; that is clearly not realistic. Merely because there is a certain density of a population in a location does not mean to say that there can be a children’s heart centre very close to the centre of that population. This is a highly specialised service and we must recognise that the centres that will deliver it will be few in number. Nevertheless, I am sure that the message that my noble friend has given will not be lost on NHS England.

[Baroness Jolly]

My Lords, it is critical that however NHS England proceeds, it does it openly and transparently. I welcome the Minister’s comments on that. Will he also agree that meetings of any review body should be advertised, public and make all necessary papers available to the public?

Health: Midwives

Debate between Baroness Jolly and Earl Howe

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, some of them already do. As I understand it, we are talking about 154 individuals as compared with 41,000 midwives on the register. If they work for the NHS, there is generally no issue; they will be covered by NHS indemnity in one way or another. The issue is if they wish to practise privately as individuals. That is the point of my noble friend’s Question.

[Baroness Jolly]

My Lords, there is a certain element of urgency here. A woman expecting her baby in October would be half way through her pregnancy now. What plans are in place to deal with such women under the care of these midwives and indeed the midwives themselves if, come October, the situation has not been resolved?

[Earl Howe]

My Lords, we are working hard on this. Officials from the department have been in discussion with stakeholders, including Independent Midwives UK, on an ongoing basis for at least four years with a view to identifying potential solutions to the issue. Arising in part from these discussions, independent midwives can now obtain affordable indemnity cover for the whole of the maternity care pathway either in the NHS or in the private sector. However, it is acknowledged that this is achievable only if they operate as part of some form of social enterprise or corporate entity. That is the issue that we have to get to grips with between now and October.

Health and Social Care

Debate between Baroness Jolly and Earl Howe

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

The noble Lord hits upon a point of central importance. The outcomes framework clearly sets out where the different parts of the health and care system share responsibility for outcomes and support joint working in the way that I have described. However, we are committed to developing a measure of people’s experience of integrated care for use in the outcomes frameworks. That is a work in progress. Meanwhile, a place holder was included within both the NHS and adult social care outcomes frameworks when they were refreshed in November last year. We have highlighted the development of this measure in the public health outcomes framework, so I hope to give the noble Lord further news in a few months’ time.

[Baroness Jolly]

My Lords, within local authorities, public health is responsible for reducing local health inequalities, particularly in areas of non-communicable disease. For those, the solutions are often long term, so would my noble friend explain how success can be measured and incentivised in the short term?

[Earl Howe]

Again, my noble friend asks an extremely good question. The year-on-year success of public health interventions to address non-communicable diseases, for example, will be measured through the public health outcomes framework. The department will incentivise some of the indicators in the public health outcomes framework through the health premium incentive scheme. Some of the indicators that will be selected may contribute to prevention of non-communicable diseases.

Health: Cancer

Debate between Baroness Jolly and Earl Howe

Monday 20th May 2013 Lords Chamber

[Earl Howe]

My Lords, I agree, and I am confident that over the years ahead we will see a much greater emphasis on stratified medicine, particularly if we can relate treatments to genomic data.

[Baroness Jolly]

My Lords, everyone—families, statisticians, managers and, indeed, researchers—wants accurate death certificates. What are the arrangements to monitor the recording of death as part of clinical governance?

[Earl Howe]

My noble friend has raised a very live issue because consultation will begin shortly on the Government’s plans to reform the governance relating to death certification. The proposed reforms will simplify and strengthen the process for death certification by appointing local medical examiners to provide independent medical scrutiny of the cause of death for all deaths not subject to coronial investigation. The medical examiner will improve the accuracy of information recorded on medical certificates of cause of death because the process will include a review of medical records and consideration of the circumstances leading to death.

NHS: GP Dispensing

Debate between Baroness Jolly and Earl Howe

Thursday 16th May 2013 Lords Chamber

[Earl Howe]

I am sure that the noble Lord is as aware as anyone of the balance that has to be struck here. A GP’s primary purpose is to provide comprehensive medical care and treatment to his or her patients. More than 90% of prescription items are dispensed by pharmacies, which is what most patients expect. However, we must have arrangements to enable patients who live in rural and more remote areas to access medicines more easily. I think the noble Lord will understand that the arrangement for some GPs to provide dispensing services has always been the exception rather than the rule. I do not think there is an appetite on anyone’s part among the professions to reopen these arrangements.

[Baroness Jolly]

My Lords, these GP-dispensed services come at a cost, but as someone who lives in a rural area I am very glad of it, because it saves me a 12-mile round trip. However, the cost of a practice-based prescription will be apportioned to the CCG in two parts: the actual cost of the medicine itself and disbursement costs. Does my noble friend expect that the disbursement cost mechanism will be looked at again in the light of GPs running CCGs, where, of course, every penny will count towards the care of the patient?

[Earl Howe]

My Lords, those particular technical matters will always be looked at very carefully to ensure that the right balance is struck. It is open to commissioners to propose a change in the arrangements. If a new pharmacy applies to open, and that could affect GPs dispensing to patients in a rural area, we would fully expect there to be consultation with patient groups and the public. There is a mechanism to ensure that that process can take place.

Emergency Services: Paramedics

Debate between Baroness Jolly and Earl Howe

Wednesday 15th May 2013 Lords Chamber

[Earl Howe]

My Lords, the issue here is that they were not unqualified, as I tried to convey. All ambulance trusts in the UK allow student paramedics to work unsupervised, but only after they have had nine months’ operational experience and have passed both a written exam and a clinical practice observation by a qualified assessor. In this case, the London Ambulance Service accepts that, despite their qualifications and experience, the crew did not act in accordance with their training.

[Baroness Jolly]

My Lords, there are also volunteer first responders, trained with a minimum skill set and working with ambulance trusts across England. Will my noble friend tell the House who keeps the information about their deployment and how they are monitored for quality outcomes?

[Earl Howe]

I think that my noble friend is referring to first responders, who should be integrated into the clinical governance structure of all ambulance trusts. The outcomes will be assessed for all calls regardless of who attended the calls in the first instance. A first responder is just that—further ambulance staff would always be sent to a call. In rural areas, these staff can often get there first and provide immediate help, so the use of those people is a matter for local decision.

NHS: 111 Telephone Service

Debate between Baroness Jolly and Earl Howe

Monday 13th May 2013 Lords Chamber

[Earl Howe]

I take the noble Lord’s point. That is why the 111 service has been created; there is no doubt that there was a very confusing landscape in which people did not know who to call out of hours, and they did not necessarily have the telephone number of the out of hours provider in their area. The 111 service is designed to simplify all that, and across the vast bulk of England people are getting a good, if not fantastic, service. Unfortunately, in two areas of the country, the south-east and the south-west, we are still seeing problems arising, and those are being gripped.

[Baroness Jolly]

My Lords, the out of hours services, the ambulance services, A&E and these 111 services need to work in a harmonious and co-ordinated way for the good not only of the patient but of the service as a whole. Will the Minister reassure the House that the 111 service will be part of the review of urgent and emergency services being led by Sir Bruce Keogh?

[Earl Howe]

I am very glad that my noble friend has raised that issue. Sir Bruce Keogh is indeed looking across the piece at urgent and emergency care services, and that will include the way in which 111 is working.

NHS: ECMO Machines

Debate between Baroness Jolly and Earl Howe

Monday 22nd April 2013 Lords Chamber

[Earl Howe]

I shall certainly take that idea away with me, but I think that there is broad consensus among the medical community that the key to success with ECMO is getting the patients connected to the equipment quickly. Although it is a moving scenario, all the evidence so far suggests that ECMO confers no benefit if some hours have elapsed since the cardiac arrest.

[Baroness Jolly]

My Lords, services that need ECMO machines would currently, in the new world, be commissioned by NHS England. Will my noble friend explain to the House what role, if any, the department now has in commissioning such services?

[Earl Howe]

My Lords, the department itself no longer has a role in commissioning highly specialised services. NHS England is implementing a single operating model for the commissioning of 143 specialised services. That replaces the previous arrangement whereby 10 regional organisations were responsible for commissioning specialised services and, to be frank, there were wide variations in the standard of those services. The new operating model represents a significant change to the previous system and should result in better outcomes.

NHS: Out of Hours Service

Debate between Baroness Jolly and Earl Howe

Tuesday 26th March 2013 Lords Chamber

[Baroness Jolly]

My Lords, in some parts of the country confidence has been lost in out-of-hours services. The NHS Commissioning Board takes over next week, so what can it do in terms of commissioning smartly to regain the public’s confidence in these services?

