Women: Public Life

Debate between Baroness Thornton and Baroness Northover

Tuesday 21st October 2014 Lords Chamber

[Baroness Northover (LD)]

My Lords, we are seeking to remove barriers that prevent women from progressing in public life. For example, the Government have established a centre for public appointments in the Cabinet Office to ensure that best practice is followed. As a result, the proportion of new female appointees to public boards has increased to nearly 40%. We have also supported political parties in increasing women’s representation through a combination of measures.

[Baroness Thornton (Lab)]

I invite the Minister to join me in celebrating the fact that the first four women were introduced into the House of Lords on this date in 1958. Since then, without doubt, great progress has been made in women’s representation in both Houses, from those few four. However, we seem to have got stuck at around 23% in both Houses. In the Commons, we in the Labour Party are doing our best to get equal representation, and a general election victory will increase our numbers further. What positive efforts are the two coalition parties each making to significantly increase the number of Liberal Democrat and Conservative women in the Commons? Does the Minister agree that, until and unless they do so, the mother of Parliaments will fall even further down the international table on equal representation?

[Baroness Northover]

My Lords, I would also celebrate 1958, when women were brought into this House. We have just seen one of my very able noble friends introduced, and I look forward to her contribution. Indeed, the Labour Party and the other parties have made all sorts of efforts to increase the number of women in Parliament. The Conservative Party now has 25% of women as general election candidates; the Labour Party is ahead with 42%, and 26% of the selected candidates for the Lib Dems are women—and 36% of candidates in our most winnable seats are women. Therefore, I look to the great British public to make sure that those seats indeed prove to be winnable.

Women: Wages

Debate between Baroness Thornton and Baroness Northover

Wednesday 25th June 2014 Lords Chamber

[Baroness Northover (LD)]

My Lords, the Office for National Statistics Annual Survey of Hours and Earnings shows that pay for women working both full-time and part-time is rising. To support these women, we are helping with the cost of childcare, introducing shared parental leave, extending flexible working to all and raising the income tax threshold, which means that 1.83 million women will be taken out of income tax by April 2015.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. Obviously we have a difference of opinion about the figures from the Office for National Statistics, because they tell us that between 2013 and 2014 women’s mean full-time earnings fell to what amounts to an average loss of £52 over the year. So, unlike men, women working full-time have seen their actual take-home pay fall. I ask the Minister to go back and look at those figures because that gender inequality is not acceptable. What steps will the Government take to remedy it?

[Baroness Northover]

I hope that the noble Baroness will be reassured that I have looked at the figures; I have them with me. She will know that the previous Government used the Annual Survey of Hours and Earnings, which is what I have just cited, and not the survey she cited. That is in part because of the difference between median and mean, which no doubt I do not have to go into in depth with her. Also, the survey she is looking at went up in the last quarter, while now there is a slight drop. However, it is self-reported, whereas the survey I am referring to is based on PAYE and HMRC information. That is the survey the Government use and which her Government used.

Convention on the Elimination of All Forms of Discrimination against Women

Debate between Baroness Thornton and Baroness Northover

Tuesday 17th June 2014 Lords Chamber

[Baroness Northover]

We have no plans to put forward a candidate for the next round of elections in 2016. We look at all UN bodies very carefully and we do not rule out nominating a UK expert in the future, but as the previous Government also concluded, ensuring that such a UK expert is elected is resource intensive. As the noble Baroness knows, we liaise very closely with CEDAW, we put huge efforts into the annual UN Commission on the Status of Women and we put major funding and other support into UN Women, currently standing at £12.5 million a year.

[Baroness Thornton (Lab)]

My Lords, in the past the Women’s National Commission, which represented millions of women across the UK—and which was abolished by this Government in their first year in office—ensured that UK women’s voices were heard as part of the CEDAW process. Those were independent voices, not always comfortable for the UK Government because they were independent, which spoke about how the UK was progressing in its elimination of discrimination against women. Who represents UK women’s voices in this process, how are they being represented and how are we ensuring that women’s voices are being heard in this process—not just the Government’s voice on their progress on the elimination of discrimination?

