DfID: Tied Aid

Baroness Northover Excerpts

Monday 11th March 2013 Lords Chamber

[Baroness Northover]

My Lords, I will now repeat the Answer to an Urgent Question asked in the other place earlier today. The Answer, given by my right honourable friend the Secretary of State, is as follows:

“I am delighted to update the House on my speech today. There is no change on Her Majesty’s Government’s policy on tied aid. I was clear in my speech on 7 February, and again this morning when I said:

‘I am not talking about tied aid. I do not believe that is the way to achieve good, sustainable development … It’s the wrong way to go about things’.

That answers his first point. DfID contracts are awarded in line with EU procurement regulations. The vast majority are subject to competitive tender. The evaluation process for large contracts includes an assessment of technical and commercial criteria, which are published at the outset of the tender. That answers his second question.

In relation to today’s speech on pursuing poverty reduction and an end to aid dependency through jobs, it is clear that economic growth is critical. Wherever long-term per capita growth has been higher than 3%, we have also seen significant falls in poverty. Sustainable public services in the developing world, as here in the UK, need a funding stream of tax receipts and that means a thriving private sector.

DfID will be putting an increased emphasis on economic development, including: reducing overall barriers to trade and investment; unlocking the ability of entrepreneurs and business people in developing countries to drive economic growth through their own businesses; and fostering greater investment by business in developing countries. I want to see more businesses, including those in the UK, joining the development push with DfID. We all have the opportunity to help build up responsible trade with developing countries.

Finally, I welcome the positive response from organisations like CARE International and the Overseas Development Institute, with the former saying that,

‘It’s no longer an option for development agencies to view business as operating in a parallel universe’”.

That concludes my right honourable friend’s Statement.

[Lord Collins of Highbury]

My Lords, we also welcome UK companies seeking access to growing markets across the developing world. However, from the media reports at the weekend, the Government’s policy was not clear. We are vehemently against tied aid, trickle-down economics, and growth that has no focus on either inequality or sustainability. I have two specific questions for the Minister. Can she tell the House what steps her department will take to ensure private sector-led projects by DfID will be required to meet decent work and labour standards? Secondly, under what circumstances does she believe it right that a British company should be awarded a contract in a developing country without having to compete in a fair and transparent tendering process?

[Baroness Northover]

My Lords, I thank the noble Lord for his acceptance that economic growth through the expansion of businesses and so on is very important for developing countries, as it was in the United Kingdom. As we have seen in China and India, it obviously has a transformative effect. I reassure noble Lords that DfID remains poverty focused. That underpins everything that we do. Therefore, we are trying to ensure the development of the private sector, it is so that those long-term aims of relieving poverty are addressed. On how British companies would be awarded contracts, as I said in the Statement from my right honourable friend, contracts awarded to British companies by DfID go through the EU procurement regulations. However, the focus of DfID is always on the relief of poverty.

[Lord Laming]

My Lords, I, too, am grateful for the Statement repeated by the noble Baroness. Could the noble Baroness reassure the House that actions are always in place to ensure that when these decisions are made the beneficiaries receive the benefit—I am expressing this badly but noble Lords know what I mean—that the money goes to the right place for the right purposes, that it is properly monitored and that we are reassured that it is not being diverted into other means?

[Baroness Northover]

I thank the noble Lord for that question. I assure both noble Lords that DfID supports responsible business standards, which are very relevant here, through various schemes such as the Ethical Trading Initiative, the UN global compact, OECD guidelines for multinational enterprises and so on. One striking thing about the United Kingdom’s potential help for developing countries is what we can offer by way of our law and justice system. I was struck in meeting the Minister responsible for mines from Afghanistan the other day to learn how initially they found that in dealing with Chinese companies the benefit was probably not for Afghanistan so much as for the Chinese companies, but that now they are rooting it very much in British law guided by British companies. That is an instance where it is of mutual benefit. Of course, it is of benefit in business to the British companies working in this area, but you can see immediately the effect in terms of the poorest in Afghanistan. That is where the greatest benefit is. Therefore, these things can be looked at as of not exclusive but mutual benefit.

[Lord Elystan-Morgan]

My Lords, I am left with the very clear impression from the Minister’s Statement that there will be no difference as far as the future is concerned in the total amount of aid that is disbursed at every level and in every way. If that be so, I heartily congratulate the Government. It is all very easy when the going is benign and happy to be charitable, but it is in situations of difficulty such as this that the true test of a community’s charity is put to the proof.

[Baroness Northover]

I appreciate what the noble Lord has to say, and I hope that he continues to say such things loud and clear, because in a time of austerity there is a clamour of voices asking whether this is the right thing to do. As we meet the 0.7% commitment, which we have built to and kept to, we have a moral obligation to address the difference in the levels of need around the world. There is also the interest in terms of greater stability. If you are addressing the most abject poverty around the world, that helps to stabilise things for everybody, whether in that region or in our own.

[Lord Tugendhat]

Does the Minister agree that Africa is now one of the fastest growing regions in the world and that we should all be very pleased about that? Aid is now a relatively small proportion of the disbursements that go from the developed world to what used to be called the developing world. Remittances and direct investment have grown enormously, and the role of aid is far less significant than it used to be. It is not a question of this Government cutting back on what they have been giving; the extraordinary thing about this Government is that, at a time when they are cutting back on almost everything else, they have been increasing the overseas aid budget by 30%. I find that barely explicable.

--- Later in debate ---

[Baroness Northover]

If the noble Lord listens to Bill Gates, for example, he will hear how small contributions looked at globally can leverage an enormous effect. The noble Lord is right that remittances are coming in and there is more inward direct investment and so on, and that is very welcome. We have to make sure that, as the noble Lord, Lord Laming, indicated, the poorest are included in that benefit and that there is the health and education provision to make sure that there is a skilled workforce to benefit from this, because it is in nobody’s interest to have countries with the instability and inequalities that that lack of provision would ensure. It is extremely important that we retain our commitment in this area, but at the same time we must make sure that these other areas, such as direct investment, grow as well and that they are to the benefit of the poorest in these countries.

[Lord Kerr of Kinlochard]

I thank the Minister for repeating the Statement. I was very pleased to hear her strictures on tied aid and her support for competition. Will she confirm that the same applies to consultancies? The only thing that worried me in her Afghan homily was the interjection that investors in mining in Afghanistan were advised by British companies. When such advice from consultancy firms comes from the aid programme is it subject to the same degree of open competition? In developing countries, one sometimes hears that rather a large share of the British aid programme does not go into projects on the ground but into consultants in London.

[Baroness Northover]

The Afghan Government chose to gain their legal advice in the way that I indicated. Consultancies are subject to open competition, so the noble Lord can be reassured in that regard.

[Lord Fowler]

I agree with what my noble friend set out as her department’s general policy. I have a specific question about the statement by the former Secretary of State that new money, extra money, would be going to the global fund for HIV and other diseases. Will that pledge be kept?

[Baroness Northover]

I am going to have to write to my noble friend to clarify that. I know that the Global Fund had some problems, with which he will be extremely familiar. I also know that DfID was working extremely closely with the Global Fund, because it had been so effective in the past, to bring it back to that position. I have not had the most recent update. I will make sure that he gets it.

Sport: Women and Girls

Baroness Northover Excerpts

Thursday 7th March 2013 Lords Chamber

[Baroness Massey of Darwen]

To ask Her Majesty’s Government what action they will take to encourage women and girls to take part in sport, and how they will seek to improve the profile of women’s sport in the media to that end.

[Baroness Northover]

My Lords, the Government are committed to encouraging more girls and women to play sport regularly as part of the sporting legacy. Sport England’s £1 billion community and youth sports strategy includes programmes designed to appeal specifically to women and girls. In addition, my right honourable friend the Secretary of State for Culture, Media and Sport has been working closely with the broadcast and print media to encourage them to cover more women’s sport.

