Student Loans: Interest Rates

Debate between Baroness Manzoor and Earl Howe

Monday 11th September 2017 Lords Chamber

[Baroness Manzoor (Con)]

My Lords—

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

My Lords, I think it is the turn of the Conservative Benches, but I hope we can also fit in a question from the noble Lord, Lord Adonis.

[Baroness Manzoor]

I thank my noble friend. Is there any merit, while the Minister is reviewing interest rates, in giving consideration to CPI, which of course is lower than RPI?

Tax Credits (Income Thresholds and Determination of Rates) (Amendment) Regulations 2015

Debate between Baroness Manzoor and Earl Howe

Monday 26th October 2015 Lords Chamber

[Earl Howe]

I do not dispute that the Institute for Fiscal Studies has looked at these things, but the figure of £1,300 that has been quoted is one that does not take into account the positives that I mentioned. Importantly for families with children, the doubling of free childcare should not be overlooked. For many people, although not for all, that will make it possible to work longer hours. Those are just some of the counterbalances. The noble Baroness, Lady Manzoor, chose not to mention them.

I cannot pretend that these have been easy decisions. However, I put it to the House that the measures that we are taking are the right thing for us to be doing—right not only for individual working families but for the nation. We are still, as a nation, living grossly beyond our means. Even so, eight out of 10 working households will be better off by 2017-18 than they are now because of the combined effect of the measures that we are taking.

[Baroness Manzoor]

Will the noble Earl say where the evidence is to support that assertion about eight out of 10 households? That is partly the problem, because those sorts of impact assessments have not been done.

[Earl Howe]

The evidence was in the Budget analysis, which I am sure the noble Baroness has read—the distributional analysis that came out at the time of the Budget.

--- Later in debate ---

[Earl Howe]

I understand what the noble Baroness is seeking to achieve here, but the fact is that the House of Commons has looked at this three times and has not overturned the proposals. In fact, it has approved them. I would simply say to the noble Baroness that if we are talking about the advice given by the Clerk of the Parliaments, there is a crucial difference between an amendment that it is procedurally permissible to bring before the House, and one which it is constitutionally proper for the House to approve. I do not take issue with the noble Baroness, Lady Meacher, or the noble Baroness, Lady Hollis, bringing forward their amendments. What I do take issue with is the idea that we should vote in favour of either of them, or indeed in favour of the amendment in the name of the noble Baroness, Lady Manzoor.

I need to conclude. For the House to withhold its consent to the regulations today would, in my submission, mean overruling the House of Commons on an issue which that House has already expressed its view on three times. In other words, it would mean doing what this House has not done for more than 100 years, which is to seek to override the primacy of the House of Commons on a financial matter. So I say respectfully to the noble Baronesses, Lady Manzoor, Lady Hollis and Lady Meacher, that there is a right way and a wrong way to challenge government policy on a matter of this kind. This is the wrong way. The right way is to table an amendment such as the one in the name of the right reverend Prelate—not that I support it, but that is the proper way of doing it—or at a suitable opportunity to table an amendment to primary legislation. Indeed, a Bill is coming to us shortly, the Welfare Reform and Work Bill, which would enable noble Lords to do exactly that, should they so choose.

My contention is this. The measures in these regulations form a central plank of the programme on which the Government were elected to office in May. It is a programme that has been in the public domain for a long time. However, even if it was not and even if these were policies dreamt up by the Chancellor overnight, I respectfully say to your Lordships that this House, under its conventions, should not reject statutory instruments or seek to overturn the primacy of the other place on a matter of very sizeable public expenditure. I therefore invite the sponsors of each of the amendments to withdraw them, and I urge the House to allow the regulations to pass. Moreover, I simply remind the House that in order to support the amendment in the name of the right reverend Prelate, the preceding three amendments need either to be withdrawn or defeated.

[Baroness Manzoor]

My Lords, I thank everyone who has contributed to this debate. Noble Lords will be relieved to hear that I do not intend to summarise the excellent contributions that have been made from all sides of the House. As your Lordships know, I am a relatively new Member, and for me it is a privilege to serve as a Member of this House. But with that privilege comes responsibility.