[Baroness Northover]

There has been a huge amount of engagement. My honourable friends Jo Swinson and Jenny Willott, who is currently covering for Jo, have engaged with a number of NGOs. We have provided funding to the Women’s Resource Centre to enable it to launch its shadow report to the committee—that is, of course, an independent voice; we have provided the Equality and Human Rights Commission funding and other funding to enable people to feed into CEDAW and to report back on what CEDAW has said about the United Kingdom Government.

Women: Board Membership

Debate between Baroness Thornton and Baroness Northover

Monday 10th March 2014 Lords Chamber

[Baroness Northover]

I thank my noble friend for her encouraging comments. I am sure that mentoring has indeed helped, and I think that transparency and pressure have helped as well.

[Baroness Thornton (Lab)]

My Lords, would the Minister care to tell the House how the Government are doing in increasing the number of women on public bodies? Those figures seem to be slightly more woeful than the ones for corporate bodies. Secondly, I am sure that the noble Baroness is aware that twice as many women as men leave the corporate sector once they reach mid-level management. Given that, does she agree that, alongside measures to increase the number of women at board level, we need to fix the leaks, as it were, in the talent pipeline and ensure that women are properly represented at every level of an organisation? How does she think this might be brought about?

[Baroness Northover]

We are aiming for women to account for 50% of new public appointments by 2015. They are currently averaging 45%, so we are moving in the right direction. The noble Baroness is quite right that we need to address this at every level. One of the beneficial things about the Davies approach to company boards is that it is also having an effect on the response of companies at other levels. This issue has to be addressed at every level.

Marriage (Same Sex Couples) Bill

Debate between Baroness Thornton and Baroness Northover

Wednesday 10th July 2013 Lords Chamber

[Baroness Northover]

My Lords, Amendment 123A replaces government Amendment 123, which, as I explained to the House on Monday, the Government were considering withdrawing and have just done so.

To give a little background, the Delegated Powers and Regulatory Reform Committee reported on this Bill in its fourth report of the Session. We are most grateful to the committee for its comments and recommendations, to which we responded in a series of amendments that the House debated on Monday. One of the recommendations of the committee was that regulations made under Clause 9, which deals with the conversion of civil partnerships, should be made by the Secretary of State rather than the Registrar-General and should be subject to the affirmative procedure on first use because it was not clear that all such provisions would be purely administrative in nature.

We were happy to accede to this recommendation but were also conscious that, in the future, the Registrar-General may need to update her administrative procedures. To require regulations to be made by the Secretary of State regarding such matters would be overly bureaucratic and break with the convention that the Registrar-General makes regulations relating to her functions that are purely administrative. For example, the Registrar-General already makes regulations, without any parliamentary procedure, prescribing the detail of marriage and civil partnership registration, the duties of those responsible for registration and the forms to be used.

We therefore proposed through Amendment 123, which has now been withdrawn, that the Secretary of State or the Lord Chancellor could make enabling provision for the Registrar-General to make regulations relating to administrative matters. We continue to believe that such sub-delegation is the appropriate way of dealing with these administrative details. However, as the chairman of the committee, my noble friend Lady Thomas of Winchester, helpfully highlighted to us before Monday’s debate, the amendment had been drafted in a way that would allow the Secretary of State or the Lord Chancellor to sub-delegate in respect of any of their order-making or regulation-making powers in the Bill.

While it was never the Government’s intention to use the proposed power in such a far-reaching way, and the use of the power was limited in any event only to where it was in connection with administrative matters relating to functions of the Registrar-General, superintendent registrars or registrars, we accept that it would not have been appropriate to move the amendment with such concerns outstanding. That is why we have tabled Amendment 123A, which is more restrictive as to the circumstances in which the Secretary of State may sub-delegate regulation-making powers to the Registrar-General. Its effect is that there are just two provisions where the Secretary of State can now exercise such a power.

The amendment states explicitly that sub-delegation may occur only where the Secretary of State considers that it is necessary in connection with the administrative functions of the Registrar-General, superintendent registrars and registrars under Clause 9, concerning conversion of civil partnerships to marriages, and Amendment 90, concerning marriage by belief organisations—if the Government in future decide to allow such marriage. We consider that the sub-delegation of regulation-making powers to the Registrar-General is necessary and appropriate in these two contexts, but it must be subject to clear restrictions. In particular, there is no power for the Secretary of State to sub-delegate provision as to fees.