[Baroness Massey of Darwen]

I thank the noble Baroness for that encouraging Answer, but can she expand on the consultation that is taking place not only with the media but with sports advisers in schools to encourage girls? In particular, what kind of sports are being identified as problematic for women and girls, and how will the media be asked to deal with that?

[Baroness Northover]

The picture here is encouraging but there is a tremendous amount more to do. I was struck by the fact that the latest figures, from December 2012, show that 1 million more women are taking part in sport than was the case when we won the Olympic bid in 2005. On coverage, in 2005 the Women’s Sport and Fitness Foundation estimated that only about 5% of media coverage was of women’s sport. The BBC has just told us that women’s sport now amounts to 25% of its sports coverage. Clearly, a lot more needs to be done and one of the things that is being taken forward by Sport England is to look at how best to encourage further development of this and encourage more women and girls to take part in sport.

[Baroness Heyhoe Flint]

My Lords, does my noble friend the Minister agree that developing a sporting habit for life is something that needs to start in primary school? There is a minimal amount of physical education within that sector and teachers of primary school children receive only a meagre six to 10 hours within a one-year training session. Back in the last century, my physical education training took three years. Would the Minister agree if I suggested that the introduction of physical education to primary school teachers would be a great advantage in developing that habit for life?

[Baroness Northover]

My noble friend speaks from a huge amount of experience and she is of course right that it is extremely important that we develop this from the earliest age—getting children out of pushchairs, for example, and onwards. As for primary schools, she is right. I am sure that she will be reassured to know that discussions are happening at the moment about how to strengthen school sport from primary schools upwards. An announcement will be made very shortly.

[Baroness Grey-Thompson]

My Lords, media coverage is very important and I declare an interest as chair of the Women’s Sport and Fitness Foundation’s Commission on the Future of Women’s Sport. However, for elite success and media coverage we also need good participation figures and recent data have shown that mums are much less likely to take their daughters to play sport than their sons because of their own experience of sport in school. Can the Minister say what plans the Government have to insist in changing the culture around women so that they encourage their daughters to play as much sport as their sons?

[Baroness Northover]

Again, the noble Baroness speaks with huge amounts of experience and the Women’s Sport and Fitness Foundation is a crucial body in trying to take this forward. Sport England has awarded a grant to that organisation to try to identify how best to encourage women and girls to be involved in sport. The noble Baroness is absolutely right that mothers who were themselves switched off from sport are less likely to encourage their children to be involved in sport. That is one key area where we welcome insights into how best to tackle this.

[Baroness Nye]

My Lords, does the Minister agree that, after the success of women athletes at the Olympics last year, it is a disgrace that two-thirds of boards of sporting organisations do not meet UK Sport’s minimum target of 25% female members and six, including British Cycling, do not have a woman on them at all? Given that public money is involved, do the Government have a strategy to deal with this?

[Baroness Northover]

The noble Baroness is right; Sport England and UK Sport are both encouraging national governing bodies of sport to increase the number of women on boards and the Government expect that all publicly funded sports bodies should have at least 25% women on their boards by 2017. That is very important but we also need more women as editors of newspapers, political programmes and so on.

[Baroness Sharples]

My Lords, does the Minister accept that the earlier you start to play sport, the more chance you have of playing golf, as I do, at the age of 90?

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[Baroness Northover]

The noble Baroness is a model we should all emulate.

[Baroness Meacher]

My Lords, is the Minister aware of the outstanding work being done in many of the mental health trusts in London to promote sport among psychotic young people? We found that taking part in regular football matches, exercise and so on significantly reduces the readmission rates of these young people. Would the Minister please put pressure on her colleagues in the Department of Health to exert pressure on the commissioning bodies to promote sport among psychotic people? Without it, many of them make very little recovery over decades?

[Baroness Northover]

The noble Baroness is right to highlight mental health generally in relation to sport. Public Health England is well aware of the importance of sport in relieving depression and so on. I am very happy to take the points that she makes back but I can assure her that the Department of Health is well aware of the significance of sport in this regard.

[Baroness Billingham]

My Lords, the Government are determined that competitive sport in schools is the key to greater participation; that view is certainly not shared by the majority of physical education experts, who fear that such a programme will alienate many boys and girls and do nothing to produce a “sport for all” approach and lasting participation. What evidence is there for the Government’s proposed formula? Our evidence suggests the reverse. As for representation in the media, will the Government look at Title IX, the American system which guarantees equal exposure in sport for girls? We cannot reproduce it perfectly here but we could do a modified version, which may well help with the lack of women’s sport seen in our media.

[Baroness Northover]

We now have 50% of schools taking part in competitive games. There is mixed evidence as to the interest of girls and boys in that, and the noble Baroness is right to highlight to need to make sure that we analyse it properly. Sport England is looking at how best to encourage girls as well as boys to come forward. Some girls enjoy being part of a team, even if that may seem too competitive for some. I hear what the noble Baroness says on Title IX. We are taking a lot of measures to try to ensure that the media recognise the significance of covering women’s sport and the appeal of it—everybody could see how outstanding the women’s team was in the Olympics.

Global Green Growth Institute (Legal Capacities) Order 2013

Baroness Northover Excerpts

Wednesday 6th March 2013 Grand Committee

Moved By

[Baroness Northover]

That the Grand Committee do report to the House that it has considered the Global Green Growth Institute (Legal Capacities) Order 2013.

Relevant document: 19th Report from the Joint Committee on Statutory Instruments.

[Baroness Northover]

My Lords, the draft Global Green Growth Institute (Legal Capacities) Order 2013 was laid before the House on 29 January.

There has been no poverty reduction at scale without strong and sustained economic growth. The sustainability of current growth models is, however, a serious concern. Although economic growth relies on environmental resources, at the same time it drives their depletion. Green growth seeks to promote actions that simultaneously improve both growth and the environment.

The Global Green Growth Institute was established in 2010 to advance the practice and theory of green growth. It hopes to work with a critical mass of countries to explore the potential of green growth and, through demonstrating its potential, to act as a transformational catalyst for change. The institute’s focus is on helping to prepare economic development strategies in countries that have expressed interest, and then helping to ensure that there is appropriate capacity and means to implement these strategies. The UK has been a keen supporter of the Global Green Growth Institute, acting as a founding member with the Deputy Prime Minister representing the UK at the agreement of its establishment in Rio in 2012.

The International Organisations Act allows us to grant international organisations legal capacity by making an Order in Council. This will enable the institute to attain formal status in UK law and so enable it to operate effectively here. Her Majesty’s Government fully support all these changes. We firmly believe that the Global Green Growth Institute may help to create a new model of environmentally sustainable economic growth. I commend the order to the Committee.

[Lord Teverson]

I shall just rise to congratulate the Minister on her excellent exposition of the connection between green growth and economic growth, for the good not just of the planet but of this nation. I hope that she will spread this message well and truly throughout the land, particularly towards 11 Downing Street, and reinforce that message as much as possible. I congratulate her and I fully support the Government in their support for this very important institute and its future work. We will see how well it does over the years.

[Lord Liddle]

On behalf of the Opposition, I also rise to support this measure. In government we fully backed international action against climate change, of which this is a useful part. I would like to hear from the Minister what the plans are for the future of the institute. Like the noble Lord, Lord Teverson, I would also like reassurance that the Government are not falling into the hands of climate change deniers.

[Baroness Northover]

My Lords, I thank my noble friend Lord Teverson for his strong support and the noble Lord, Lord Liddle, for his support. I assure both noble Lords that I will do my very best to promote green growth, which is strongly supported, as they know, by DfID and this Government. I assure the noble Lord, Lord Liddle, of that.

As to the future of the institute, we are very optimistic about its future programme, but that will be its responsibility. This order enables the institute to operate in the way that I have said in the United Kingdom, and we look forward to its further work in the future. On that basis, if the noble Lord, Lord Liddle, is content, I beg to move.

Motion agreed.

Overseas Aid

Baroness Northover Excerpts

Wednesday 27th February 2013 Lords Chamber

[The Lord Bishop of Liverpool]

To ask Her Majesty’s Government what proportion of the overseas aid budget is being earmarked for peacekeeping in areas of conflict.