Tabling this Motion was not something I did lightly. I do not discount the strength of feeling on the role of the House and I do not believe that this is a situation in which the House should find itself regularly. However, ultimately this is about the House making a decision on whether we think it is acceptable for the Government to cut off vital support for 3 million families which they claim to support. It is about whether we think it is acceptable for the Prime Minister to make these changes not via primary legislation, but by a procedural instrument—in direct contradiction of what he said to people during the general election. It is about whether we think it is acceptable for this House to relinquish its responsibilities to those affected.

I welcome the Leader of the House saying that the Chancellor will be listening to this debate—and I hope also to the country—very carefully. But I could not look myself in the eye tomorrow if I had not done all I could to stop this devastating measure going through. I know that many in my party feel the same, and while I hold no ill will against anyone who does not share our view, I hope that those who agree that the lives of the 4.9 million children who will be affected should be our primary concern will join us in the Division Lobby. Tax credit cuts for low-paid working families are short-sighted and deeply damaging, not only to the parents and children who will bear the cost, but to the Government’s own long-term goals. I urge the Government to rethink, and I hope the House will choose to reject the regulations as they stand. I wish to test the opinion of the House.

Barts Health NHS Trust

Debate between Baroness Manzoor and Earl Howe

Thursday 19th March 2015 Lords Chamber

[Earl Howe]

The noble Baroness is right. The CQC found that there was a culture of bullying at Whipps Cross. They had concerns about whether enough was being done to encourage a culture of openness and transparency—something on which, as she knows, we place great emphasis in the light of the report on Mid Staffordshire NHS Foundation Trust. I can only say to the noble Baroness that this is one of the issues that will be top of the list for the new improvement director at Whipps Cross.

[Baroness Manzoor (LD)]

My Lords, the culture within the NHS appears to be changing, and not for the better. Is the Department of Health looking at that, as well as at the issue of PFI across the NHS, and is it doing so not in a piecemeal fashion whereby things are identified only when they go wrong?

[Earl Howe]

It is precisely because we have wanted to confront the issue across the NHS that so much has been done following the report of Sir Robert Francis into Mid Staffordshire NHS Foundation Trust. All the recommendations flowing from that report should resonate with every part of the NHS. The recent work done by Sir Robert on whistleblowing can be put into the same category. There are lessons and messages for the NHS as a whole, and I believe that progress is being made, as it needs to be in particular quarters.

Gender-based Violence: Screening

Debate between Baroness Manzoor and Earl Howe

Monday 9th March 2015 Lords Chamber

[Earl Howe]

My Lords, we are concerned about the sometimes patchy provision of mental health services in certain parts of the country, and we have channelled additional money to address that in recent months. One of the main ways in which we have demonstrated our commitment to parity of esteem is by introducing, for the first time, waiting-time standards for mental health treatment. That it is a landmark.

[Baroness Manzoor (LD)]

My Lords, can the Minister please give an assurance that FGM is given a high priority in the health commissioning groups’ plans?

[Earl Howe]

Yes, my Lords. The Government hosted the first ever Girl Summit last year on ending female genital mutilation as well as forced marriage and other issues. We set up a specialist female genital mutilation unit following that summit. We provided money last year for the FGM prevention programme, and as part of this we introduced the first ever data collection in the NHS for all acute trusts, which are now required to record in a patient’s healthcare record whenever FGM is identified. We have also said that front-line professionals will in future have a mandatory duty to report cases of FGM in those under 18.

Jimmy Savile: NHS Investigations

Debate between Baroness Manzoor and Earl Howe

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

The noble Baroness has our admiration for the way in which she has coped with her spinal injury over these many years. She is, of course, absolutely right about the way in which Jimmy Savile duped so many people. He was a forceful character as well as somebody with a superficial charm, and he got away with what he did. She is, of course, correct that the protection of patients lies at the centre of all this and we must ensure that we have proper systems in place to make them feel confident that they can come forward.

I take the noble Baroness’s point about patients perhaps not feeling able to complain to the ward staff. The answer to her question is that the patient, or someone on their behalf, can complain to the chairman of the organisation or trust or to a member of the board, and thus bypass the clinical staff. There should always be a member of the board at the hospital whose responsibility is the protection of patients above all. In the end, it is for that organisation to investigate its own supposed failings. If somebody is not satisfied with the result of that investigation, it is then open to them to go to the ombudsman. We believe that complaints should be investigated at a local level, either with the provider of the service or, if that is not thought appropriate for any reason, with the commissioner of the service.