[Earl Howe]

We have known that out-of-hours care has been in need of reform for some considerable time. The much strengthened commissioning arrangements that we have put in place, including the national quality requirements that I mentioned earlier, will enable that to happen.

Mid Staffordshire Foundation Trust Inquiry

Debate between Baroness Jolly and Earl Howe

Tuesday 26th March 2013 Lords Chamber

[Baroness Jolly]

My Lords, I thank my noble friend the Minister for repeating the Statement. I am sure that many noble Lords will welcome, in due course, a full and spirited debate on this issue. Will my noble friend clarify which of the recommendations that are being adopted will require primary legislation, what the timescale might be and what the mechanism might be for that?

We welcome my noble friend’s remarks on the duty of candour but, as with all these things, the devil is in the detail. My question is about the chief inspector regime in general. We are going to have a chief inspector of hospitals so it would seem sensible to have a chief inspector of social care. Will we then need a chief inspector for public health and another one for mental health? Is that the way to have all the bases covered?

[Earl Howe]

My Lords, it is a little early to say what legislation we will need, but I can tell my noble friend that we can deal with the duty of candour by secondary legislation. It may be that many of the follow-up actions to Francis can be done without any legislation at all. However, primary legislation would appear to be the obvious route when statutory roles are to be changed.

With regard to the chief inspectors, the only firm decisions we have taken so far are to appoint a chief inspector of hospitals and a chief inspector of social care. We are looking at the merits of a chief inspector of primary care but we need to make sure that there is a genuine issue that needs to be addressed by way of a chief inspector role rather than leaving the CQC to perform its role in the normal way. Further details will be forthcoming at an appropriate time.

UK: Ageing Population

Debate between Baroness Jolly and Earl Howe

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

My Lords, I very much agree with the noble Baroness. It is our ambition that people should receive high-quality, integrated, person-centred services that deliver the best outcomes to the service user. Making the service as a whole more efficient is the other benefit of integrating service. There is no single definitive model of integration. Some localities are further advanced than others in thinking about new ways of delivering it. We are developing the concept of pioneers to support the rapid dissemination and uptake of lessons learnt across the country, but we want to encourage local experimentation as much as we can to allow local areas to provide integrated care at scale and pace.

[Baroness Jolly]

My Lords, there are several common themes between the report from the noble Lord, Lord Filkin, and his group, and that of the scrutiny committee of the draft Care and Support Bill, which was published today. One of those themes is the funding of personal care, which has to be shared between the individual and the state. As recommended by the Dilnot commission, will the Government invest in an awareness campaign to inform people of this situation and the importance of planning ahead?

[Earl Howe]

I am sure my noble friend is right that there is a job of work to do to inform people about the new arrangements that we are bringing in to implement the Dilnot recommendations. My right honourable friend the Chancellor’s announcement at the weekend confirms that we will introduce a cap on care costs and extend the means test upper capital threshold at the earlier date than previously announced, namely on April 2016. The reason for the change in date is to bring it into line with changes to single-tier pensions. We will need to disseminate this information sooner than we would otherwise have done.

Health and Social Care Act

Debate between Baroness Jolly and Earl Howe

Tuesday 5th March 2013 Lords Chamber

[Baroness Jolly]

My Lords, I thank my noble friend for meeting Members from these Benches on this issue nearly two weeks ago. Will he confirm for the House that, in line with assurances given during the course of the Bill last year, the regulations will promote integration of services in the best interest of patients?

[Earl Howe]

I think that everybody was agreed during the passage of the Health and Social Care Bill that we wish to encourage integration in the way that services are commissioned. Integration in this context should be taken as a term that reflects the experience of the patient. The patient has to feel that he or she is on a seamless pathway of care. That care may be provided by a number of agencies, if necessary, whether in the NHS or social care, but the patient’s experience should not be disjointed. Therefore, as my noble friend will remember, numerous provisions were inserted into what is now the Act to ensure that commissioning should be on that basis. Nothing in these regulations interferes with that, but it is very much in our minds to make it crystal clear that integration of services is one of the main factors which commissioners should take into account.

NHS: Healthcare UK

Debate between Baroness Jolly and Earl Howe

Thursday 14th February 2013 Lords Chamber

[Earl Howe]

I am sure the noble Lord will know that a number of our flagship hospitals already have private facilities which treat domestic and international private patients, including Great Ormond Street and the Royal Marsden. All such treatment of course takes place outside NHS provision. However, it is important to emphasise that Healthcare UK is about much more than private patients. In fact, that will not be its primary focus. It is about sharing this country’s expertise, technology and knowledge to support healthcare systems and infrastructure with international partners. Healthcare UK will provide support if there are NHS organisations wanting to bring patients in from overseas but that will not be its principal focus.

[Baroness Jolly]

My Lords, the NHS brand is the envy of the world and we welcome this enterprise. Will my noble friend tell me how many clinicians he expects might be involved and in what particular roles and disciplines?

[Earl Howe]

It is a little too early to say because the business plan for Healthcare UK has yet to be drawn up. We have appointed a managing director in the shape of Howard Lyons who I think will do an excellent job. It remains to be seen what requirements are needed. We are looking at certain target markets at the moment—in particular, the Middle East, the United Arab Emirates, Saudi Arabia, Libya, China and India. But it depends on the requests that we get from those countries as to what skills set might be needed.

NHS: Private Companies

Debate between Baroness Jolly and Earl Howe

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My Lords, the Government’s policy is that competition should never be deployed for competition’s sake but only in the interests of patients. Furthermore, competition should be on the basis of quality and not price. The answer to the noble Lord’s question is that we need to arrive progressively at a system of tariffs that fairly reflect the value and cost of the work that providers do, and that all providers should compete equally on that basis.

[Baroness Jolly]

My Lords, Parts 3 and 4 of the Health and Social Care Act were rigorously debated. Will my noble friend confirm that the regulations covering this will be laid down soon, as 1 April is less than two months away?

[Earl Howe]

I can tell my noble friend that the Government intend to lay these regulations shortly.

Social Care Funding

Debate between Baroness Jolly and Earl Howe

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My Lords, I thank the noble Lord. I am with him in spirit. I say that because not only do I believe in cross-party consensus on a matter as important as this, but I hope he will accept from me that the way we have tried to structure this package, taking the cap and the means test in combination, has precisely been to target those of more modest means. Currently only those with assets of less than £23,250 and a low income receive help from the state with their care costs. Our changes will mean that those with property value and savings of £100,000 or less in 2010 prices will start to receive financial support. That means that the most support will go to those in greatest need. I am advised that had we, for example, opted for a higher means-test threshold, it would not in practice have brought into the net that many more people. We felt that the fairest way of cutting the cake was to try to concentrate the benefit on those of lowest means while also removing the fear of catastrophic care costs from everybody in the system.

[Baroness Jolly]

My Lords, we on these Benches are delighted that the Government decided to implement the principles of the Dilnot report. The care and support Bill places a duty on local authorities to provide information and advice. In addition, there will be a need to set up some sort of taxi-metering system in order to achieve that outcome. Has the Minister any idea about how that might be achieved?

[Earl Howe]

My noble friend is absolutely right. One of the tasks that faces us over the next two or three years is to ensure that every member of the public has easy access to information which enables them to make plans and take decisions about their own or their family’s future. We will therefore be working very closely with local authorities on that front. It is important that there are websites. My department is already devoting a section of its website to appropriate information on this front. More generally, we need to ensure that the system is not only fair to people, but clear to people.

Social Care: Funding

Debate between Baroness Jolly and Earl Howe

Monday 21st January 2013 Lords Chamber

[Earl Howe]

My Lords, we have to speak speculatively and hypothetically because I cannot give the noble Baroness any indication of the level at which the Government will finally propose to set the cap. The level of the cap needs to represent an affordable and sustainable relationship between the state and the individual. We will give due regard to the Dilnot recommendations for the cap while taking into account current economic circumstances. We will set out further details in the coming weeks but I am sure that the point that the noble Baroness effectively makes will be closely borne in mind as we approach decision time.

[Baroness Jolly]

My Lords, with more people needing social care, and with a higher cap than anticipated under Dilnot being probable, what provisions are being made to assist local authorities to cope with managing deferred payments for care?

NHS: Clinical Commissioning Groups

Debate between Baroness Jolly and Earl Howe

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

My Lords, that is a very important principle. It is one of the reasons why we felt that the NHS Commissioning Board should be responsible for the allocation of resources to CCGs and not Ministers, to avoid any perception of party-political interference. However, the Government’s mandate to the board makes clear that we would expect the board to place equal access for equal need at the heart of its approach to allocations. That is why ACRA has been charged with developing formulae independently to support the decision that the board takes.