[Baroness Northover]

My Lords, the Government are committed to scaling up their work in fragile and conflict-affected states. We have committed to spending 30% of official development assistance—ODA—by 2014-15 to support these countries and to tackle the drivers of instability. In 2011, £58.7 million of ODA was spent on multilateral peacekeeping operations. This represented less than 1% of the UK ODA spend in 2011 and we anticipate that it will remain at a similar level.

[The Lord Bishop of Liverpool]

My Lords, I can see the virtue of closer co-operation between peacekeeping and development programmes, but what steps will be taken to reduce the risk of humanitarian workers and beneficiaries of such aid being seen as agents of a foreign power, especially in fragile and unstable countries?

[Baroness Northover]

The right reverend Prelate is right. Those working in these areas are at huge risk anyway. That comes home very strongly. I have just come back from Pakistan and the difficulties of working in such areas are very clear. It is very important to draw the distinction that the right reverend Prelate makes. However, given that we are acutely aware of that, as are the organisations, I can assure him that that will continue to be the case.

[Baroness Kinnock of Holyhead]

Does the Minister agree that it is absolutely clear that both the UK’s International Development Act and the OECD guidelines would be breached if the Prime Minister’s statement on using aid money for military purposes was to be implemented? Should the Prime Minister therefore be heeding the OECD and British law instead of trying to appease recalcitrant Tory Back-Benchers who oppose the ring-fencing of development aid?

[Baroness Northover]

I suggest that the noble Baroness reads what the Prime Minister said. She will find that it is perfectly consistent with the approach taken by her Government. We work across the MoD, the FCO and DfID to do what we can to tackle instability in some of the poorest countries. It is because they are fragile states that there are such levels of poverty and such a lack of development. That is why it is extremely important to work to support those countries. DfID’s conflict pool and the Building Stability Overseas strategy build on what the previous Government rightly did. This is controlled by the OECD definition of ODA, which does not allow spending for military uses. Therefore it could not come out of DfID’s budget. DfID needs to reach its 0.7% contribution to aid, and we are committed to that. If this came out of it, it would not reach that 0.7%.

[Lord Alderdice]

My Lords, it is clear that peace and stability are critical not just in fragile states but in the development of all states. It would be helpful if my noble friend could clarify how Her Majesty’s Government will decide how far political interventions and interventions involving the Ministry of Defence will receive support. How will the proportions and the kind of help that will be given be decided? It would be helpful to know that to understand this better.

[Baroness Northover]

My noble friend is right to ask for that. It is extremely clear that the OECD defines what does and does not count as overseas development assistance. Most of our peacekeeping, for example, goes through the UN. Some 6% of that budget counts as ODA, and the rest does not. With the EU civilian missions, 100% counts under the ODA rules. This is extremely clearly defined. Where the MoD supports humanitarian assistance—the Navy, for example, supplies tents, as it did in Jamaica after the hurricane—that is counted as assisting and not as providing military equipment. These things are clearly defined.

[Lord Collins of Highbury]

My Lords, as the right reverend Prelate said, Labour supports a co-ordinated approach to tackling conflict that brings together defence, diplomacy and development. The Prime Minister’s attempt to suggest that aid money may be used to off-set deep defence cuts is misleading and will not stand up to scrutiny. I ask the noble Baroness to reassure this House that the absolute purpose of the proportion of money that we continue to spend is to alleviate property, improve basic services and support job creation, all of which are central to ending conflicts everywhere.

[Baroness Northover]

My Lords, I have to say that the noble Lord is misleading. I suggest that he read the Prime Minister’s words. He says:

“Conflict states haven’t met a Millennium Development Goal between them”,

and that,

“it’s obviously true that if you can help deliver security and help provide stability … that is the base from which all development can proceed”.

We all agree about that. He does not say that he is filling in some MoD black hole; he is saying, as the noble Lord stated at the beginning of his question, that we need to work together to ensure that we establish security for people in these fragile states in order that development can build upon that.

[The Lord Bishop of Exeter]

My Lords, peacekeeping is obviously very important, but so is peacebuilding. Does the noble Baroness recognise that many of the areas that have traditionally been funded by overseas development aid, such as increasing the capacity of civil society, advancing women’s rights and strengthening and improving governance, are also a really important part of peacebuilding? Will she give an assurance that programmes that have traditionally been bent towards those ends will be protected, and that the money will not be diverted to these new peacekeeping elements of the programme?

[Baroness Northover]

That is where the focus is. That is ODA. In providing support in areas such as Libya, Somalia, South Sudan, Pakistan, de-mining in Nepal and humanitarian aid, DfID is following these principles and this Government will continue to follow them because of the importance that the right reverend Prelate rightly ascribes to them.

Transport: HS2

Baroness Northover Excerpts

Tuesday 26th February 2013 Lords Chamber

[Baroness Northover]

I remind noble Lords that this is a time-limited debate and when the clock reaches three, noble Lords have had their three minutes.

Crime: Domestic Violence

Baroness Northover Excerpts

Thursday 14th February 2013 Lords Chamber

[Baroness Gale]

To ask Her Majesty’s Government what steps they are taking to support the campaign One Billion Rising, which aims to draw attention to the level of domestic violence worldwide.

[Baroness Northover]

My Lords, preventing violence against women and girls is a top priority for the coalition Government. The Department for International Development has significantly scaled up its efforts to tackle this issue overseas. The department is also supporting the One Billion Rising campaign by working with partners on the ground to raise awareness of the campaign and highlight work to prevent violence against women and girls.

[Baroness Gale]

I thank the Minister for her reply but does she agree that the 1 billion women who are raped and beaten is a truly horrific figure? In the light of that, would the Minister agree to work with international agencies such as the Council of Europe and the United Nations, as well as the devolved Administrations in the United Kingdom, so that a comprehensive programme could be organised to eliminate the violence against women on a global scale?

[Baroness Northover]

The noble Baroness is absolutely right that the figures on this are appalling. Globally, one woman in three is beaten or sexually abused in her lifetime, which is utterly unacceptable. We are working with all international organisations, and nationally as well, to try to raise this issue. It is a focus, as the noble Baroness will know, of the UN Commission on the Status of Women in New York in March. My honourable friend Lynne Featherstone is leading the delegation from here; that commission is focusing on violence against women and girls. The Foreign Secretary is focusing on this as part of our leadership of the G8 this year and, of course, it forms part of the discussions on the MDGs as we take them forward. It is extremely important. It is about time that it is on the agenda and we seek to tackle it.

[Lord Chidgey]

One of the cruellest and most insidious forms of domestic violence is that among young girls, some as young as four, who are subjected to female genital mutilation, or FGM, as it is known. There are more than 100 million women in the world suffering from the effects of that, mostly in Africa, and as many as 3 million young girls a year are at risk from this form of mutilation. Can my noble friend the Minister say whether the Government, in their development programme, are helping NGOs such as AWEPA on the ground—in the villages and at the grass roots—to try to stop this rather revolting and dangerous form of mutilation?

[Baroness Northover]

My noble friend is right that this is a terrible practice, which we seek to counter both in the United Kingdom and overseas. We are funding civil society organisations which are working to end the practice in Ethiopia and Kenya, and my honourable friend Lynne Featherstone is developing a major new programme to address FGM. We know that work with communities, as my noble friend says, including affected women and girls is key to ending the practice. Organisations such as AWEPA, which engage parliamentarians, are crucial in bringing about the change that we all need to see.

[Baroness Nye]

My Lords, does the Minister agree that when one in two boys and one in three girls in the UK think that there are some circumstances when it is okay to hit a woman, or to force a woman to have sex, it is essential that sex and relationship education is made statutory in our schools? That must include free schools and academies.