Amendment 123A also makes it clear that the default position is that any delegated regulations made by the Registrar-General would attract the negative procedure, unless varied by the Secretary of State in the event that she felt that this was justified because of the nature of the particular regulations. I can assure noble Lords that any regulations of the Secretary of State’s sub-delegating powers to the Registrar-General will be put before Parliament for scrutiny.

The chairman of the committee has written today to confirm that the committee is content with the revised amendment; I am pleased about that. I hope that noble Lords will agree that this amendment is a measured and appropriate response to the committee’s concerns, which delivers our policy intention while ensuring that there can be no inappropriate use of the powers. It is extremely nice to end Report on what I hope is a constructive and consensual basis; I note that many noble Lords left the Chamber as I started. I commend Amendment 123A to the House.

[Baroness Thornton]

My Lords, I thank the noble Baroness for that very clear exposition of this very sensible amendment. I am pleased to say that we will, of course, support it.

Marriage (Same Sex Couples) Bill

Debate between Baroness Thornton and Baroness Northover

Wednesday 19th June 2013 Lords Chamber

[Baroness Thornton]

My Lords, I recommend that the noble Lord, Lord Trefgarne, should google marriages at sea. It says that captains can perform marriages, but they need a licence to do so, just like anyone else. There are no laws that automatically grant captains the right to marry, although you would not know that from watching the television. Apparently this possibly originates from the days of sail when Europeans would have to travel by ship for months at a time to reach far-flung colonies. A couple might meet, court and marry while en route to their destination.

The same Google search threw up a quote. I am a great fan of “Star Trek” and the Starship “Enterprise”. Apparently, Captain James T Kirk said:

“Since the days of the first wooden vessels, all shipmasters have had one happy privilege, that of uniting two people in the bonds of matrimony”.

Captain Kirk’s successor, Captain Jean-Luc Picard, played by Patrick Stewart, a fellow Yorkshireman and great Labour supporter, said, “Make it so”.

[Baroness Northover]

My Lords, my noble friend’s amendment would enable marriages of same-sex couples to be conducted by the master of a British-registered vessel on the authority of a superintendent registrar’s certificate outside the territorial waters of England and Wales. However, this is not a right possessed by opposite-sex couples, so this would in fact be out of line. I am absolutely delighted to fill in my noble friend on marriage at sea, and I have learnt a great deal about it as well.

At present, the validity of a marriage on board a British merchant vessel is governed by the law of the country in which that vessel is registered. In the law of England and Wales, the Marriage Act 1949 does not provide for marriages to take place on board UK registered vessels at sea, and the Foreign Marriage Act 1892 applies only to marriages outside UK jurisdiction. Neither is it clear that the common law of England and Wales provides authority for the validity of marriages that are celebrated on merchant vessels at sea, although there are historic authorities which suggest that a marriage could be formed under the common law only if it was not possible to wait until the ship reached port. It is unclear whether those authorities still apply, given that there is now statutory marriage law covering both domestic and foreign marriages. However, in any event, such a scenario is extremely unlikely to arise in current times. Therefore, at present, we do not believe that it is possible for a heterosexual couple to have their marriage formally solemnised by the master of a British ship.

I can fill my noble friend in on some additional material, but probably not tonight. The purpose of the Bill is to enable same-sex couples in England and Wales to marry in a civil ceremony, or in a religious ceremony if the religious organisation opts in. It is not intended that marriage for opposite-sex couples should be altered, even if everybody does want them to get married at sea, or that the Bill should bring about wider changes to marriage law. I hope, therefore, that although he is no doubt disappointed, my noble friend will be happy to withdraw his amendment. Lastly, I will supply him with more information than either Google or his own investigations have produced.

Women: Board Membership

Debate between Baroness Thornton and Baroness Northover

Monday 17th June 2013 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to increase the number of women on boards.