[Baroness Jolly]

My Lords, the first rule of funding is that recipients are never happy with their allocation. Given that, will the Minister assure the House that, with new configurations that we have with public health and CCGs, the model used will regularly be reviewed to ensure that it remains fit for purpose?

[Earl Howe]

Yes, my Lords. As I have indicated, as regards the NHS allocations, the board is clear that the model needs to be reviewed. That does not necessarily mean that it will need to change; the board will have to keep an open mind about that. Clearly, the board was not happy that the formula as currently constructed best met future needs. As regards public health, I think that we are in a better place. As my noble friend will know, the allocations were announced recently and they provide for considerable real-terms increases everywhere around the country.

NHS: Liverpool Care Pathway

Debate between Baroness Jolly and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

My Lords, once again, I am sure that the noble Baroness, Lady Neuberger, will wish to look at that very issue. The CQUIN payment framework that the right reverend Prelate mentioned was designed to incentivise good practice, and the LCP is considered internationally to be best practice. In one sense, it is therefore logical that the two should be combined. It is equally important for me to emphasise that the Department of Health has not attached any set financial targets to the LCP; on the other hand, some commissioners in the NHS have introduced local incentives. The way in which those incentives have been applied should be the subject of close attention.

[Baroness Jolly]

My Lords, the Liverpool care pathway is widely used, but some care providers choose to use a slightly different pathway. Will my noble friend confirm that all similar pathways will be included in the inquiry led by the noble Baroness, Lady Neuberger?

[Earl Howe]

I will be happy to speak to the noble Baroness about that. I was not aware that she had that in mind. I do not think that there would be an objection on anyone’s part if she did, but it will really depend on the extent to which there is widespread concern about the use of those other pathways.

NHS: South London Healthcare Trust

Debate between Baroness Jolly and Earl Howe

Tuesday 8th January 2013 Lords Chamber

[Earl Howe]

My Lords, all questions of process must be for my right honourable friend to consider, including that one. I emphasise the Government’s approach to reconfiguration decisions. When the Government came into office, we took a very clear decision about four tests that needed to be applied to any sustainable reconfiguration within the NHS: the changes, whatever they were, had to command support from GP commissioners—that is to say, the clinical community; the public must be engaged in the process; the recommendations must be clinically sustainable and sound; and, as the statement mentioned, they must leave patients with a clear choice of good-quality providers. Those safeguards were not there before, but they are there now and my right honourable friend will be looking at those tests when he considers not just the matter of Lewisham but the totality of the administrator’s recommendations.

[Baroness Jolly]

My Lords, today it is the South London Healthcare Trust, and there is anxiety abroad that tomorrow it could well be another trust. Can the Minister tell the House how many trusts are in the “at risk” box today and what role is being played by Monitor and others in these cases?

World Sepsis Declaration

Debate between Baroness Jolly and Earl Howe

Wednesday 19th December 2012 Lords Chamber

[Earl Howe]

My Lords, I absolutely agree with the noble Baroness. The need to rapidly identify sepsis when it occurs is vital to ensure that unnecessary death is prevented. A crucial measure to tackle sepsis when it appears is early treatment with broad-spectrum antibiotics. My understanding is that once the bacterium has been identified, the treatment of choice is to have a more focused antibiotic, but rapid reaction is of the essence.

[Baroness Jolly]

My Lords, every year sepsis kills 37,000 people and costs the NHS £2.5 billion. Can my noble friend please tell the House what research programmes are in place across the NHS into care pathways and diagnosis?

[Earl Howe]

My Lords, the department’s National Institute for Health Research is funding a range of research on sepsis, which includes a study into the clinical and cost-effectiveness of early resuscitation protocols for emerging septic shock. Other examples include a trial of vasopressin versus noradrenaline as initial therapy; a study on how risks associated with nutropenic sepsis are conveyed to and interpreted by patients undergoing chemotherapy; and there is also a very interesting project on a point-of-care test for sepsis.

NHS Commissioning Board: Mandate

Debate between Baroness Jolly and Earl Howe

Tuesday 13th November 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord for his welcome to the overall structure of the mandate and its content. I do not believe that there is an inconsistency between those two paragraphs. We have had a number of debates about specialised healthcare. I can confirm to him what I have said in the past: it will be the responsibility of the NHS Commissioning Board to commission services in relation to highly specialised conditions and, on top of that, those specialised conditions that are currently commissioned by the regional specialised commissioning groups. It is services for not only very rare conditions but slightly less rare conditions that the board will commission. That is a positive step that has been welcomed by the specialised healthcare community. We will spell out in regulations exactly what conditions are specialised conditions.

Paragraph 9.3 states that the way in which the board is held to account should be directly analogous to the way in which other commissioners in the health service are held to account. In other words, the board cannot expect not to be held to account by the department in a similar fashion. I hope that with that clarification, the noble Lord will be reassured.

[Baroness Jolly]

My Lords, I note that the mandate no longer sets quantifiable levels of ambition. The Minister explained how progress might be measured. There will be overarching indicators and improvement areas that will all match or mirror the five parts of the outcomes framework. Will my noble friend the Minister explain to the House how frequently progress is likely to be reported, and how it will be monitored by parliamentarians?

[Earl Howe]

I am grateful to my noble friend. The board will have to publish its progress against the objectives in the mandate. The Government will publish an annual assessment of its progress. We have set an objective for the board to demonstrate progress against all the indicators in the NHS outcomes framework. We will use a range of evidence to assess the board’s performance, including asking CCGs and other stakeholders for their feedback. This will be important, because it will provide the board and everybody else with a much more rounded view of how the health service is doing. The information will be publicly available, so everyone will be able to judge for themselves whether the NHS has achieved these stretching goals. In year, Ministers will hold the board to account. In particular, the Secretary of State will hold formal accountability meetings with the chair of the board every two months. Minutes of those meetings will be published. The meetings will be an opportunity to review performance and discuss issues as they arise, and as is right and proper.

Winterbourne View

Debate between Baroness Jolly and Earl Howe

Tuesday 30th October 2012 Lords Chamber

[Earl Howe]

My Lords, I am absolutely in agreement with the noble Lord, Lord Laming, that it is really important that people are held to account for making change happen. We have indicated what we think that change should be, and that is why we have developed a concordat with key partners to get them to commit to the actions they will take. We also plan to strengthen the learning disability programme board, in particular to make sure that key delivery partners—such as the NHS Commissioning Board, the CQC, ADAS and the Local Government Association—are core members. The board will review progress on implementing the action set out in the final departmental report and the concordat. We have tried to address the issue that the noble Lord homed-in on—which is speed of action—but the core of his point was that there are too many people currently in specialist in-patient learning disability services, including assessment and treatment units, and that they are staying there for too long. This is often due to crises which are preventable or which can be managed if people are given the right support in their own homes and in community settings. That is the agenda that faces us.

[Baroness Jolly]

My Lords, what action can be taken against partners that fail to comply with the concordat?

[Earl Howe]

My Lords, I think that part of this involves defining roles and responsibilities. There is no single answer to my noble friend’s question. However, the transparency of the delivery of care, measuring outcomes and measuring the quality of commissioning in local areas are all important. It is also important to ensure that systems are in place to expose poor practice when it occurs. The problem with Winterbourne View is that, for too long, people did not know that those dreadful things were happening. Therefore, levers such as the introduction of local Healthwatch, the promotion of the new elements of the NHS constitution and ensuring that the CQC focuses its attention on where risk may most strongly lie, all have to be considered in the mix. I can tell my noble friend that this very subject will be covered in the report that my department will be publishing by the end of next month.

Mental Health Act

Debate between Baroness Jolly and Earl Howe

Monday 29th October 2012 Lords Chamber

[Baroness Jolly]

My Lords, will the review look at whether the SHAs have made any approvals under any other legislation, such as the Mental Capacity Act?

[Earl Howe]

My Lords, the review by Dr Harris will take into consideration any lessons that need to be learnt. We have asked him to take into account any other possible lessons that we should take on board, particularly in the run-up to April 2013. However, I am happy to reassure my noble friend that her request will be passed on. If there is a relevance to the Mental Capacity Act, I will ensure that Dr Harris takes it into account.

NHS: Accident and Emergency Services

Debate between Baroness Jolly and Earl Howe

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

The premise behind the noble Lord’s question is that it is automatically worse to have fewer A and E departments in an area. I beg to disagree with that premise. In serious or complex cases, the noble Lord will know that patients need to access exactly the right care, so it is often better and safer for them to travel further to see specialists in major centres than to go to a local hospital. Although it may be closer, it may not have the right specialists, the right equipment or sufficient expertise in treating patients with their condition. The prime example of that has been stroke care in London, where 32 centres were reduced to, I think, eight and there has been a dramatic reduction in the number of deaths following admission.