[Baroness Northover]

It is clearly unacceptable when children in our society hold these points of view, and I know that it is prevalent. The noble Baroness will be pleased to hear that today we are putting increased effort into a teenage relationship abuse campaign, because it is extremely important that we get across to teenagers—girls as well as boys—that this is unacceptable and what actually constitutes abuse so that it does not then lead on into domestic violence. That campaign will need to be targeted in every possible place.

[Lord Elystan-Morgan]

Does the Minister accept that there is every reason to believe that only a fraction of very serious cases of domestic violence find their way to the courts, due very probably to the fear of reprisal, the consideration of the situation of children and so on? Does she accept that in a criminal situation where domestic violence is proven, there is every reason why sentencers at all levels should regard such conduct as being worthy of condign punishment?

[Baroness Northover]

The noble Lord speaks from a lot of experience. Of course, this is very complex. Relationships are very complex. Quite often, people are unwilling to come forward. If one were to apply the same kind of test to another group—say that it was an ethnic minority that suffered in that way—it would be crystal clear that something was unacceptable. I think there has been something of a sea change in the attitude of the judiciary and the police, but we need to see that go much further. We are seeking to support those changes.

[Baroness Jenkin of Kennington]

My Lords, were we not here in the Chamber now, I am sure that my noble friend and I would be joining many colleagues from the other place who, as we speak, are rising up in Parliament Square to support the campaign. I will resist the temptation to dance on the Benches. As the Prime Minister says:

“I want to see an end to violence against women and girls in all its forms”,

and I am proud to add my voice to all those who stand up and oppose it. Does my noble friend agree that because of changes to the law, which include the criminalisation of forced marriage, widening the definition of domestic violence and making stalking illegal, it is far more likely that those who perpetrate those crimes will now be punished than in the past?

[Baroness Northover]

I agree with my noble friend. I also support the campaign that is occurring today, and DfID is supporting the campaign that will be seen in Cape Town today—which, in the light of the news this morning, is perhaps particularly relevant. My noble friend is right to highlight the way that we have taken this forward; there are, for example, two specific criminal offences of stalking that came into effect in March 2012, and the DPM announced in September the widening of the definition of domestic violence to include 16 to 17 year-olds and coercive behaviour. We are working very hard to bring greater protection for victims and to bring more offenders to justice. It is also important that we work with criminal justice professionals to ensure proper guidance and training so that we can support these changes in the legislation.

[Lord West of Spithead]

My Lords—

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[Baroness Corston]

My Lords, is the Minister aware that domestic violence is a major cause of women in this country ending up in prison? With which organisations in this country are the Government working to eradicate this drastic harm to all these lives?

[Baroness Northover]

I am well aware of the importance of domestic violence in bringing about women being in prison, and all the other challenges that women in prison face. We are very keen to carry forward the work that the noble Baroness did to try to ensure that we address the reasons why women end up in prison, which is often not in their interests or those of the family. We are working across the board with a number of different organisations. I myself have been at various meetings where these organisations have put their case, which is a very cogent one. We will continue to do that. Anything that the noble Baroness wishes to feed in to me, I would be very happy to receive.

Health: Neglected Tropical Diseases

Baroness Northover Excerpts

Wednesday 30th January 2013 Lords Chamber

[Baroness Northover]

My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate and for all her work in this area. Her passionate and expert speech and those of other noble Lords remind us how important it is to tackle the so-called neglected tropical diseases. They blight the lives of more than a billion people, cause disability, disfigurement, stigma and an estimated half a million deaths annually in some of the poorest countries in the world. They cause terrible suffering and perpetuate dire poverty. The noble Baroness, Lady Hayman, spoke of diseases of neglected people. That is a good way of describing them.

Last year, as noble Lords have mentioned, we made a fivefold increase in our commitment to this area and we are maintaining that support to ensure that these diseases and those who suffer from them are neglected no more. This is an area in which some of our outstanding institutions, such as the Liverpool School of Tropical Medicine, the London School of Hygiene and Tropical Medicine and Imperial College, are playing a leading role. Various noble Lords mentioned that the London Centre for Neglected Tropical Disease Research has formally opened this afternoon at the London School, which everybody is extremely pleased to see. The noble Lord, Lord Patel, spoke of the work being done in Dundee and of the importance of public/private partnerships, something which DfID strongly supports and has built into its approach to tackling NTDs.

As the noble Baroness, Lady Hayman, the noble Lord, Lord Sheikh, and others have said, there is partnership across a number of organisations here. The pharmaceutical industry is playing a vital part in this regard. We are also working with the World Health Organisation, the Bill & Melinda Gates Foundation and the US Agency for International Development.

One year on from the London launch, I am grateful to the noble Baroness, Lady Hayman, and others for the tribute that they have paid to the step change that DfID has made in this area. Like the noble Baroness, the noble Lord, Lord Crisp, and others, I pay tribute to my honourable friend Stephen O’Brien, the former Parliamentary Under- Secretary of State for International Development, for his leadership here, as well as to all the others who played their part in the London declaration. I pay tribute, too, to the various organisations, including those led by the noble Baroness, Lady Hayman, and noble Lord, Lord Crisp, who have worked for a long period in this area.

I can assure noble Lords that DfID now expects to reach more than 140 million people who suffer from NTDs by 2015. Since the London declaration, the UK has launched a programme to complete the global mapping of trachoma; agreed a programme to take an integrated approach to tackling NTDs in Nigeria, one of the highest-burden countries in the world; and helped the World Health Organisation strengthen its NTD staffing and improve its co-ordination of the kala-azar programmes in south Asia and east Africa.

Last year, the UK Government offered to increase and extend their support to guinea-worm eradication, provided that others stepped in to help close the financing gap. Noble Lords will be pleased to hear that the Bill & Melinda Gates Foundation, the United Arab Emirates and the Children’s Investment Fund Foundation rallied to this call. The programme now has the funds that it needs to achieve eradication. That will be a stunning achievement. I can assure the noble Baroness, Lady Hayman, that we continually encourage other donors to contribute.

In 2012, fewer than 600 new cases of guinea-worm disease were reported in just four countries, Chad, Ethiopia, Mali and South Sudan—almost half the number of cases in 2011. This trend is very positive, but it is clear that there is no room for complacency. The endemic countries’ health systems and regional security are fragile—noble Lords have made reference to that. The Mali conflict remains a significant threat to the eradication timeline and the success of the global campaign.

Meanwhile, DfID continues to develop and expand the UK’s support for taking NTDs in three distinct but integrated ways. They are: additional support to control elephantiasis, river blindness and bilharzia, building on a number of existing successful partnerships; driving more research—to which the noble Baroness, Lady Hayman, referred—to increase our knowledge of NTDs and improve delivery and effectiveness in addressing them; working on new programmes to help control kala-azar and trachoma, as well as a programme which takes an integrated approach to tackling a range of NTDs in South Sudan. I assure the noble Lord, Lord Rea, that we will include vector control in the design of our work on kala-azar. The noble Lord, Lord Stone, asked about feedback loops. I can assure him that we realise that good monitoring and evaluation are key to this area and we check that treatments get to those who need them. We check to make sure that we are making progress in controlling and eliminating these diseases and are getting best value for money for the funds committed. I seem to recall the noble Lord raising this matter at an APPG meeting that I spoke at and my putting him in touch with DfID. I hope that that takes things further forward.

Expanding our involvement requires a collaborative international effort and response. We are working closely with colleagues, particularly in USAID, the World Bank, WHO and the Bill & Melinda Gates Foundation, to improve mechanisms for tackling these diseases. National Governments are key partners, too, particularly in mass drug administration through schools and communities and in efforts to improve water and sanitation services. We recognise the importance of joining all that up.

In the UK, it has not just been the Government responding to the challenge; there has been a positive response also from organisations, particularly in the private sector. This includes the Children’s Investment Fund Foundation and Geneva Global. I particularly appreciate the all-party parliamentary group’s support for the UK Government’s work on NTDs and for the opportunity that it gave me to speak at the launch of its annual report in November.