[Baroness Manzoor (LD)]

My Lords, in relation to the protection of patients, I ask the Minister whether it would it be possible, each time a patient is seen by anyone—whether it is an external visitor or, indeed, a doctor—to ensure that there is another person present, such as a nurse. Just recently, a colleague went for a breast examination. She was seen by only one person, a male doctor; no safeguarding was available there. As part of that consultation, I would welcome this assurance.

[Earl Howe]

I take my noble friend’s point. However, I would hesitate before committing to a situation where, in every instance that a doctor or nurse examined a patient, they had to have somebody with them. In the real world, I do not think that is going to be practical. What one should have, however, is an assurance that whoever examines the patient, or performs some intimate caring service with the patient, should have been checked for both a criminal record and a previous employment history. I will take my noble friend’s point away, but I think that what I have said would be accepted by those in the National Health Service as the only practical way forward.

NHS: Financial Tariff for 2015-16

Debate between Baroness Manzoor and Earl Howe

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, yes of course the bureaucratic nature of commissioning needs to be minimised and we do all we can to achieve that. However, the need to ensure that we make a careful distinction between commissioners and providers does, I am afraid, mean that rather a lot of numerical work has to go along with that and, as is right, discussion between commissioners and providers to ensure that the system works smoothly.

[Baroness Manzoor (LD)]

My Lords, Choose and Book has been a success story for the Government. It is a hidden gem. Will this be affected by the level of tariffs that are to be offered and will patients have a real choice?

[Earl Howe]

My Lords, no, Choose and Book will not be affected, although NHS England has plans to update it to make it a much richer and more informative system.

HIV: Late Diagnosis

Debate between Baroness Manzoor and Earl Howe

Monday 1st December 2014 Lords Chamber

[Earl Howe]

My Lords, local authorities have an important part to play in the battle against HIV and AIDS. They are mandated to commission open access sexual health services, and that means that people can self-refer to the service of their choice, regardless of its location. However, as the noble Baroness will know, this is an issue that goes beyond local authorities. The key message from National HIV Testing Week, which was last week, was that we should all take responsibility for reducing HIV transmission, and that those who feel they may be at risk should take an HIV test.

The testing taking place in sexual health clinics in 2013 was up on the year before. We are seeing very good work with, for example, African faith leaders, and we have also piloted national HIV self-sampling services, which undoubtedly have a great utility for those who are too embarrassed to go to a clinic.

[Baroness Manzoor (LD)]

My Lords, geographically the highest rates of late diagnosis of HIV were in the Midlands and the east of England with 52%, followed by the north of England with 42%, the south of England with 41% and London with 35%. In light of the announcement that was expected later in the week but which was made at the weekend by the Chancellor of the Exchequer—that there will be an additional £2 billion for the NHS—can my noble friend say whether community testing for HIV will be part of the money being spent?

[Earl Howe]

It is far too early for me to say how the new money will be spent. In any case, that has to be a decision for commissioners weighing up the healthcare priorities that face them. But the new money is excellent news for the NHS, and there will be a Statement later today about that.

NHS: Funding

Debate between Baroness Manzoor and Earl Howe

Monday 17th November 2014 Lords Chamber

[Earl Howe]

My Lords, I cannot speak for a party other than my own, but I can tell the noble Lord firmly that we are averse to any system of charging and wish to keep the NHS free at the point of use, regardless of ability to pay.

[Baroness Manzoor (LD)]

My Lords, the NHS five-year review clearly highlighted that there was a need to upgrade preventive and public health services. Can my noble friend the Minister say how this will be done, particularly when you go back to the 2011 WHO agreement on 25 goals, under which 25% of deaths have to be reduced by 2025?

[Earl Howe]

My noble friend is right to highlight the role of public health. That is why many people are encouraged that health and well-being boards, which now oversee the planning and prioritisation of healthcare in their local areas, are taking those public health goals into account and building them into the strategic health assessments. So the co-ordination of healthcare and public health is in a much better position than it was before the reforms.