[Baroness Jolly]

My Lords, does the noble Earl agree that wherever there are improvements to patient care that involve restructuring not only of services but premises, the impact assessment in the consultation document should include general transport and ambulance access?

[Earl Howe]

I agree with my noble friend. The planning assumptions made in north-west London, which is the subject of the Question, are a good example of that, where Transport for London is co-operating actively by producing some sophisticated analysis not only of ambulance transport times but of bus and car journey times to make sure that nobody loses out in any reconfiguration.

Care Services: Elderly People

Debate between Baroness Jolly and Earl Howe

Wednesday 17th October 2012 Lords Chamber

[Baroness Jolly]

My Lords, safeguarding the vulnerable needs real commitment from us all. Will the Minister tell the House whether the Government intend to support this by ring-fencing funds, as have Wales and Scotland?

[Earl Howe]

My Lords, we are not taking that approach. However, we have declared our intention to strengthen safeguarding arrangements to prevent and reduce the risk of significant harm to adults in vulnerable situations. That is a key priority for the Government. We intend to put safeguarding adult boards on a statutory footing. This will assist in furthering the agenda which my noble friend rightly raises, by ensuring that organisations involved in safeguarding have to make a co-ordinated contribution to local adult safeguarding work. Of course, it continues to be an offence for a provider to employ a person barred by the Independent Safeguarding Authority.

NHS: Professional Qualifications Directive

Debate between Baroness Jolly and Earl Howe

Monday 15th October 2012 Lords Chamber

[Earl Howe]

The SiMAP and Jaeger judgments are very much the focus of our representations to the EU Commission. The disquiet about those judgements and the inflexibility that they have brought is shared by other member states. It is also important to recognise that none of us wants to go back to the past, with tired doctors working excessive hours. Tired doctors make mistakes; there is substantial evidence to support that. No one wants or deserves to be treated by tired doctors. There is a balance to be struck. The inflexibilities in the directive need to be addressed, but we should not go back to the bad old days when doctors became too tired to do their work.

[Baroness Jolly]

My Lords, if a clinician fails to understand a patient or to make themselves understood, their clinical competence is undermined. Will the noble Earl tell the House the current situation regarding the required level of English language competence of a doctor or other clinician from an EU state who wishes to practise in England?

[Earl Howe]

My Lords, we are now talking about the mutual recognition of professional qualifications directive. We have made it clear that we want to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests. As a result, we have explored the idea of strengthening language testing for doctors through the use of responsible officers; and explored also the GMC’s ability to take action where concerns arise. The directive review is a key priority for the Government, and the Commission’s proposals include greater flexibility on language. It is helpful that the proposal from the Commission makes it clear that controls on language checks are permissible and may be undertaken before a professional is able to practise.

NHS: Walk-in Centres

Debate between Baroness Jolly and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

My Lords, no. The previous Government did not collect the figures and we have chosen not to either. This is a decision for local commissioners and there is a limit to the extent that we can require the NHS to fill in forms and send them to Richmond House.

[Baroness Jolly]

My Lords, no one doubts the worth of walk-in centres or minor injury units. It is well established, but we need to know where they are. Will the noble Earl tell the House how often the information on the Department of Health website is updated? Who is responsible? Will he please pass on the message that it is woefully out of date and inaccurate, thus defeating its object?

[Earl Howe]

I can only express my gratitude to my noble friend for pointing that out. I will ask my officials to review the information provided on the DoH website and to ensure that it is as up to date as possible.

NHS: Health Workers

Debate between Baroness Jolly and Earl Howe

Thursday 19th July 2012 Lords Chamber

[Earl Howe]

There is a clear role here for the professional bodies. Training should be done in the right disciplines and numbers and in the right way. I am sure I do not need to tell the noble Lord that in virtually all the medical royal colleges and through the Royal College of Nursing, there is an increasing emphasis on leadership backed by resources from the Department of Health. We are seeing a drive forward for innovation and the breaking down of professional barriers, which is another aspect of this issue.

[Baroness Jolly]

My Lords, we now accept nurse prescribing as perfectly normal and sensible, and these changes were implemented when the NHS was the major provider of health services. Therefore, what challenges or opportunities does the Minister think that the new diverse health economy will pose to task shifting?

[Earl Howe]

My noble friend poses an extremely complex question. She is right that regulatory improvements such as nurse prescribing are making a difference and we are looking to see what other professions can also share in that sort of freedom. As the NHS gets more plural, we are able to drive the consistency and quality of practice through the NHS standard contract, through regulation, as the noble Lord, Lord Crisp, emphasised, and also through the clinical leadership referred to by the noble Lord, Lord Kakkar. That applies not only in NHS settings, but in private and independent settings as well.

NHS: Private Finance Initiative Costs

Debate between Baroness Jolly and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

My Lords, the Treasury has been very helpful in advising my department on the kinds of flexibility that we may have in these difficult situations. It has also been helpful in refining the current PFI model so that, as and when we use PFI again, we have a tighter structure which strikes a better balance between risk and reward to the private sector.

[Baroness Jolly]

My Lords, many community health schemes were funded using the LIFT programme. What is the Government’s view of their affordability now?

[Earl Howe]

My Lords, LIFT is one tool that we have in financing capital schemes in the community, many of which have been successful. Such schemes promote integrated services, which I know my noble friend will welcome. All LIFT schemes have been and will be assessed for affordability and value for money. It is not a universal prescription by any means, but we look constructively at LIFT as one way of delivering capital schemes.

Care and Support

Debate between Baroness Jolly and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

My Lords, I fully agree with the noble Lord about the need for cross-party consensus. If we are to have a long-term sustainable solution for the funding of social care, we must have that political consensus. Indeed, that was the intent behind the cross-party talks. I very much regret the leaks. These were not our doing, but they did create an impression of bad faith. Again, I regret that. No bad faith was intended from our quarter or indeed from any other quarter in government. I think there was an element of misunderstanding about our intentions, but I agree with the noble Lord that the cross-party bonhomie has been disrupted. We very much wish to put the whole process back on track, and I hope that his party will respond accordingly.

[Baroness Jolly]

My Lords, I am a glass half-full sort of person, so I heartily welcome the White Paper and the draft Bill on care and support, and note the progress report on funding reform. We are certainly looking forward to pre-legislative scrutiny. Can the Minister give the House some indication of the timetable and the process? Will he also tell the House what the Government’s view is on including enabling clauses in the draft Bill to allow the Dilnot-based scheme to be implemented?

[Earl Howe]

My Lords, my provisional understanding —and I stress that—is that pre-legislative scrutiny will begin in the autumn, probably in November. Between now and then, plans will be put in place to decide the composition of the pre-legislative scrutiny committee so that the process will conclude by the end of this Session of Parliament. In principle, there is no reason why enabling clauses should not be inserted into the legislation. As I have emphasised before, it would be preferable if they were clauses on which we could all agree.

NHS: Dental Care

Debate between Baroness Jolly and Earl Howe

Tuesday 26th June 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend is correct. Treatment provided on the NHS carries only one pricing tariff, which cannot be varied. The OFT report found that only 1% of NHS patients and 2% of private patients chose a dentist on the basis of price. I stand to be corrected, but I do not believe that it made any suggestion that NHS charges were uncompetitive; they are, and always have been, a subsidised contribution to NHS costs—they are not a market price. Therefore, I imagine that the OFT report reflected the fact that patients were comparing private charges with NHS charges. Of course, the NHS is in general free at the point of use, but my noble friend is right. It is important that we are clear that some charges exist, as they have in dentistry for 60 years.

[Baroness Jolly]

My Lords, some may avoid the dentist because they cannot find one, others for fear of high costs, and others just for fear. Have the Government carried out any work to determine what proportion of the population does not attend a dentist, and the reason why?

Older People: Health and Social Care

Debate between Baroness Jolly and Earl Howe

Monday 18th June 2012 Lords Chamber

[Earl Howe]

My Lords, decisions about the content of the mandate will be made on the basis of a full public consultation, which will take place in the summer. More details on that score will follow in due course so there is a limit to what I can say at the moment. However, as I indicated during the passage of the Health and Social Care Act, the mandate is likely to include expectations for improving healthcare outcomes for patients, based on the NHS outcomes framework. That framework reflects the Government’s ambition for an NHS that provides high quality, safe and effective care, treating patients with compassion, dignity and respect.