Noble Lords will also be pleased to hear that a number of institutions in the UK have formed the UK Coalition against Neglected Tropical Diseases as a collaborative partnership in research, implementation and capacity building. It is at the forefront of the push for integration, especially at the country level with national and other developmental partners.

The NTD community is adjusting to the post-London declaration situation. The WHO annual report makes clear how we have all stepped up and the challenges for tackling NTDs globally from 2013. These challenges include the need for increasing ownership by Governments in the affected countries. National Parliaments have an important role to play here in making the case to Health and Finance Ministers to increase domestic resource provision.

The noble Baroness, Lady Hayman, and others asked about integration of work on NTDs. The noble Baroness asked in particular about integration with the Global Fund. As she knows, the Global Fund in its support for health systems, which has developed over the years, makes a contribution beyond malaria, AIDS and TB. It is vital that all these approaches are integrated—the right reverend Prelate made this point very strongly—so that each element supports the other.

In this regard, I concur with the point made by the noble Earl, Lord Sandwich: mass campaigns need to strengthen and underpin fragile health systems. The right reverend Prelate illustrated that very point. I assure him that drugs for NTDs are delivered by volunteer community health workers, and that that is used to help to strengthen health systems. The noble Earl, Lord Sandwich, the noble Baroness, Lady Hayman, and the noble Lords, Lord Crisp and Lord Collins, referred to water and sanitation as connected issues. Indeed they are, and we are well aware of that. I assure noble Lords that the increase in funding for NTDs is additional to DfID’s existing health, water and sanitation commitments. Integrating with the health system is an important tenet for NTD programmes to help to strengthen that effectiveness and improve sustainability. If we maintain that approach, those diseases can be eradicated, as the noble Lord, Lord Trees, said. We are determined to carry that through—just as we are in sight of eradicating polio, and as we did with smallpox, to which the noble Lord, Lord Patel, referred.

We have grasped a fantastic opportunity here to make a real difference to the lives of those affected by these diseases. In 2013, the task is to finalise remaining programmes, monitor the portfolio closely, continue to promote integration and work with others to expand the donor base and endemic country commitment.

Noble Lords have pointed out that these are diseases of poverty and that we must tackle poverty across the board. They are right, and that is how we view this task. This is indeed about tackling poverty, and we welcome noble Lords’ contribution in this key area.

Arts and Culture: Economic Regeneration

Baroness Northover Excerpts

Tuesday 29th January 2013 Lords Chamber

[Baroness Quin]

My Lords, I welcome the opportunity to introduce this debate on a subject which I feel strongly about but which also has great topicality, given the cuts to arts budgets which are taking place, both nationally and in many regions and localities. These are, not surprisingly, the subject of widespread concern.

First of all, may I say what a pleasure it is that the Minister is replying to this debate? I have not previously had the chance to congratulate him publicly on his appointment but I now do so warmly. We have made common cause in the past on agricultural issues, not least in our concern for the survival of the red squirrel. Given that he will have to defend the Government’s record in the area we are discussing, I have a feeling that our former harmony might be temporarily dissonant—but I very much hope that that will, indeed, be only temporary. I am also delighted that my noble friend Lady Jones is on the Front Bench for the Opposition, as I know how much she cares about the issue being raised this evening.

I do not have any financial interests to declare but the register of interests does list that I am president of the Northumbrian Pipers’ Society, an important cultural organisation in the north-east which promotes the playing and appreciation of our own regional musical instrument. I have also for many years been a volunteer tourist guide for the great city of Newcastle upon Tyne and, perhaps most relevantly to this debate, I was also a Member of the other place representing Gateshead. The arts and culture have been hugely significant in that town’s economic regeneration but—through projects such as the “Angel of the North”, the Baltic art gallery, the Sage music complex and the award-winning Gateshead Millennium Bridge; this is not an exhaustive list—the benefits have also been felt throughout the whole of Tyneside, the north-east and the country. I feel hugely proud of Gateshead Council and the remarkable way that its members, many of whom come from a traditional industrial background, grasped early on the cultural agenda in the way that they did. I therefore take every opportunity to pay tribute to them and the way that they worked in partnership with other parts of the public and private sectors in the many projects that they pursued.

Indeed, given Gateshead’s record, it is frustrating that in the important Newcastle-Gateshead partnership of recent years, Gateshead’s achievements are often ascribed to Newcastle by those who do not come from the area. I am sure that the noble Lord, Lord Shipley, as a former leader of Newcastle City Council, will understand my frustration, while none the less recognising, as we both do, how important the Gateshead-Newcastle partnership has been in recent years, and how it has promoted economic regeneration..

The wording of the Question for Short Debate speaks of the contribution of the arts to regional and economic regeneration more generally in order to bring in the wider national and UK dimensions to the subject. Many of us believe that the arts, culture and the creative industries are a crucial part of our national economy, and it is my contention this evening, therefore, that supporting the arts and cultural projects nationally and regionally has to be a vital part of our economic growth strategy and policies for national economic recovery.

In documentation produced by the Arts Council, it is pointed out that our creative economy, as a proportion of GDP, is the largest in the world. Our cultural sector accounts for nearly 70,000 businesses and contributes £28 billion each year to the UK economy. The creative industries provide 1.5 million jobs and our arts and culture attract millions of overseas tourists, helping to promote Britain as a world hub of creative talent. However, if arts and culture are important to our economy nationally, they are also vital to our regions and localities and have played a crucial part in the economic successes of many towns and cities in recent years. Examples that come to mind include Liverpool, Birmingham, Bradford, Bristol and east London. Cultural projects and initiatives have also revitalised and reversed the decline of some of our traditional seaside resorts such as Folkestone and Margate, where the Turner Contemporary has attracted approaching half a million visitors since it opened in 2011. In the north-east, the Sage Gateshead has contributed £146 million to the north-east economy since it opened and currently supports 660 or more jobs. In 2011, the entries for the Turner Prize that were exhibited in the Baltic art gallery attracted a record number of visitors and had a positive economic effect. Overall, culture and the arts have contributed to a dramatic growth in the tourist industry in the north-east—a growth rate that has by far outperformed any other sector and brought our tourism industry right into the economic mainstream.

There is no doubt that arts and culture have made a great contribution nationally and locally in recent years. However, there is now considerable concern about the future arising from the Government’s current approach. I, like my party, am concerned that with the arts, as with the rest of the economy—as we have been discussing this afternoon—the cuts are too deep and too fast. To begin with, the Arts Council itself has had its budget cut by 30% since 2010. While I applaud the Arts Council in its work and recognise that, in implementing these reductions, it has sought to protect the artistic front line—by which we mean support for cultural projects and productions in some of the least well-off parts of our country—none the less, cuts of the order demanded now and for the future, on top of the economies already made, threaten the front line in my view. This is a view that is shared by many in the cultural sector both nationally and regionally.

My noble friend Lord Beecham had a Written Question on arts funding which was answered by the noble Viscount, Lord Younger, on 8 January, and I would like to ask the Minister some questions about it. My noble friend asked what proportion of central government funding for the arts in 2011-12 and 2012-13 was for capital funding, and what proportion was for revenue funding. The Answer surprisingly began by saying that the Government were unable to provide information on potential funding for the arts across central government because they did not hold the information centrally; it said that the information could be provided only “at disproportionate cost”. This begs the question: if central government spending plans are not held centrally, where are they held? The Answer gave information about the reduction in Arts Council funding and about DCMS funding in addition to Arts Council funding. This showed that the additional funding was being reduced overall from £2.198 million to £1.025 million and that for this year, 2013, no capital funding was envisaged at all in that part of the DCMS budget. Can the Minister explain this?

The Government have claimed that philanthropic giving might help fill the funding gap. The Culture Secretary herself has expressed hopes that this might double over the coming years. However, the figures that I have seen—and I do not know whether the Minister can confirm them—which were released in 2011, show a reduction in corporate giving of 11% and a reduction in individual giving of 4%. Neither of these figures augurs well for the future. Also on this question, I refer the Minister to comments from Sir Nicholas Hytner, director of the National Theatre, who, writing in the Observer, said that,

“80% of philanthropic giving to the arts benefits London, and almost invariably private funding follows public funding”.