[Baroness Northover]

My Lords, the Government are supporting the voluntary, business-led strategy of the noble Lord, Lord Davies, to increase the number of women in UK boardrooms. At the time of the noble Lord’s latest report of April 2013, women had secured 34% of all FTSE 100 board appointments in the previous year. The UK corporate governance code now requires boards to report on their diversity policy. Headhunters have pledged to ensure that women make up 30% of longlists and, from October 2013, quoted companies will be required to disclose the gender balance at various levels within their organisation.

[Baroness Thornton]

My Lords, this is not what the Cranfield review of women on boards says, which is that that in the past six months, progress in the number of female non-executive directors in FTSE 100 companies has reached a plateau; it is flatlining and stuck at between 26% and 30%. It also says that there has been a lack of progress at the executive-director level of FTSE 100 companies. A rise from 5.5% to 5.8% since 2010 is not impressive. What will the Government do next? It seems that they have got the low-hanging fruit on this issue. If they have set their face against quotas, what does the Minister suggest doing about the abysmal lack of gender diversity, about ageism and about the lack of ethnic diversity in the country’s boardrooms?

[Baroness Northover]

I start by paying tribute to the noble Lord, Lord Davies, the noble Baroness’s colleague, for all that he has done to flag up this issue, and for the way in which he has driven it forward. He in turn has thanked the media for what they have done to make sure that this moves forward. He is absolutely right that we need to continue to make progress. There was an indication of plateauing. The situation now seems to be improving again. Business needs to show that it is making progress—as the noble Lord, Lord Davies, says—so that the Government can say that no quotas are needed. However, they are there as a back-stop.

Health and Social Care Bill: HIV/AIDS Programmes

Debate between Baroness Thornton and Baroness Northover

Wednesday 21st March 2012 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the risks posed by implementation of the Health and Social Care Bill to HIV/AIDS programmes.

[Baroness Northover]

My Lords, HIV services are, and will continue to be, comprehensive. They include surveillance and national and local prevention, treatment and care. The NHS Commissioning Board will lead on commissioning treatment and care services. This recognises that HIV treatment is specialised and that prevalence varies. Local authorities will commission HIV prevention services in line with their wider remit regarding sexual health and health inequalities.

--- Later in debate ---

[Baroness Thornton]

I thank the Minister for that Answer, which confirms that HIV treatment and care will be commissioned by the national Commissioning Board, that some preventive work will be conducted by local authorities and that national HIV prevention will be commissioned by Public Health England. However, it is unclear who will commission post-exposure prophylaxis following sexual exposure, PEPSE, which is vital specialist work to halt the spread of HIV. Who will commission that work, and how do the Government intend to ensure that all the services will not be diminished by being commissioned by at least three different bodies or lost when those bodies begin their work?

[Baroness Northover]

I assure the noble Baroness that the current high level of care and commissioning will continue. The reason the Commissioning Board is taking responsibility nationally is that this is a costly disease to treat and its prevalence is varied around the country, so it makes sense if the board has overall responsibility for that. As the noble Baroness knows, public health has moved to the local authorities, which is why it is appropriate for prevention to be placed at that level. With regard to joining up care, as she knows, the health and well-being boards locally will do a great deal to ensure that they look at the needs of the population in that locality and that care is delivered appropriately in their local area.

--- Later in debate ---

[Baroness Northover]

Public Health England will be liaising with the different parts of the United Kingdom to ensure that what is learnt in one area is propagated to others so that the different parts of the United Kingdom can learn from each other. We look to what happens in England, Scotland and Wales. That came up frequently in the Bill and will continue to be the case.

[Baroness Thornton]

My Lords, perhaps I may come back to the noble Baroness as she completely failed to answer one of my questions, which was about PEPSE. Who will commission the vital work which halts the spread of HIV?

[Baroness Northover]

I was accused of answering at too great a length. The Commissioning Board will oversee commissioning. It is working out how that can best be delivered and whether various things should be commissioned at the local level. If the noble Baroness would like to feed into that process, that would be very welcome.

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Thursday 8th March 2012 Lords Chamber

[Baroness Northover]

I am very sorry if there was a conflict of timing. Obviously it is difficult to schedule all the various meetings. My noble friend Lord Howe has had 100 meetings on this Bill.

[Baroness Thornton]

This has happened all the way through.