Mental Health: Beds

Debate between Baroness Manzoor and Earl Howe

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

My Lords, if people with a learning disability are detained under the Act, this must be for assessment or treatment of mental illness. The person must satisfy the strict criteria laid down in the 1983 Act. When a learning disability is identified as well as a need for assessment or treatment of a mental disorder, the important thing is that alternatives to the use of the Mental Health Act are considered—for example, use of the provisions of the Mental Capacity Act and whether reasonable adjustments would assist the person with learning disabilities fully to access the assessment and treatment. This is an area we have explicitly covered in the draft code of practice, which is currently out for consultation.

[Baroness Manzoor (LD)]

My Lords, more black and ethnic minority people continue to be detained under the Mental Health Act. Can my noble friend the Minister say what is being done to address that issue?

[Earl Howe]

Yes, my Lords, we know that BME groups are overrepresented in the detained patient population. The reasons for that are quite complex. Research studies indicate that rates of detention reflect the needs of patients at the time of detention. We know that the rates of psychosis, for example, are higher in some BME communities, and they often access mental health services in a crisis. The reasons for that are not entirely clear. We recognise that more work needs to be done to establish the causes of higher rates of mental illness in some communities.

Health: Midwives

Debate between Baroness Manzoor and Earl Howe

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My Lords, we attach great importance to choice in maternity care and, in particular, to each mother having a named midwife throughout the care pathway. That is what we are aiming at and what NHS England and Health Education England are charged with delivering. As regards the age profile of midwives, my advice is that there is not a particular age bulge, although we are keen to ensure that we do not lose qualified midwives who, clearly, we can ill afford to lose. However, we have made a commitment to ensure that the number of midwives in training is matched to the birth rate and, so far at least, we have been successful in that.

[Baroness Manzoor (LD)]

My Lords, continuity in care is very important, particularly when you consider that one in 10 women suffers from postnatal depression, and that number increases to four in 10 for teenage mothers. Can my noble friend reassure the House that, first, there is good identification of health needs for mothers during the prenatal stage; and, secondly, that there is one-to-one care during labour and postnatal so that these women are helped and supported?

[Earl Howe]

My noble friend makes two important points. As I said, we attach great importance to each mother being able to have throughout the care pathway a named midwife. Improving diagnosis and services for women with pregnancy-related mental health problems is one of our objectives for maternity care. The mandate from the Government to NHS England includes an objective for NHS England to work with partner organisations to reduce the incidence and impact of postnatal depression through earlier diagnosis and better intervention and support. We are clear that midwives have a key role to play in that.

NHS: Hospital Waiting Times

Debate between Baroness Manzoor and Earl Howe

Thursday 10th July 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, the Government have stated that there is to be parity of esteem between mental health services and acute services. Will my noble friend the Minister state whether this will include waiting times for the provision of mental health services to both adults and children?

[Earl Howe]

Up to now, mental health has been omitted from the waiting time standards. However, we are looking actively at what might be possible within the bounds of affordability.

NHS: District Nurses

Debate between Baroness Manzoor and Earl Howe

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

I am happy to look into that case, but clearly we need to ensure that there are the right skills for the right patients, and this is what the health service increasingly aims to achieve. The district nursing team has to contain those multidisciplinary skills. If there is a case of someone being inappropriately looked after, then that is certainly a cause for concern.

[Baroness Manzoor (LD)]

My Lords, nearly 50% of district nurses are over the age of 50. I heard what the Minister said regarding the number of nurses in training but perhaps the numbers could be looked at again, because quite a number of district nurses will soon be retiring.

[Earl Howe]

My noble friend makes a good point, and this was highlighted by the royal college. Health Education England was established precisely to ensure a greater connection between the needs and demands of local employers and the education and training commissions which are made. It takes into account all the relevant variables, such as the age profile of the workforce, to ensure that it sets the appropriate number of training places for district nurses to meet future capacity and capability service needs. As I mentioned earlier, Health Education England has in fact increased the number of training places for district nurses by 7% this year, to 431 places.