If Sir Nicholas is right—and he obviously speaks from great experience—then charitable giving will not fill the gap and will not, in any case, help the regions, about which I will now speak further.

If the reductions in funding at national level are causing concern then the situation is even worse at regional level. As we know, the local government spending review was debated in your Lordships’ House on 17 January. Considerable concern was expressed about the cuts that local authorities were facing overall. The cuts—the result of the squeeze in local government spending—have already been felt in the arts and culture sector, but the likely effect of current and future cuts are even worse. It is not that local authorities want to cut back spending on arts and culture or that they think that such money is unimportant, but they have their overriding responsibility to continue providing services such as social care and child protection, waste collection and all the other main areas of service which local authorities have an overriding duty to provide.

I express my sympathy with councils such as Newcastle in the current situation. I think that it really does find itself between a rock and hard place—although I note that the council is continuing to discuss ways forward with arts organisation locally. Instead of cutting Newcastle’s money further, I hope that the Government will work with the city, and with other cities in a similar situation, to ensure that arts spending is not reduced in the way that is currently proposed in the consultation that Newcastle City Council has embarked on. What I say about Newcastle also applies, surprisingly, to places like Westminster, where they are also suggesting a total cut in the arts budget.

Unfortunately, I am rapidly running out of time. I shall conclude by referring to the coalition Government’s recent mid-term review. It is both regrettable and astonishing that the creative industries and culture and the arts have played so little a part in the review. In particular, no goals seem to be set by the Government for arts and culture for the next two years. Of the five commitments that are mentioned by DCMS in the mid-term review document, not one of them mentions culture or the arts. I wonder how the Government can explain that.

It seems to me that the Government need to demonstrate through new words and deeds that the arts, culture and the creative industries are indeed an indispensable part of this country’s growth strategy and that such a growth strategy should extend to all parts of the country. Nothing less than a fundamental change of heart by the Government will do in the face of the current crisis.

[Baroness Northover]

My Lords, I remind noble Lords that this is a time-limited debate. When the clock reaches 10, noble Lords have had their 10 minutes.

National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012

Baroness Northover Excerpts

Tuesday 29th January 2013 Grand Committee

Moved by

[Baroness Northover]

That the Grand Committee do report to the House that it has considered the National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012.

Relevant document: 15th Report from the Joint Committee on Statutory Instruments

[Baroness Northover]

My Lords, the draft National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012 set out the persons for whom a CCG will not be responsible, where it otherwise would be. We are here to discuss them today because the Delegated Powers and Regulatory Reform Committee recommended that they be subject to the affirmative procedure. The committee advised that the power being exercised to make the regulations, Section 3(1D) of the National Health Service Act 2006, relates to a fundamental provision of the new commissioning arrangements. In theory it could be exercised in such a way that some groups of people were left without a body responsible for commissioning their healthcare services. But I hope to be able to reassure noble Lords that this has never been the policy intention, nor is it the effect of these regulations.

It may be helpful if I first explain these draft regulations in their wider context. As with PCTs, each CCG will cover a geographical area defined in their constitution, and the whole of England will be covered by CCGs, with no overlap. Under Section 3(1A) of the National Health Service Act 2006, CCGs will have continuity of commissioning responsibility for all patients registered with a GP practice member of the CCG, and anyone usually resident in the CCG area who is not registered with a GP practice anywhere. They will be under a duty to commission secondary care health services to meet the reasonable requirements of the people they are responsible for, with the exception of certain services commissioned directly by the NHS Commissioning Board, and those public health services commissioned by local authorities.

Additional provision relating to the responsibilities of CCGs is made in the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This includes imposing on CCGs responsibility for every person in their area in relation to the provision of ambulance services or accident and emergency services. That instrument also makes provision about the services to be commissioned by the NHS Commissioning Board. Taken together with this affirmative instrument, this will ensure that the board and CCGs do not have overlapping responsibilities for particular services or particular patients. There will be no gaps, and a commissioner will not be able to dispose of a commissioning obligation by moving the patient out of area.

It is also important to emphasise that both sets of regulations concerning commissioning responsibilities do not introduce any new policies, but apply the existing principles of PCT responsibilities to CCGs, taking into account, of course, some necessary differences to reflect the responsibilities of the board and local authorities.

These draft regulations for affirmative resolution prescribe, by way of exception, categories of people and circumstances where CCGs will not have the duty to commission services. I will briefly describe the provisions set out in these regulations. Regulation 1 defines the terms used throughout the regulations and sets out a coming into force date of 1 April 2013.

I have already explained that under Section 3 of the 2006 Act, CCGs will have commissioning responsibility for all patients registered with a GP practice member of the CCG, and anyone usually resident in the CCG area who is not registered with a GP practice anywhere. However, within the categories of people for whom a CCG will otherwise be responsible, there will be some for whom, and some circumstances under which, it is appropriate that the responsibility will lie with another CCG or another health body. These are set out in Regulation 2, which has the following provisions.

People registered with a GP in England, but who are usually resident in Scotland, Wales or Northern Ireland will not be the responsibility of the CCG of whom the English GP practice is a member. Instead, under Regulations 2(2)(a) to 2(2)(c), the responsible body will be the health body in the relevant Administration – the Scottish Health Body, the Welsh Local Health Board or the Health and Social Care Board in Northern Ireland.

Where a person, normally the responsibility of one CCG, becomes the temporary patient of another, the first CCG will not be responsible for them; instead, under Regulation 2(2)(d) the patient temporarily becomes the responsibility of the CCG where they access GP services. This is to ensure that the patient can access any subsequent care he or she needs while remaining a temporary patient; otherwise, there could be delays in their receiving prompt treatment. The provision also ensures that the receiving CCG has responsibility for commissioning services to meet the needs of temporary patients—particularly important in CCG areas with significant numbers of such patients, for example in areas containing holiday resorts.

Regulation 2(2)(e) provides that, if a person is provided with primary medical services by a member of a CCG and these do not include essential services within core hours, that CCG is not responsible for that person. Instead, they would be the responsibility of the CCG, a member of which does provide those services, or, if not, the CCG in whose area they usually reside. This reinforces the principle that a core requirement of CCG membership is to be a provider of essential services.

Under Regulation 2(2)(f), CCGs will not be responsible for people detained in an immigration removal centre, secure training centre or young offender institution. In such cases the responsible commissioner will either be the board or another commissioning body such as the Home Office. Under Regulation 2(2)(g), a CCG will not be responsible for people for whom another CCG is wholly responsible under Regulation 4 and Schedule 1 of the corresponding negative responsibilities regulations.

Where another CCG or a local authority has placed a person in a CCG’s area, the second CCG will not be the responsible commissioner. Like the other provisions in these regulations, this continues the current policy under PCTs. This occurs, for example, for the purposes of NHS continuing healthcare, whereby the responsibility remains with the placing commissioner. However, in these cases the disapplication of responsibility relates only to the services for which the other CCG is responsible. For example, where a person receiving continuing healthcare is placed outside a CCG’s area, the placing CCG would be responsible for nursing care but not for secondary care.

Regulation 2(3)(a) makes it clear that a CCG that has responsibility for a person on the basis of GP registration or usual residence in its area is not responsible for securing the provision of ambulance services or accident and emergency services if that person is present in the area of another CCG. Responsibility for this falls to the CCG of that other area. For the avoidance of doubt, Regulation 3 sets out the rules for determining where a person is usually resident for the purposes of Regulation 2.

Noble Lords may have noticed that these regulations cross-refer in places to “the Responsibilities Regulations 2012”. These are the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 that I mentioned. We are not here today to discuss them, but since they are so closely related I will briefly set out the content of relevant parts so that the noble Lords may have the full picture before them.