[Baroness Northover]

I am very sorry if that was the case. If it was the case all the way through, as the noble Baroness, Lady Thornton, indicates, perhaps it might have been an idea to feed that in.

[Baroness Thornton]

The noble Baroness might like to check with the Box. I informed the noble Earl’s office of the times of our group meetings at the beginning of proceedings. Meetings and seminars have clashed all the way through.

[Baroness Northover]

I am very sorry if that is the case. I would hope that we would be able to have other such meetings. As these arrangements are taken forward, it would be extremely useful to have people’s engagement. I was extremely glad that, even in such a clash, the noble Baroness, Lady Wheeler, and her noble friend were there.

The noble Lord, Lord Harris, should have received the letter about the amendments, but I gather that he thought he had not. A letter and briefing notes were sent to all Peers when the amendments were tabled and a full narrative of local healthwatch policy has been published on the Department of Health website. If the noble Lord has not seen the letter then I will feed that into the department to make sure that he receives this information so that he has it at his fingertips when he is contacted late at night by people who email him with concerns.

As I have mentioned before, it is very important that the local healthwatch seeks out views right across the area. It is an important factor in this arrangement that the local healthwatch will have a seat on the health and well-being board. I hope that that will help to reassure people of the influence of local healthwatch.

The noble Lord, Lord Harris, talked about privatisation by so-called social enterprises, or he flagged that up as a concern. I emphasise that the Government are huge fans of social enterprises, which perform a range of roles across the NHS. Social enterprises such as Turning Point are, of course, extremely valuable. This is not about privatisation or competition, as I feel we have made very clear.

The noble Lord, Lord Harris, also referred to my noble friend Lord Howe. My noble friend’s concern in 2007 was that local LINks should have at least a basic structure of governance. That is precisely the concern that has led us to propose that local healthwatches should be social enterprises. The question of governance is quite separate from the question of whether or not an organisation should be statutory. Perhaps the noble Lord, Lord Harris, can enter dialogue with my noble friend Lord Howe on all of that in due course.

The noble Lord, Lord Harris, also asked about the possibility of there being more than one local healthwatch. Only one local healthwatch will be permitted for each local authority area. Each local authority will be able to make only one contract. If the local healthwatch wishes to subcontract some of its functions it can do so if the local authority permits, but the functions would still remain the responsibility of the local healthwatch. I hope that that clarifies the position.

International Women’s Day

Debate between Baroness Thornton and Baroness Northover

Thursday 1st March 2012 Lords Chamber

[Baroness Thornton]

My Lords, I thank the noble Baroness, Lady Verma, for opening the debate. I am looking forward to the contributions of many noble Lords who are speaking today.

I wondered whether I could find a phrase other than “my Lords” to address the House collectively in an International Women’s Day debate. There is, of course, the term “noble sisters”, which we can take to embrace the men who are going to speak today, just as we have to accept that the words “my Lords” cover women too. Perhaps today they might do the reverse and accept that the term “noble Baronesses” covers them also—if the term “noble sisters” is too radically feminist for them.

The noble Baroness, Lady Verma, has asked us to celebrate the contribution of women to economic growth. That is a good thing to do in our women’s day debate and, of course, it does not just concern women’s role in the workforce, as the noble Baroness, said, but the whole of women’s lives in society. Where the noble Baroness and I may part company is on the question of whether this Government deserve that much credit for their contribution to the position of women in our economy today. Expecting to be congratulated on now supporting policies which any enlightened person or organisation might do, and some of us did decades ago, is perhaps going too far.

It would be churlish of me to remind the noble Baroness, for example, that her party branded me and the London Labour Party as “loonies” because we embraced workplace nurseries, the expansion of childcare and employers supporting their employees with childcare and job sharing as positive measures to support women in the workplace. We heard from all quarters of the Conservative Party that this would be the end of civilisation as we know it and would undermine the family, but I rejoice at a sinner repenting.

Of course, I congratulate Conservative women on their achievements in increasing the number of women representatives in Parliament, for example. However, it is worth saying that, come the next general election, it is possible that unless both of the parties in the coalition take positive action to address the gender imbalance of MPs and prospective candidates, when Labour makes its gains—which I think it will—this may be disastrous for the representation of Liberal Democrat women MPs in particular, because they are in marginal seats. It will also not be good for women Conservative MPs. That is a matter of great concern for our democracy. I think the parties opposite need to address that issue very seriously indeed. Perhaps they might look at the examples that we continue to set in the Labour Party about how one increases the number of women representatives in Parliament and other places.