National Health Service: Nursing Staff

Debate between Baroness Manzoor and Earl Howe

Monday 16th June 2014 Lords Chamber

[Earl Howe]

My Lords, I do not agree with that because nursing numbers are now at a record high, which cannot indicate that hospitals are being starved of resources for their nurses. I do not see it as ironic that some senior posts have been reduced, bearing in mind the effect of Robert Francis’s report which has caused hospitals to increase the number of nurses on the wards. By and large, nurses at grades 7, 8 and 9 are in managerial positions and not in front-line posts.

[Baroness Manzoor (LD)]

My Lords, can the Minister say if an impact assessment has been undertaken on losing senior nurses from the NHS and the impact it has on service standards? The noble Lord, Lord Hunt, has already made the connection with the Francis report. Can the Minister also say whether an exit strategy has been undertaken to see why senior nurses are leaving?

[Earl Howe]

My general answer to my noble friend is that it is not for the Government to decide how many nurses hospitals should employ. We have not done an impact assessment. That is a matter for local hospitals to judge. They are in the best position to do that, based on the needs of their patients and local communities. What the Government should do, and are doing, is to ensure that staffing levels are available for public scrutiny and comparison on a patient safety website. That work is currently in train. It will now be much more evident to patients and the public what their local hospital is doing in terms of safe staffing ratios.

National Health Service: Nursing Staff

Debate between Baroness Manzoor and Earl Howe

Monday 12th May 2014 Lords Chamber

[Earl Howe]

The guidance issued today by NICE on staffing ratios, to which I think the right reverend Prelate is specifically referring, is in draft, but the deputy chief executive of NICE has stressed that there are no floor or ceiling numbers on the required number of nursing staff that can be applied either across the whole of the NHS or in a particular ward setting. What the profession is seeking, and what NICE is looking to give it, is a reference tool or guideline that will enable it to judge correct staffing levels in accordance with the particular circumstances of a ward and the skill mix of the staff on that ward. It is a guideline rather than a mandatory prescription.

[Baroness Manzoor (LD)]

My Lords, my question relates to specialist nurses. NICE has issued guidelines in relation to TB, and I am delighted to see that Public Health England has also issued a strategy on TB, making it a key component. However, there are variations in the number of TB nurses within trusts. How are the Government and NHS England going to adhere to the ratios that have been advocated by NICE?

[Earl Howe]

My Lords, as regards specialist nurses, the Government have supported the development of a range of specialist roles within the profession. In the end it is for local NHS organisations, with their knowledge of the needs of the local population, to invest in training for specialist skills and to deploy specialist nurses. We recognise that more could be done by some local healthcare organisations in this area, and Health Education England is able to support employers with continuing personal and professional development—but within clear limits. The planning process has created an opportunity for employers, through the LETBs—local education and training boards—to prioritise investment in this area.

Health: Liver Disease

Debate between Baroness Manzoor and Earl Howe

Tuesday 6th May 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, the incidence of liver cancer and liver disease is increasing significantly in young people, and it is the only cancer that continues to increase. Can my noble friend state whether there is a high-profile health education strategy that will help to tackle alcohol abuse and raise awareness among young people, who now talk about getting “preloaded” before they go out to drink alcohol, and which will highlight the issue of obesity? We need a high-profile health education campaign in that area.

[Earl Howe]

My Lords, as my noble friend knows, there is of course scope to include alcohol awareness in relevant lessons in secondary schools. However, I take my noble friend’s point. I am encouraged by recent figures which show a drop in binge drinking, but that is no cause for complacency. It still takes place, and too many young people end up in specialist care and sometimes lose their lives. That is very much on Public Health England’s radar.

NHS: Midwives

Debate between Baroness Manzoor and Earl Howe

Monday 17th March 2014 Lords Chamber

[Earl Howe]

I thank the noble Earl for bringing the example of the Chelsea and Westminster to my attention. I am sure it is a model of good practice, as I know how good that hospital is. With regard to supervision, the noble Earl is right. This bears upon the whole question of midwife numbers, to ensure that we have enough midwives not only looking after women about to give birth and giving birth, but also to ensure good practice in our hospitals and midwifery units.