Regulations in Parts 2, 3 and 4, with their associated schedules, make provision about additional commissioning responsibilities for both CCGs and the board. Regulation 4 and Schedule 1 make provisions effectively mirroring Regulation 2 of the draft National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012, in prescribing the categories of people for whom a CCG will be responsible for commissioning—

[Lord Hunt of Kings Heath]

My Lords, I am sorry to interrupt the noble Baroness. She said that we were not here to discuss the standing rules today, but are they not subject to the regulations that we are debating? I would like to clarify that.

[Baroness Northover]

My understanding—no doubt I will get clarification on this—is that the Delegated Powers and Regulatory Reform Committee picked up certain elements of this and thought that they should be subject to the affirmative procedure. What I seek to do here is lay that out, but also lay out a fuller picture so that noble Lords can set it in context. I will continue and seek clarification. It is to give that fuller picture, which I hope will help noble Lords, that I am outlining this.

Regulations in Parts 2, 3 and 4, with their associated schedules, make provision about additional commissioning responsibilities for both CCGs and the board. Regulation 4 and Schedule 1 make provisions effectively mirroring Regulation 2 of the draft National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012, in prescribing the categories of people for whom a CCG will be responsible for commissioning health services in addition to those set out in the 2006 Act.

The list in Schedule 1 includes people placed by their local authority or a CCG in a care home, children’s home or independent hospital outside the CCG’s area. It also includes two other categories of person: the first is all persons in the CCG area who are resident outside the UK and who are not provided with primary medical services by a member of any CCG. The second is all persons resident in Scotland, Wales or Northern Ireland and present in the CCG’s area who are “qualifying persons” within the meaning of Section 130C of the Mental Health Act 1983 and who are not provided with primary medical services by a member of any CCG. Qualifying persons are broadly those persons detained under the Mental Health Act 1983, conditionally discharged restricted patients, those subject to guardianship under the Act and supervised community treatment patients.

Paragraph 6 of the schedule also includes provision for continuity of responsibility where a PCT has made arrangements and is then succeeded by a CCG. Part 3 of the regulations sets out additional services that will be commissioned by the board under Section 3B of the 2006 Act. Under Regulation 6, the board will commission all hospital and community dental services; a list of the hospital services is included in Schedule 2.

Regulation 7 provides that except for emergency services which are, of course, the responsibility of CCGs, the board will be responsible for all secondary and community services for members of the Armed Forces and their families where they are registered with Defence Medical Services. This includes fertility treatment services. Regulations 8 and 9 require the board to commission fertility services for those who have lost their fertility in service, generally due to injury caused by a blast, and are in receipt of compensation from the Armed Forces Compensation Scheme.

Regulation 10 sets out the requirements for prisoners and other persons detained in prescribed accommodation. The services concerned are, except for emergency services, all community and secondary services. The prescribed accommodation includes all prisons, whether public or private, all but one young offender institutions and, as specified in the schedules, some secure children’s homes, secure training centres and immigration removal centres. Regulation 11 and Schedule 4 require the board to commission specified specialised services for rare and very rare conditions. Regulation 12 requires the board to make arrangements for the continued provision of services currently provided by certain independent sector treatment centres under contracts currently held by the Secretary of State. Regulation 13 requires the board to commission specialist mental health services for people who may pose a risk to prominent people or locations.

Finally, Regulations 14 and 15 require CCGs and the board respectively to commission mental health aftercare services for certain groups of people who have been detained in hospital for treatment of their mental disorder after their discharge from hospital; this is under Section 117 of the Mental Health Act as amended by the Health and Social Care Act 2012. These regulations make it clear that the responsibility for commissioning aftercare services should, wherever possible, sit with the CCG commissioning services to meet that patient’s other healthcare needs. However, the board would be responsible for commissioning services as part of a person’s aftercare under Section 117 if it, rather than any individual CCG, would otherwise be responsible for commissioning the NHS part of the aftercare package.

I realise that I have described these regulations at some length, but I hope that I have demonstrated that CCGs’ commissioning responsibilities under the 2006 Act, when looked at as a whole and as supplemented by regulations, form a coherent set of responsibilities. I commend the draft regulations to the Committee.

--- Later in debate ---

[Baroness Northover]

My Lords, I thank my noble friend Lady Jolly and the noble Lord, Lord Hunt, for their consideration of what I have presented. Perhaps I may clarify for the noble Lord, Lord Hunt, that the Delegated Powers and Regulatory Reform Committee recommended that only the National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012 should be subject to the affirmative procedure, and that is why they are before us today. The NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 are subject to the negative procedure, which is why they do not form part of today’s debate. However, I sought to set out all the elements so that noble Lords could see what we are looking at in context. Noble Lords may table Motions on negative regulations, should they wish to do so, although I am happy to answer questions as far as I can. However, it may be that in these other areas the noble Lord, Lord Hunt, may either wish to flag them up in future or we will write comprehensively to answer any questions that I have not responded to satisfactorily.

My noble friend Lady Jolly asked about a major disaster in a CCG area. I want to assure her that all NHS organisations are required to maintain preparedness to respond safely and effectively to a full spectrum of significant incidents and emergencies that could impact on health or patient care. From April 2013, all NHS organisations will be required to contribute to co-ordinated planning for emergency preparedness and service resilience through their local health resilience partnerships. No doubt she will also be pleased to note that the board has a duty under Section 252A of the 2006 Act to take steps as it considers appropriate for ensuring that each CCG is properly prepared for dealing with an emergency, and funding is a matter for the board.

My noble friend also asked about the arbiter in terms of patients. As set out in the NHS Commissioning Board’s guidance as to who pays, the underlying principle is that there should be no gaps in responsibility, and obviously she knows that. The NHS Commissioning Board expects that all disputes would be resolved locally, ideally at the CCG level, but in cases that cannot be resolved at that level, local area teams of the NHS Commissioning Board should be consulted and should arbitrate where necessary.

My noble friend asked about the mandate in terms of reporting on this and on inequalities. We will of course be using a range of evidence in addition to the NHS outcomes framework to assess the performance of the board and CCGs against the objectives and legal duties, including asking CCGs and other stakeholders for their feedback. As she will know, the first mandate between the Government and the NHS Commissioning Board was published in November. It states that the NHS Commissioning Board is under specific legal duties to tackle health inequalities, and the outcomes framework will be used to help monitor that.

The noble Lord, Lord Hunt, asked a series of questions. I would like to write to him with a response on abortion services in Northern Ireland.

[Lord Hunt of Kings Heath]

My Lords, I am grateful to the noble Baroness and I realise that it is a complex question. However, I am concerned about this order going through the House without me knowing the answer. The key question here is whether, under these regulations, CCGs are allowed to provide NHS services for persons normally resident in Northern Ireland, including abortion services. It is a very important question. I do not know when this order is going back to the Chamber, but if it goes back tomorrow it does not give me very much time to decide whether or not to call for a debate in the Chamber. It might be a matter for the usual channels to deal with. I accept that the noble Baroness will need to write to me, but the question is: how soon?

[Baroness Northover]

I would like to be able to give a fuller answer. I hope that BlackBerrys are buzzing behind me and that, perhaps while I respond to his other questions, I will be given a fuller answer because I would prefer that. I will speed along any such response, bearing in mind what he has just said.

[Lord McAvoy]

Would the Minister be good enough to copy me into that correspondence as I also have an interest in the subject?

[Baroness Northover]

I shall be very happy to copy it to anyone who would like to see it.

I think I may not have answered fully my noble friend Lady Jolly—I hope that I did—when she asked about where a patient might come in terms of who is responsible. I would like to emphasise what I said in my introductory remarks, that the default position is that the 2006 Act applies, covering everybody. So a CCG where the person’s GP is a member would be responsible for them, and if they are not registered with a GP, it would be a CCG in which the person usually resides. Perhaps I may emphasise, in relation to temporary patients, that if a person is registered with a GP in England but is not resident here, the Scottish, Welsh or Northern Irish body commissions secondary care, assuming the person is in one of those areas.