In the few moments left to me I should like to reflect on the lessons from the struggles that women have had. As we used say in my women’s group at the LSE in the 1970s, the personal is political. So I am going to look at a struggle that took place where I grew up, in Manningham, which is in my title. Samuel Cunliffe Lister, the first Baron Masham—not related to our dear noble Baroness, Lady Masham—is celebrated in Bradford as a former industrial giant and a benefactor to the city. There is a statue of him in Lister Park, the local park. Many may be aware of his great monument: the Italianate splendour of the towering chimney of Lister’s Mill, Manningham, which still dominates the city skyline more than 100 years after he breathed his last. He may have been the head of a dynasty of worker-bashing mill owners, but a closer look reveals that he could have been responsible for helping to create the Conservative Party’s deadliest rival, the Labour Party. I am referring to the Manningham Mills strike, lasting from 16 December 1890 until 27 April 1891—nearly 19 weeks. This was a war of attrition that was symbolic, in all aspects, of the clash of interests between capital and labour, particularly among the textile workers in the West Riding. The dispute was initially around pay but escalated into a dispute about solidarity, freedom of speech and how the Poor Law criminalised the poor. Unfortunately, the workers in that strike were starved back to work and returned after 19 weeks with the reduced wages that they had been offered.

However, the lesson for us today is that the unintended consequence was that tens of thousands of workers in the mill industry—the strike was led by women, which is why it is important—joined trade unions. Two years later, the Independent Labour Party was founded in Bradford. I claim for the women of Bradford the fact that we helped to found the Labour Party and all the consequences that have led from that. The lesson we might take from that today is that we need to pay tribute to the brave working women who have improved working conditions throughout the past 100 years or so—the women of the match girls’ strike, the Asian women in Grunwick and the women of Dagenham. We should pay tribute to those women in this debate and be grateful to them.

This Government and their policies for women, particularly working women, are an example of where the reality does not match the rhetoric. We know that women are suffering hugely from redundancies and that unemployment among women aged between 50 and 64 has rocketed by almost 20 per cent in the past year. According to Netmums, in February 2012, 70 per cent of families were financially on the edge, women were missing meals to feed their children—a survey of 2,000 mothers found that one in five was missing meals so that her children could eat—and a quarter of families were living on credit cards. It is the women who bear the brunt of this. Of course, I congratulate this Government where they have helped women at work—I have worked with the noble Baroness on that—but we need to address the very real issue that this economic downturn and this Government’s policies are having a very detrimental effect on women’s lives in this country.

[Baroness Northover]

I remind noble Lords—I should have done this at the very beginning of the debate—that this is a time-limited debate, and when the clock hits six minutes noble Lords have had their time. Could we be as disciplined as possible, because there is another major debate and a Third Reading following on after this?

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Wednesday 29th February 2012 Lords Chamber

[Baroness Thornton]

My Lords, perhaps I may just say that when I was a Minister this was one of the few battles that I had and lost in the department. I shall be very glad if the noble Earl has had the battle and won—congratulations. I also say well done to all those who have been campaigning on this issue, particularly my noble friend Lady Gould.

[Baroness Northover]

My Lords, I am the lucky one who has drawn the long straw on this issue and I am very grateful to my noble friend Lord Howe for allowing me to have that long—rather than a short—straw. I am especially grateful to my noble friend Lord Fowler for bringing back this important issue. Again, I pay tribute to his enormous commitment in improving HIV services for all and, of course, to the outstanding work he did to protect the public from infection.

As I advised in Committee, the Department of Health has now concluded its review of the current policy, under which some overseas visitors are excluded from free HIV treatment. The review considered many issues, including the public health and economic arguments for providing free treatment. We also noted the recommendation and findings on this in the No Vaccine, no Cure report, published last year by the House of Lords Select Committee on HIV and AIDS in the United Kingdom, chaired by my noble friend Lord Fowler.