[Baroness Manzoor (LD)]

My Lords, I congratulate the coalition Government on two facts. One is that there are many more midwives than there were in 2010. The second, as my noble friend says, is that there are 6,000 more student midwives in training. There is, however, an issue regarding the attrition rates of student midwives leaving before the end of their three-year training. Can my noble friend state what the Government are doing to understand why the attrition rate is as high as one in four students leaving, and whether this information is being collected by exit surveys?

[Earl Howe]

My noble friend is right to draw attention to the attrition rate. NHS England is focusing on this very closely. It is not always possible to predict the attrition rate because midwives leave practice for varying reasons—for instance, to take a career break. It is, however, very important that the motivation of midwives should be maintained. There is a great deal of work going on to ensure that we do not lose highly qualified and skilled midwives from the NHS.

Health: Midwives

Debate between Baroness Manzoor and Earl Howe

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

Yes, my Lords, that would be a very simple solution but it was rejected by Independent Midwives UK when it was put to it.

[Baroness Manzoor (LD)]

My Lords, the Royal College of Midwives says that there is a shortage of 4,800 midwives —a welcome drop from the 6,000 in recent times. However, this shortage and the shortage of obstetricians are resulting in variations in maternity services and in standards of care among trusts. What is the Government’s strategy to address these concerns?

NHS: General Practitioners

Debate between Baroness Manzoor and Earl Howe

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

My Lords, the current Government have maintained funding for the National Health Service; that is contrary to the Labour Party manifesto of 2010, which promised to cut funding to the National Health Service.

[Baroness Manzoor (LD)]

My Lords, I am fortunate that I am registered with an excellent GP practice which is well run, accessible and innovative. Over the last 30 years, I have seen significant improvements, and not only in the range of services that the practice provides. Who is responsible for ensuring that GPs are learning from other GPs the excellent practices which are available across the country?

[Earl Howe]

My Lords, there is a variety of means to ensure that GPs have continuous professional development. It is partly up to Health Education England to see that that happens and that there is peer-to-peer learning and review. Clinical commissioning groups also have an interest in ensuring that the quality of service provided by every member practice is of an equally high standard.

NHS: Black and Minority Ethnic Nursing Directors

Debate between Baroness Manzoor and Earl Howe

Monday 10th February 2014 Lords Chamber

[Earl Howe]

My Lords, I have already mentioned some of the initiatives that are in train. However, I can tell my noble friend that, within the NHS Leadership Academy, there are two programmes specifically for nurses and midwives that map to foundation, mid and executive level leadership development. There is the front-line leadership programme which is for staff who have leadership responsibilities—for example, ward sisters and nurses working in primary care. We expect 6,000 nurses and midwives to participate in that programme in the first year. There is also the senior operational leaders programme which provides senior nursing clinicians with an opportunity to enhance their leadership skills.

[Baroness Manzoor (LD)]

My Lords, a web audit found that only 80 NHS trusts publish annual staff data broken down by ethnicity. Will the Minister reassure the House that all NHS trusts meet their legal obligations under the Race Relations Act and that all workforce issues faced by black and minority ethnic staff are identified?

[Earl Howe]

My noble friend raises a crucial issue about transparency. I can assure her that this is squarely within the sights of the Chief Nursing Officer and her advisory group.

NHS Property Services Ltd

Debate between Baroness Manzoor and Earl Howe

Thursday 30th January 2014 Lords Chamber

[Earl Howe]

My Lords, the National Audit Office is indeed looking at the company—only to assure us and itself that the company is properly organised and structured. We welcome that, as does the company. There was no sinister purpose or concern underlying that process; it is perfectly normal and natural.

[Baroness Manzoor (LD)]

My Lords, can the Minister confirm best value for money on all properties sold and that there has been proper consultation with local organisations on all NHS estates?

[Earl Howe]

My Lords, I can assure my noble friend of that. The company ensures best value by marketing through an arm’s-length open market process, which ensures that the market value is achieved in a sale. Where necessary, the sale price is supported by a district valuer or other third-party independent valuation.