[Baroness Jolly]

What measures will be taken by the national Commissioning Board to ensure that clinical commissioning groups always pay proper attention to dignity when commissioning services for older people?

NHS: General Practitioners

Debate between Baroness Jolly and Earl Howe

Wednesday 23rd May 2012 Lords Chamber

[Earl Howe]

My Lords, this is a very exciting area. I have seen some extremely good examples of telemedicine that will deliver not only greater efficiency within the health service, sometimes enabling clinicians to diagnose conditions in patients from a remote standpoint, but also greater safety and effectiveness of care for patients. For example, I saw a demonstration of stroke diagnosis that can be done remotely by laptop. This is an area on which the department is focusing a lot of attention, not least through the 3millionlives initiative, through which we hope over the next few years to ensure that 3 million people benefit from telecare and telemedicine.

[Baroness Jolly]

My Lords, what role should practice-based patient participation groups have in moulding the services that their GPs offer?

[Earl Howe]

My noble friend is extremely familiar with this area. I have also come across some extremely effective practice-based patient groups that are enormously valuable, and are valued by the GPs and other primary care staff with whom they interact. It is very much part of the world of the NHS today and we wish to see it continue.

NHS: Risk Register

Debate between Baroness Jolly and Earl Howe

Tuesday 15th May 2012 Lords Chamber

[Baroness Jolly]

My Lords, risk registers are a tool to inform policy-making, so is the department currently working on a risk register for the implementation of the social care Bill, including the risks around the failure to reform the funding of social care?

[Earl Howe]

In answer to that characteristically helpful question from my noble friend, the department will put in place thorough programme-management arrangements as it takes forward the draft care and support Bill and plans for its implementation. That will include monitoring and assessing risks as they arise, to ensure smooth passage through to implementation.

Health and Social Care Act 2012

Debate between Baroness Jolly and Earl Howe

Wednesday 25th April 2012 Lords Chamber

[Earl Howe]

My Lords, the performance of the health service will be very visible as we go along: we will have the NHS Commissioning Board producing its annual report; each clinical commissioning group will be publishing an annual report; directors of public health must produce an annual report; the Secretary of State has to report annually on the overall performance of the health service; and HealthWatch England has to publish an annual report. So there will be no shortage of transparency along the way.

[Baroness Jolly]

My Lords, as for the Health and Social Care Act, scrutiny was, of course, done by this House. However, there is still more to be done, because there is quite a lot of secondary legislation still to come down the track. Can the Minister give the House some indication of how many pieces of secondary legislation are still to come, when they might be introduced and what areas they will cover?

[Earl Howe]

My Lords, I cannot yet give my noble friend a precise number, but before the House breaks up in the summer we hope to lay a number of statutory instruments. Some will come into force this October, others are designed to come into force next April, but we will of course be consulting, where appropriate, on all of those and I shall be happy to give the House further information when I have it.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Monday 19th March 2012 Lords Chamber

[Baroness Jolly]

My Lords, I shall speak briefly to Amendments 15 and 16 as well. They seem to be another correction to the minutiae of the provisions to establish a system of “nothing about me without me”—patient and public involvement—which we all support. However, it seems counterintuitive to aim to empower local people to improve health and social care without checking with them on the detail of how that empowerment should take place. The checks and balances of local patient and public involvement will be particularly important as the rest of these reforms are implemented, so we must get it right now.

Most of this part of the Bill was subject to a redraft, just a week or so ago, without any public consultation. Therefore, it would be helpful if the Minister could give an undertaking that there will be public consultation on all the many regulation-making powers within it. Thirty-six provisions are dependent on regulations, as are two lots of statutory guidance and two lots of directions.

In all previous iterations of patient and public involvement structures, there has been consultation on regulations. Given the complexity of the latest set of provisions and the limited opportunity to scrutinise them, it would seem wise to consult on them. I hope that the Minister will confirm that this will be done.

[Earl Howe]

My Lords, I am grateful to the noble Lord, Lord Patel of Bradford, for all that he said. I hope that the House will accept the amendments, which I assure noble Lords are intended to bolster and support the amendment previously agreed by your Lordships.

To address the issues raised by my noble friend Lady Jolly, as my noble friend Lady Northover said on Report, we have always envisaged that local authorities will have some freedom and flexibility over the organisational form of their local healthwatch, depending on local needs and circumstances. On reflection, we felt the Bill did not provide the right legal framework for this policy to be realised. My noble friend Lady Jolly makes a good point about the need to get this right. I should like to reassure her that we have already begun to engage key stakeholders on the content of the regulations and will continue to do so while they are being developed.

It may also be helpful to point out that we envisage the content of a number of these regulations—for example, those on the duties of service providers to respond to local healthwatch and allow entry to local healthwatch—will be based on the current Local Involvement Network regulations.

The noble Baroness, Lady Finlay, asked me about the Welsh amendments. I can confirm that the ombudsman covers all patients funded by the NHS. It is not something that is judged on an organisational basis. I hope that is helpful.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Tuesday 28th February 2012 Lords Chamber

[Baroness Jolly]

My Lords, I thank the Minister for his ever-open door and his willingness to listen. Will he further explain to the House how he believes that the NHS will be stronger for the scrutiny from all sides of the House? How does he believe that the objections of the Royal Colleges, such as the Royal College of Nursing, the BMA and other professional bodies have been met as a result of this cross-party scrutiny?

[Earl Howe]

My Lords, I completely agree with my noble friend. I feel that the debate and discussions that we have had in your Lordships’ House have made this a better Bill, as I said a moment ago. Again, a prime example of that is the clauses relating to ministerial accountability. With regard to the Royal Colleges, we have made all sorts of improvements, such as those in response to concerns about the integration of services, education and training, research, health inequalities, ensuring that competition is never an end in itself and a number of other important issues. I am glad that these changes were all welcomed by a wide range of Royal Colleges.

NHS: Management Consultants

Debate between Baroness Jolly and Earl Howe

Monday 13th February 2012 Lords Chamber

[Earl Howe]

Yes, I can. The reform of the NHS is a major project. Frankly, it would be irresponsible if the Government were not to commission expert professional advice in undertaking a project of this kind. Consultancy, if used judiciously, can be highly cost-effective. I assure the noble Lord that the implementation of the Health and Social Care Bill is occupying our minds night and day and, so far, I am pleased to report that it is going well.

[Baroness Jolly]

Can my noble friend tell the House how many reports were written for the Department of Health by McKinsey between 1997 and 2010?

[Earl Howe]

I do not have the figure that my noble friend asks for. I do have a figure for the spend by the previous Administration between 2006 and 2010 on consultancy from McKinsey. That amounted to nearly £30 million. In 2005-06, just one year, the previous Government spent more than £170 million on consultancy services with Accenture plc.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Monday 13th February 2012 Lords Chamber

[Baroness Jolly]

Certainly local government will play a key role in all this, so the scrutiny committees would seem to be a sensible place to take information from, which would then work in with their local healthwatch.

[Earl Howe]

My Lords, let me begin by setting out what we intend for the standing rules. We intend to use the rules to replicate core elements of the current system that need to be maintained in the future. For example, the standing rules will be used to provide the legal basis for certain patient rights as set out in the NHS constitution. Amendment 38, tabled by the noble Lord, Lord Hunt, will do three things. First, it seeks to require the Secretary of State to make standing rules as opposed to enabling him to do so. Secondly, it would require rather than enable him to update the standing rules no less than once a year; and finally, the Secretary of State would be obliged to share the standing rules with the relevant committee of the House of Commons for consideration at least two months before they are laid in Parliament. I hope that I can help the noble Lord here.

It is already our intention to make standing rules and to review them on an annual basis alongside the mandate. Where it is necessary, the Secretary of State would update the standing rules. Imposing a requirement on him to produce regulations regardless of whether an update is necessary will introduce what I believe is a needless administrative and bureaucratic burden on the system, and we surely do not want that. The amendment would also set out a requirement in legislation for the Health Select Committee to examine the proposed standing rules. I hope that I can reassure him that the committee would have the opportunity to examine proposals, and that Ministers in the department would engage constructively with the committee on any inquiry. However, I do not think that it is usual practice for legislation to set expectations as to the subject that Select Committees should examine or what areas committees should focus on. I should also remind the House that any regulations laid in Parliament are also considered by the Merits Committee of your Lordships’ House, as well as the Joint Committee on Statutory Instruments.

I turn now to the remaining issues. I think that it would be helpful to set out what we aim to achieve with the mandate. The mandate will bring with it an unprecedented degree of transparency, scrutiny and accountability to government policy for the NHS. For the first time, the Government’s core objectives for the NHS commissioning system will be subject to full public consultation.