I am seeking answers to some of the other questions. The noble Lord, Lord Hunt, flagged up the point about Healthwatch England, and I remember very acutely giving the assurance that Healthwatch bodies could campaign. He asked whether any public comment on regulations has been published. I am looking for an instant answer to that, which seems not to be coming. I may need to return to him on that in a moment.

In terms of local accountability, the noble Lord wanted to know whether a member of the public might be able to insist on an appeal if certain treatments were turned down. CCGs will be under a statutory obligation to arrange for provision of care to meet the reasonable requirements of the people for whom they have responsibility. The CCG must work closely with the local authority through the health and well-being board to assess local needs and to develop a strategy to meet them which will inform their commissioning plans. Where a CCG chooses not to commission a service, as in the kind of instance the noble Lord is talking about, it would have to be satisfied that it was not necessary to do so in order to meet the reasonable requirements of its patient population. The CCG will be under a duty to involve patients in the planning of their commissioning arrangements. The noble Lord will be aware that not everything is possible under the NHS and never has been, but obviously, as before, it is important that all reasonable requirements are provided for, and the CCGs, just like the PCTs, have that responsibility.

The noble Lord asked about the membership of panels. Again, I am hoping that a light bulb will suddenly come on and I will be able to inform him as to why there should be those differences and answer some of his other questions.

To clarify further on Northern Ireland and the issue about abortion, but unfortunately I have some difficulty reading writing that is not as clear as it might be, so I do not think I will provide that answer in case it is not what it is supposed to be. I can assure the noble Lord that I will not move the approval Motion until he gets his response.

[Lord Hunt of Kings Heath]

My Lords, that is very helpful. I thank the noble Baroness.

[Baroness Northover]

The noble Lord is extremely welcome.

I am hoping that clarification will suddenly appear in my brain for the answers to the other questions that the noble Lord has put because I would like to be able to answer as much as I possibly can. My brain is moving very slowly, I am afraid, and I will write to him to address anything that is outstanding. We will not expect anything to be finally agreed until we have those answers for the noble Lord. I hope that, with those reassurances, noble Lords will accept the regulations.

[Lord Hunt of Kings Heath]

My Lords, I am very grateful to the noble Baroness. Of course, I do not want to detain the Grand Committee any longer. The issue of the panels that are to be convened to hear appeals by members of the public against decisions to restrict treatment made by clinical commissioning groups is something that I hope will be given further thought. CCGs are different from primary care trusts. A CCG is essentially a group of professional people. Most CCGs will have only a limited number of lay people who could be said to represent the public interest. If those CCGs make decisions that restrict drugs or treatment, there should be some mechanism whereby a member of the public can refer such a decision to an independent panel. I hope that this will be given some consideration by the noble Baroness’s department.

[Baroness Northover]

I am very happy to take the noble Lord’s suggestion back for it to be given further consideration.

Motion agreed.

NHS Mandate: Health Inequalities

Baroness Northover Excerpts

Monday 28th January 2013 Lords Chamber

[Baroness Williams of Crosby]

To ask Her Majesty’s Government what steps they are taking to reduce inequalities in health provision in line with the objectives of the NHS Mandate.

[Baroness Northover]

My Lords, legal duties in relation to reducing health inequalities will apply to the Secretary of State and NHS commissioners. Local authorities must have regard to reducing inequalities when commissioning public health services. The NHS and public health outcomes frameworks will be used to monitor progress. We are working across government to address inequalities through tackling the wider causes of ill health.

[Baroness Williams of Crosby]

I thank my noble friend for her reply. In November, the BBC pointed out that the gap between the least served and best served people was widening in this country. Cancer Research UK pointed out in a recent survey that the likelihood of an unskilled worker dying of cancer was twice as great as that of a professional worker in the same region. In light of these figures, the Liberal Democrats proposed, and the Government accepted, a specific duty on the Secretary of State to have regard to inequalities in health. Despite that, the outcomes framework has among its five domains no reference to health inequalities and, despite the very strong support expressed by the public in the mandate consultation, there was no specific reference to inequalities in health in any of the recent DfH documents. Can I therefore ask the Minister directly whether she will agree that, when the review of the outcomes is made next year, a greater attempt will be made to have a specific section dealing with health inequalities and, one hopes, measuring real progress in this most difficult of areas?

[Baroness Northover]

My noble friend is right to focus on health inequalities that remain. The last Administration and previous Administrations have sought to address them, as have we. In the Health and Social Care Act 2012, for the first time there were specific legal duties to reduce health inequalities. I am slightly puzzled by what my noble friend says about outcomes, because if she looks at the public health outcomes framework and the NHS Outcomes Framework —in particular the public health ones—the two overarching outcomes are increased health life expectancy, and reduced difference in life expectancy and healthy life expectancy between communities. That is the measure against which we will judge what is done in public health.

[Lord Tomlinson]

Will the Minister accept that the proposals to close the excellent and much-admired accident and emergency hospital in Lewisham, and to downgrade its maternity services, have been made not because there is anything wrong with the hospital but because a government-appointed administrator has said that that should be done in order to help the neighbouring National Health Service trust, which has run up £130 million-worth of debt? Will she accept that closing and downgrading good facilities is an act of almost criminal stupidity, which leads to nothing but increased health inequalities when the Government’s objective is to reduce them?

[Baroness Northover]

The noble Lord might have heard his noble friend Lord Darzi comment on the difficulty of reorganising services so that they are as efficient and effective as possible. I would ask him to have a look at that.

[Lord Tomlinson]

What is your answer?

[Baroness Northover]

My answer is that, as I have said, the Act puts reducing health inequalities at the centre; that is a responsibility at every level, and those things will be monitored in certain ways. As the noble Lord, who is winking at his colleague and perhaps not looking at me right now, might remember, the Secretary of State is answerable to Parliament and will be answerable for all these areas. If the noble Lord is right, and actions that are taken do not reduce inequalities, there will be an opportunity to hold the Government to account.

[Baroness Hollins]

My Lords, the first priority in the mandate is about preventing people from dying prematurely. The Minister spoke about inequalities between communities, but I am concerned about two of the improvement areas mentioned in this priority, which are about reducing premature mortality in people with serious mental illness and people with learning disabilities. Will the Minister tell the House about the clinical leadership being put in place to ensure that these two areas are addressed energetically in order to reduce health inequalities within communities?

[Baroness Northover]

The noble Baroness is right to highlight this area. I point out that the NHS Commissioning Board has recently advertised nine posts which focus on health inequalities. I am sure that that kind of focus will help. The noble Baroness is right in that there are certain groups within communities that are particularly vulnerable. She will probably also be pleased to hear about the Inclusion Health programme, which focuses on particular groups which have particularly poor health outcomes, and which is chaired by Professor Steve Field, of whom she will be well aware.

[The Lord Bishop of Wakefield]

My Lords, given that one aspect of the Government’s strategy to improve patient outcomes and reduce health inequalities is to encourage a shift from hospital-based to community-based care, will the Minister say what steps are being taken to address the shortage of district nurses, whose numbers have fallen by more than a third in the past decade?

[Baroness Northover]

I will write to the right reverend Prelate with numbers, as I have seen them but I do not have them in my brief here. I point out that because health will be far more focused in the local area, it is extremely important for the health and well-being boards, for example, to look at how health is delivered in their area. If there are problems because of a lack of staff, they will need to address that.

[Baroness Farrington of Ribbleton]

My Lords, would the noble Baroness care to correct a mistaken idea that she may have put to the House? I listened very carefully to my noble friend Lord Darzi, who said that his general comments about centres of excellence in no way related to the Lewisham situation, on which he was not commenting. Could she correct that, please?

[Baroness Northover]

The noble Lord commented on the difficulty of reorganising, which is what I have just highlighted, and it was in relation to the controversy over what is happening in south London. He explicitly said, it is true, that he could not comment on that case but it is extremely important in these cases that a strategic overview is taken of where provision is best set. The Department of Health is obviously well aware of what is said about the strength of accident and emergency at Lewisham Hospital. No doubt if that is a proved case, it will be necessary to bear it in mind.