Health: Confidential Patient Information

Debate between Baroness Manzoor and Earl Howe

Thursday 23rd January 2014 Lords Chamber

[Earl Howe]

My Lords, there are circumstances in which potentially identifiable data can be released, but they are very severely circumscribed. A public health emergency is one, but Section 251 of the National Health Service Act 2006 could also allow identifiable information to be shared for specific purposes. However, the controls around that are extremely strict and the only people who can take that decision are the Secretary of State and the Health Research Authority—and then only after expert advice from the Confidentiality Advisory Group.

[Baroness Manzoor (LD)]

My Lords, some patients do not understand the implications and possible effects of the proposed EU legislation. What steps are being considered to ensure that those patients have full understanding?

[Earl Howe]

My Lords, until we are clear about the text that is agreed at European level, it is difficult to issue public advice on what the effect of that proposed measure would be. The text is still being argued over. While my noble friend is absolutely right that a public information exercise would be advisable once we are aware, we are not at that point yet.

NHS: Essential Services

Debate between Baroness Manzoor and Earl Howe

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, I should first tell the noble Baroness that we cannot reconcile our own figures with those of Dr Foster. We believe that there has in fact been a significant increase in the number of cataract and knee and hip replacement operations since 2009-10 and not a drop. Regardless of that, I suggest to her that the absolute numbers of operations taking place do not tell us anything about possible rationing or the absence of it. That question can be answered only with the benefit of fuller data. The key to consistent access to these treatments is a common understanding among commissioners of the evidence base in each case. That is exactly what Sir Bruce Keogh is working towards and will provide guidance on in due course.

[Baroness Manzoor (LD)]

Can the Minister state which local NHS services NHS England has deemed to be essential? If an independent provider of these services gets into financial difficulty, who will provide and pay for those services—NHS England or the clinical commissioning groups?

[Earl Howe]

My Lords, from April this year, CCGs and NHS England will begin to identify formally those healthcare services that they consider essential to protect in the event of the financial failure of their providers. They will be required to designate such services as commissioner requested services. In doing so, they must have regard to Monitor’s published CRS guidance. Should an independent provider of CRS get into financial difficulty, then Monitor will work with the provider and relevant partners to determine the right solution.

NHS: Clinical Commissioning Groups

Debate between Baroness Manzoor and Earl Howe

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

My Lords, the CCG target formula recommended by ACRA this time a year ago was rejected by NHS England for the very reasons that the noble Lord cites: because it did not include an adjustment for deprivation and health inequalities. At a recent Health Select Committee hearing, Paul Baumann, the chief finance officer of NHS England, indicated that the proposed new formula would have an adjustment for a health economy’s unmet need—in other words, an adjustment for deprivation where low life expectancy suggests that people are not accessing health services.

[Baroness Manzoor (LD)]

My Lords, can my noble friend the Minister clarify that responsibility for the development of primary care is to be shared between CCGs and NHS England area teams, particularly as CCGs now control two-thirds of the NHS budget?

[Earl Howe]

My Lords, at present primary care is commissioned by NHS England and has three broad ingredients: primary medical care, primary pharmaceutical services and primary dental services. However, we are looking at ways of making the whole process of primary care commissioning more creative. That could well involve a joint process by NHS England and clinical commissioning groups.

Female Genital Mutilation

Debate between Baroness Manzoor and Earl Howe

Thursday 7th November 2013 Lords Chamber

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

My Lords, the Government welcome the intercollegiate report Tackling FGM in the UK, which is published this week. Female genital mutilation is illegal. It is important that children and young women are protected from this abhorrent procedure. My honourable friend Jane Ellison has supported the development of this report. As Minister for Public Health, she has stated that one of her priorities is to continue to work towards eradicating female genital mutilation with the organisations that are promoting the report, among many others.

[Baroness Manzoor (LD)]

I thank the Minister for his reply. Does he welcome, as I do, the proposal that FGM should be treated by healthcare workers as a crime and reported to the police? Does he also welcome the work of the Liberal Democrat Minister, Lynne Featherstone, in prioritising the eradication of FGM in her work in the Department for International Development?

[Earl Howe]

My Lords, I agree with my noble friend. Female genital mutilation is child abuse and violence against girls and women. It is also a criminal offence, and cutters and perpetrators need to be brought to justice. I pay tribute to the work currently in train in the Department for International Development, which has begun an ambitious programme to address FGM in Africa and beyond.