A number of the amendments in this group, both government and from your Lordships, focus on the parliamentary scrutiny of the mandate. Amendments 41 and 46, tabled by the noble Lord, Lord Hunt, would make the mandate subject to the affirmative resolution procedure and require the Secretary of State to lay the mandate in Parliament in draft. I hope that I can reassure your Lordships that we have already built in sufficient parliamentary scrutiny of the mandate to render the amendments unnecessary.

Following the Delegated Powers and Regulatory Reform Committee’s recommendations, the Government have tabled Amendments 45 and 47, to which I now speak, to allow specific parliamentary scrutiny of the “requirements” within the mandate by providing that they can be brought into effect only by regulations subject to the negative resolution procedure.

However, making the mandate as a whole subject to the affirmative procedure would go too far. Parliament will set the parameters that the NHS will operate within, through this Bill and the legislation that will support it. This is a Bill that takes many powers away from Ministers and gives them back to Parliament, but it should be for the elected Government of the day, not for Parliament, to set specific policy objectives within that legislative framework following full consultation.

Of course, parliamentarians will have an interest in the mandate, and will have the opportunity to debate and influence it in the usual ways. As Clause 1 of the Bill makes clear, following our debate last week, the Secretary of State retains his responsibility to Parliament for the health service; and Parliament has the right to hold him to account for the health service, including the setting of the mandate.

Amendment 43, tabled by my noble friend Lady Williams and three of my other Liberal Democrat noble friends would require the Secretary of State to explain how the mandate supported his cross-cutting duties. I think that part of the motivation for the amendment is a concern to ensure that the mandate is not simply about financial issues. I hope that I can reassure my noble friend Lady Williams in particular on this point. It is our firm belief that the mandate should focus on the strategic outcomes and policies that the Government wish the NHS Commissioning Board to achieve. At the heart of this should be objectives for improvement against the NHS outcomes framework. The mandate will also be an opportunity for the Government to set specific objectives about the policies that we have set out in the NHS White Paper and the government response to the NHS Future Forum; for example, about extending patient choice and enabling clinical commissioning groups to flourish.

While the mandate will set the budget for the board and could include objectives relating to efficiency or financial management, it definitely will not be primarily about financial controls. Of course financial controls are essential, but the Bill has separate provisions for these under Clause 23. The mandate will not be a narrow and technical financial document which requires a separate justification of how the Secretary of State has fulfilled his legal duties; rather, it will visibly embody his duties. So I do not believe that an extra reporting requirement in the Bill is necessary.

Amendment 49 would require the board in consultation with the Secretary of State to set standards for the management of commissioners’ and providers’ accounts to enable efficiency comparisons. This comparison would be published annually by the Secretary of State. I understand the concerns which have led to the tabling of the amendment, but it would be an unnecessary and perhaps bureaucratic imposition on NHS providers and commissioners, distracting them from improving outcomes for their patients and the wider QIPP challenge.

It is important to be able to make comparisons of efficiency, but the board and, in turn, CCGs should be given the autonomy to decide whether and how to do this. I happen to know that work is currently proceeding in this area.

Monitor’s role currently includes the oversight of the financial management of foundation trusts, and the Trust Development Authority will do the same for non-FTs, so this information is already available for providers.

My noble friend Lady Jolly referred to HealthWatch England. It is specified in subsection (8) of new Section 13A as someone the Secretary of State must consult in developing the mandate. HealthWatch England will be able to feed in the views of local healthwatch as well.

Amendments 48 and 293, tabled by the noble Lord, Lord Hunt, would require parallel mandates to be set for Monitor and the Care Quality Commission. Again, I hope that I can persuade him that that is not necessary.

Monitor and CQC are independent regulators, with clearly defined statutory functions. Their core role is unchanging and regulatory, rather than about achieving a series of evolving policy objectives. Therefore, there is far less reason for the Government to set them a specific mandate. The fact that there is a statutory mandate in the Bill for the Commissioning Board reflects the different nature of the board’s role.

As with any arm’s-length body, there is a framework agreement between it and the sponsor department, which is used as the basis for monitoring the body’s ongoing performance. That is the approach that the department uses and will be using for all of its arm’s-length bodies, including CQC and Monitor. That will be underpinned by formal reviews of each organisation’s capability, at least every three years.

The department will retain overall stewardship, system leadership and accountability for ensuring that the different national bodies are working as Parliament intended. As I have mentioned on previous occasions, the Secretary of State will have formal powers to intervene in the event of significant failure. I hope that that reassures the noble Lord, and that he will feel able to withdraw his amendment.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Wednesday 8th February 2012 Lords Chamber

[Baroness Jolly]

Before the Minister sits down, will he clarify whether the same processes that he has just outlined would apply to people in receipt of specialist services that are commissioned by the NHS Commissioning Board, not by local CCGs?

[Earl Howe]

My Lords, where a service is commissioned by the NHS Commissioning Board—and let us imagine that it is a specialised service—the patient’s recourse should be to the board. However, of course, the board will be represented at a local level rather than only centrally, and we expect that the board will be represented in health and well-being boards and in the discussions that take place there. It would therefore be possible for a patient to address their concerns, in the first instance, to the health and well-being board, which would have the ability and power to communicate directly with the NHS Commissioning Board, if that was felt to be appropriate. However, as I said, the patient would be able to go straight to the board in those circumstances.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Thursday 19th January 2012 Lords Chamber

[Baroness Jolly]

My Lords, health reforms rarely come at low cost. Can the Minister tell the House how much the previous Government’s health reforms cost between 1997 and 2010?

[Earl Howe]

My noble friend is right to remind the House of the repeated reforms of the health service made under the previous Administration. I do not have a figure for how much they cumulatively cost the taxpayer, but it was clearly a great deal and I recall that one of the reforms took place over the course of the summer without any reporting to Parliament at all. The contrast between those reforms and this one is marked. We are doing this to get better care for patients. The previous Government were really only doing it to rearrange the deckchairs.

NHS: Transition Risk Register

Debate between Baroness Jolly and Earl Howe

Wednesday 18th January 2012 Lords Chamber

[Earl Howe]

My Lords, to answer the second part of the question first, a substantial number of the risks pertaining to the Bill are already in the public domain and we are considering whether there is scope to draw these sources of information together in a single place, so that noble Lords can look at them more easily. To answer the first part of the noble Baroness’s question, I made inquiries about NHS London. Its situation is very interesting and quite different from that of the Department of Health. NHS London developed its risk management strategy with a view to it being visible to stakeholders and the public, as its document says. It is therefore a reasonable assumption that officials will have worded their risks for inclusion in the register in the knowledge that that wording would be likely to form part of a document placed in the public domain, so there is a very real difference between the two situations.

[Baroness Jolly]

My Lords, as has been suggested, there are wider issues here. Could my noble friend the Minister tell the House to what extent he believes the use of risk registers might be compromised if their authors feel they cannot be entirely candid?

[Earl Howe]

My Lords, risk needs to be thought about and assessed thoroughly and often in worst case terms in order to inform policy development and implementation. Risk registers are therefore a basic policy management tool and, for robust risk management to take place, officials have to be free to record all potential risks fully and frankly, with absolute candour, in confidence that anything they say will not be disclosed. If officials knew or believed that what they wished to say was going to be disclosed, that would inhibit them in expressing views fully and frankly. That, in turn, would erode confidence in policy-making and impede good government.

Health: Pathfinders

Debate between Baroness Jolly and Earl Howe

Thursday 12th January 2012 Lords Chamber

[Baroness Jolly]

To ask Her Majesty’s Government what support and guidance is being offered to pathfinder clinical commissioning groups in commissioning integrated health and social care services.

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

My Lords, pathfinders are receiving national and local development support. With their SHA and PCT cluster, pathfinders are exploring approaches to clinical commissioning, including integration of health and social care. Key to this will be engagement with local authorities and secondary care. Our national learning network allows pathfinders to share learning and best practice. Pathfinders will be authorised to take on their full commissioning functions only when the NHS Commissioning Board is certain that they are ready.

[Baroness Jolly]

I thank the Minister for his reply. He outlined the fact that local authorities will play a key role in this new world. We hope that they will commission for patients and not for the condition. For the health and well-being boards to operate effectively, they, too, need support. What support are the Government able to offer, and what support are they offering pathfinder health and well-being boards within local government at present?

[Earl Howe]

My noble friend is right. We were very pleased to see the NHS Future Forum says that running right through the Health and Social Care Bill is the desire and aim to integrate services. That is certainly right. We recognise that there is a balance to be struck between allowing local ideas to spring up and people to progress their own ideas and having the necessary support from the centre to do that. We have established a national learning network for pathfinders to complement the support given to them by strategic health authorities and PCTs. Those learning networks will ensure that best practice is spread and, specifically, that pathfinders support other local groups which are less developed.

Health: Influenza Vaccination

Debate between Baroness Jolly and Earl Howe

Tuesday 10th January 2012 Lords Chamber

[Earl Howe]

I agree that there is some way to go. It is encouraging that we have made significant progress this year. Of course, the season is not yet at an end, and we hope that more healthcare workers will still be vaccinated. Uptake rates in healthcare workers have historically been low, as the noble Lord will be aware. A number of reasons have been suggested for that, but there is no doubt about the importance of this issue. Part of the reason is the need to ensure that healthcare workers do not transmit flu to those they are looking after. Also, it is in the interest of employers to ensure that absenteeism for sickness reasons is kept to a minimum.

[Baroness Jolly]

My Lords, will the Minister clarify whether the same measures will be taken whenever public or NHS money is spent, which is not only in the public sector but in the private voluntary and mutual sectors?

[Earl Howe]

My Lords, in general it is incumbent on employers, whether in the public or the independent sector, to ensure that their staff are protected appropriately. If my noble friend’s question alludes to the fact that independent providers may be offering services to the NHS, then I agree that there is a duty there, and we will see, as we already see, that that provision is taken account of in the contracts that commissioners take out with independent providers.

Health: Flu Vaccine Research

Debate between Baroness Jolly and Earl Howe

Wednesday 23rd November 2011 Lords Chamber

[Earl Howe]

The noble Baroness is quite right. The Chief Medical Officer wrote to the NHS on 25 May, citing four studies that provide strong evidence of the benefit of influenza vaccination for front-line healthcare workers. These studies show clearly that healthcare workers can transmit influenza to patients, that vaccination of healthcare workers can prevent that transmission and that vaccination of healthcare workers can lead to better health outcomes in the vulnerable patients with whom they very often deal.

[Baroness Jolly]

My Lords, can my noble friend confirm that there is a problem with supplying the H1N1 vaccine? If that is the case, how is it proposed to target it more effectively and what steps will be taken to make sure that vulnerable people are targeted first?

[Earl Howe]

My Lords, there were supply problems last winter, but my advice is that there are none this winter. Indeed, the quantity of vaccine that has been ordered for this winter’s anticipated flu outbreak is considerably larger than was the case last year. The Government also have a reserve stock of vaccine to be deployed in the event of local shortages.

NHS: Waiting Times

Debate between Baroness Jolly and Earl Howe

Tuesday 22nd November 2011 Lords Chamber

[Earl Howe]

My Lords, we believe that the safeguards are already in place, but the figure I cited in my original Answer is very similar to the figure we have seen over the past two and a half years. Little progress has been made over that time. We do not think that that is satisfactory, so we are broadening the operational standard to ensure that more patients are treated in a timely way. I am sure all noble Lords would wish to see that.

[Baroness Jolly]

My Lords, approaching 250,000 patients have been waiting for more than 18 weeks and I expect that they would like to know why, as would the House. Can the Minister give us any indication, apart from the five hospitals mentioned earlier, of whether there is a regional pattern to this—while we still have regions—or of whether it is the result of financial pressures, clinical management issues or maybe a combination of all three?

[Earl Howe]

It does seem to be a combination of all three, although it is clear that in certain areas there is a shortage of the necessary specialist consultants. Sir Bruce Keogh, the NHS medical director, is addressing this urgently with the British Orthopaedic Association in particular. That is expected to result in a solutions paper being put to the NHS Operations Executive in the new year.

Health and Social Care Bill

Debate between Baroness Jolly and Earl Howe

Monday 14th November 2011 Lords Chamber

[Earl Howe]

Will my noble friend allow me to write to him on that point?

[Baroness Jolly]

I thank the noble Earl for his reply, the noble Baroness, Lady Wheeler, for her commitment to quality and the noble Lord, Lord Whitty, for the patient voice input. I beg leave to withdraw the amendment.

NHS: Hinchingbrooke Hospital

Debate between Baroness Jolly and Earl Howe

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

I will, of course, write to the noble Baroness with detailed answers to the first part of her question, which would take too long for me to answer now. I can say that this is a transfer of risk to the private sector. That is why it is a good deal. It is also a good deal in another sense, because patients will still have a hospital in Hinchingbrooke. This is a hospital that in common parlance could be described as a financial and clinical basket case. No NHS bidders were willing to take it on. When the previous Administration left office, only independent sector operators were in the frame to do so. We therefore knew at the last election that there would be an independent sector solution. I think that it is a win-win situation all round. It is good news for Hinchingbrooke patients, and I understand that under normal Freedom of Information Act rules the contract involved will be made available, subject to commercially confidential details being redacted.

[Baroness Jolly]

My Lords, will the Minister please tell the House who was consulted in making this decision and what sort of support was found among the local community and hospital staff?

[Earl Howe]

My Lords, there was extensive consultation, but the important point for my noble friend to understand is that this was a locally led process. Ministers—and, for that matter, civil servants in the department—were not involved in the decision process. The decision was made by the strategic health authority board and the recommendation then came to Ministers. However, I can tell my noble friend that support for this decision has been very widespread, not least among the medical community in the area.

EU: Economy

Debate between Baroness Jolly and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

[Earl Howe]

My Lords, except in limited circumstances, which must be set out in their contract, primary medical service contractors—GPs, in other words—cannot directly or indirectly seek or accept from any of their patients a payment or other remuneration for any treatment. The prohibition not only relates to treatment provided under the primary medical services contract but extends to any treatment that may be provided to the patient.

[Baroness Jolly]

My Lords, we all agree that the NHS logo must be one of the most trusted brands in the UK. It is currently outside diagnostic and treatment centres which are privately run, so can the noble Earl tell the House whether the Government will issue guidance to any qualified private providers about the use of the logo?

Health Authorities (Membership and Procedure) Amendment Regulations 2011

Debate between Baroness Jolly and Earl Howe

Monday 31st October 2011 Grand Committee

[Baroness Jolly]

My Lords, I will add to the points raised hitherto. I welcome the emphasis on continuity, but I wonder whether there is an opportunity to think whether we are closing the door completely on appointing new non-executive directors. We are moving into a new world with a new mindset and culture. If we are going to retain non-executive directors currently in situ in SHAs, will that opportunity be lost? I should like that to be clarified.

We must not lose sight of the fact that these are enormous organisations geographically. From one end of Cornwall to the other end of Kent is further, distance-wise, than from London to Edinburgh. There are issues about representation on boards. There must be complete understanding of the different issues in metropolitan, rural and urban settings. That will be critical for any board.

Also, does the noble Earl have any figure for what the savings in management costs might be? I seem to remember that when this was done for PCTs and they were all enlarged to become coterminous with local authorities, management savings were promised but not delivered. What is the size of the savings that we hope for? Have the Government factored in the risk with all of this?

[Earl Howe]

My Lords, I am grateful to noble Lords for their questions, which I will try to deal with in order. The noble Lord, Lord Beecham, asked about the extent to which the new bodies will be subject to local authority scrutiny. There is no change to the existing arrangements for scrutinising SHAs. All 10 SHAs still exist. They must meet their duties as set out in legislation.

The noble Lord also made a good point about geographical representation, geographical balance and the spread of local knowledge. What we tried to achieve with the ring-fenced competition, to which I referred, across the geographical boundaries of each cluster was to arrive at a point where we had as much geographical representation as was practicable. The chairs of individual SHAs who were not appointed as cluster chairs were invited to become vice-chairs so that corporate knowledge could be preserved.

NHS: Hospitals

Debate between Baroness Jolly and Earl Howe

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

My noble friend is right. The statistics for the productivity of the NHS over the past 10 or 12 years show that it has actually gone down by about 3 per cent in total. We certainly think that the private sector has a role to play in places where it can introduce the higher quality of service that patients actually want. There is no question, however, of the Government forcing private enterprise into health services where it is not wanted and not in the interest of patients.

[Baroness Jolly]

My Lords, within England there are already several NHS-badged private hospitals. Can my noble friend tell the House how many of these establishments were set up by the previous Government and how many of their employees are non-UK nationals?

[Earl Howe]

My Lords, I am grateful to my noble friend for that question. I am sorry to say that I do not have those figures in front of me, but she is absolutely right to make the point that the independent sector treatment centres introduced by the previous Government were a perfectly proper move to increase choice for patients, and in many cases we have seen the quality of care in those hospitals encourage the NHS to raise its own game. Competition on that basis is highly beneficial.

NHS: Medical Records

Debate between Baroness Jolly and Earl Howe

Wednesday 7th September 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is absolutely right. We have to measure performance in order to improve upon it. That is why we are focused on producing an information strategy, which we hope to publish later this year. A lot of work has already gone on and the NHS Future Forum, as he may know, is looking at this area. He is absolutely right that this will be central to the performance management of the NHS.

[Baroness Jolly]

My Lords, we are now well into the 21st century. Can the Minister give us some indication as to when patients might be able to access their own records online?

[Earl Howe]

This is a commitment that we have made. We fully support the concept of patients having full access to their medical records online. A great deal of work is going on at the moment to make sure that the protocols are sound, because clearly the one thing one does not want is for the wrong people to access the wrong patient data. If we can achieve that and do it in a simple way, we shall roll the programme out as soon as we can.

NHS: University Health Centres

Debate between Baroness Jolly and Earl Howe

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, there is no doubt that the QOF had many beneficial effects when it first began, and we recognise those. However, there is a general feeling that it needs to evolve and refocus itself more on those things for which it was originally intended, which were to promote quality and better outcomes in patient care.

[Baroness Jolly]

My Lords, student health does not quite fit the national pattern. Who is currently responsible for public health campaigns within the student body and, with the advent of clinical commissioning groups, is their future assured?

[Earl Howe]

I am not sure whether my noble friend is asking me whether university practices are assured under clinical commissioning groups or whether those public health efforts are assured.

[Baroness Jolly]

I am asking about the public health campaigns.

[Earl Howe]

My Lords, my noble friend will know that public health campaigns and health improvement efforts are currently being commissioned and directed by primary care trusts. That will continue until such time as local authorities take responsibility locally for the public health endeavour.

NHS: Clinical Excellence Awards

Debate between Baroness Jolly and Earl Howe

Monday 27th June 2011 Lords Chamber

[Earl Howe]

I agree with my noble friend. We have identified a number of anomalous features in the current scheme which need to be looked at. He is absolutely right to point out that the current scheme is far from transparent. It enables rewards to continue that are based on historic performance rather than anything more up to date.

[Baroness Jolly]

My Lords, clinical excellence is important at community level as well. Would the Minister tell the House whether any restrictions will be placed on the commissioning groups concerning the payment of rewards to their members?

[Earl Howe]

My Lords, the pay structure for clinical commissioning groups is a separate issue from clinical excellence awards, which apply only to those holding a consultant’s contract in the NHS. To the extent that anyone holds a consultant’s contract in any of the clinical commissioning groups, they will be subject to whatever new scheme the DDRB recommends and the Government accept.

Drugs: Prescribed Drug Addiction and Withdrawal

Debate between Baroness Jolly and Earl Howe

Thursday 23rd June 2011 Lords Chamber

[Earl Howe]

I agree with the noble Lord that it would be very nice to have a better handle on the numbers here, but the two reports found that nationally available data do not actually provide a definitive prevalence estimate of dependence on prescription and over-the-counter medicines, much as we would wish otherwise. The reports, not unreasonably, consider the full spectrum of need in relation to the issue of addiction. The key point here is that, while different people might start taking these medicines for different reasons and may present with a different range of needs, no one at all should be excluded from the treatment and support that they require. The reports distinguish between the two groups of patients, not just those who are dependent on prescription and over-the-counter medicines but also those who are dependent on illegal drug use. That enables us to make some useful comparisons.

[Baroness Jolly]

Cognitive behaviour therapy is often considered as an alternative to benzodiazepines. Does the Minister believe that that low-risk alternative might be available more readily through the proposed clinical commissioning groups?

[Earl Howe]

My Lords, my noble friend will know that we have set aside a very considerable sum of money over the spending review period to expand the availability of talking therapies. I entirely agree that it is an important avenue of treatment.

NHS: Chiropody and Podiatry Services

Debate between Baroness Jolly and Earl Howe

Tuesday 26th April 2011 Lords Chamber

[Baroness Jolly]

My Lords, in some parts of the UK it is not possible to train as a podiatric surgeon. Consequently, podiatric surgery is not widely available. Will my noble friend tell the House whether in England the Government are planning to encourage more centres for training appropriately qualified podiatrists, thus remedying the situation?

[Earl Howe]

My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.

NHS Reform

Debate between Baroness Jolly and Earl Howe

Monday 4th April 2011 Lords Chamber

[Earl Howe]

That is a very interesting question. GPs should already be subscribing to the Nolan principles. They are attributes which they would wish to demonstrate in their working lives anyway—having said which, it is the responsibility of every public body to ensure that it takes account of the Nolan principles. Consortia will be public bodies, ergo they will have to take account of the Nolan principles.

[Baroness Jolly]

Would my noble friend tell the House whether any staff have already been seconded to the pathfinder commissioning consortia, as a result of the clustering of the PCTs?

[Earl Howe]

We are assigning particular staff to pathfinder consortia. Those staff will remain within the PCT clusters. They will not transfer officially to the consortia because the consortia are not officially in existence yet. The point here is to have staff who are dedicated to supporting the emerging consortia over the next few months. This is already in train.

Health: Preventable Sight Loss

Debate between Baroness Jolly and Earl Howe

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes some extremely important points. This is a good news story and very good progress has been made; more people with diabetes are being offered screening for retinopathy than ever before, and to higher standards. More people are being offered screening now than when the screening programme was announced in January 2003. At that time, 1.3 million people with diagnosed diabetes in England were being screened. The latest figures, for December 2010, show that 2.21 million people were offered screening.

[Baroness Jolly]

My Lords, given that sight loss will cost the economy £8 billion a year by 2013, will the Minister outline for the House the determining factors in extending free sight tests to all?

[Earl Howe]

My Lords, various categories of patients are eligible for free sight tests. Free tests are available under the NHS to a large number of people, including people aged 60 and over, children under 16 and people on low incomes. As I mentioned, the uptake of sight tests is increasing, which shows that people are continuing to get good access to NHS eye care services; but as regards an extension of the numbers, that will of course depend on available funding.

NHS: Reorganisation

Debate between Baroness Jolly and Earl Howe

Thursday 24th March 2011 Lords Chamber

[Earl Howe]

I am very grateful for the noble Lord’s question, because it gives me the opportunity to pay tribute to the skill and dedication of our managers and administrators in PCTs and strategic health authorities, whose skills we will most certainly need once the modernisation plans have been completed. We are clear that those who are able to provide these skills and can give us continuity into the new system are people we want to keep. We are encouraging them to stay and hope that they will. We are encouraging also the pathfinder consortia to engage with the PCTs to enable that to happen.

[Baroness Jolly]

My Lords—

Health: Visitor Service

Debate between Baroness Jolly and Earl Howe

Monday 14th March 2011 Lords Chamber

[Earl Howe]

The right reverend Prelate draws attention to a very important area. Family Nurse Partnership is essentially a preventive programme for vulnerable young first-time mothers. It complements and supports the work of health visitors, providing intensive care. We are committed to expanding the Family Nurse Partnership Programme for those families and doubling the number of places on the programme by 2015.

[Baroness Jolly]

My Lords, this is a really large programme. Will the noble Earl clarify whether, if these posts are filled from within the NHS, those posts will in turn be backfilled?

[Earl Howe]

My Lords, we hope to recruit nurses and midwives for upskilling from a variety of sources. Some will come out of retirement, we hope, while others will, we trust, come from the acute sector. As my noble friend knows, the trend for a long time has been to try to get care increasingly out of acute settings and into the community. I think that we will see that transfer of skills taking place from a variety of sources.

Health: Multiple Sclerosis

Debate between Baroness Jolly and Earl Howe

Wednesday 2nd February 2011 Lords Chamber

[Earl Howe]

My Lords, at the moment, the appeal process is to the primary care trust. Under the Government's proposals, the appeal will be, in the first instance, to the GP-led consortium and, thereafter, if appropriate, to the NHS commissioning board.

[Baroness Jolly]

My Lords, medication is clearly critical for patients with MS, but a whole range of aids are also available. How does my noble friend think that those aids might be more readily available under the new, reformed NHS?

[Earl Howe]

Again, my Lords, the requirement for aids will emerge from two driving processes: one will be the clinically led commissioning process and the other will be patient-led groups. Neurological Commissioning Support is already driving forward an extremely coherent and up-to-the-minute commissioning pattern of pathways for the emerging GP consortia. Patient power will have a big influence as well.