Since the debate in Committee we have also taken account of the views of other government departments with an interest in this issue and I am pleased to report that the Government have agreed to support the change that this amendment proposes. The evidence on the public health benefits of HIV treatment is compelling. Research published last year, and subsequently reviewed and endorsed by our own Chief Medical Officer’s expert group, shows that treatment reduces infectivity and onward transmission by up to 96 per cent. Reducing transmission will reduce the risk of new infections in the wider UK population and, as noble Lords have said, reduce the NHS costs associated with treating late diagnosis of HIV. Around half of new HIV diagnoses in the UK are diagnosed late; that is, after HIV treatment is clinically recommended. As the noble Baroness, Lady Masham, said, late diagnosis results in increased mortality and morbidity and more expensive treatment.

As my noble friend Lord Fowler said, it is estimated that there are 91,000 people living with HIV in the UK, of which one-quarter are unaware they are infected, which means they can continue to transmit HIV to others. Without access to treatment upon diagnosis there are no or few incentives for testing. Amending these regulations will remove this barrier. It is also worth noting that the knock-on effect of improved public health protection for HIV is that reduced onward transmission will itself reduce the number of new cases within the overall population. The noble Baroness, Lady Gould, made reference to the importance of all of this. Earlier diagnosis, resulting from the testing of those previously put off by the prospect of charges, will reduce the number of late cases with more complex emergency healthcare needs. Together these benefits should reduce overall NHS costs significantly over the longer term.

Therefore, we agree that where clinically necessary we must provide HIV treatment, free of charge, to all who are present in the country, irrespective of their residency status. In doing so, this actually does no more than to bring HIV treatment in line, as others have said, with that for all other major communicable diseases, such as TB and hepatitis, and for all other sexually transmitted infections for which treatment is free without a qualification period. However, my noble friend’s amendment as drafted proposes to include a residency qualification period of six months for HIV treatment. I understand why he put that provision in. Our view is that such a limitation could compromise our primary public health objective and that therefore there should be no such exclusion. However, I recognise that my noble friend had included this limitation to address wider concerns about attracting others to come here for treatment. We share those concerns.

The NHS is, and must remain, a national not an international health service. While it should also provide for the emergency and humanitarian needs of others, we are clear that in implementing this change we must avoid creating an incentive for people to travel to the UK solely for the purpose of free HIV treatment. In fact, they should not have to; there has been huge progress globally on increasing access to free or subsidised HIV treatment. Some African countries have achieved universal treatment coverage. Average treatment coverage in Africa has increased to almost 50 per cent, with even higher treatment coverage in eastern and southern African. While the different models of healthcare systems in other countries make direct comparisons difficult, research suggests that free HIV treatment is available, regardless of a person’s residency status, in France, Spain, Holland, Italy and Portugal. The noble Lord mentioned the situation in the rest of the United Kingdom.

The Department of Health is already in the process of drafting, with HIV clinicians and others, new clinical guidance to support implementation in a fair and consistent manner. This will limit the extent of immediate access to drugs after a person is diagnosed and allow for continued review of the duration of any drug supplies before another visit is required. So it simply will not be the case that tourists can get off the plane and access immediate long-term supplies of drugs. If clinicians identify a person who is in the country just to receive free treatment, the NHS will not provide it unless there are exceptional circumstances, such as extreme infectiousness or pregnancy. Treatment for any conditions other than HIV itself remains chargeable.

Furthermore, we will continue to monitor any change in new HIV diagnoses in the UK of HIV infections acquired abroad. We will strengthen our current monitoring and collect additional anonymised data on residency status that will help to identify any abuse. In addition, we will maintain existing stringent procedures to check for fraudulent registrations at GUM clinics. It will also remain the case that receiving HIV treatment will not be sufficient to overturn an immigration requirement to leave the country and there are no provisions under the Immigration Rules for a person to travel into the UK in order to access the NHS.

To conclude, I am very grateful for the opportunity to discuss this important issue again and I am very grateful to noble Lords around the House for all their work over a number of years. I pay tribute also to the noble Baroness, Lady Thornton. This is a very sensitive issue and I appreciate the constructive way that people have dealt with it. There is a compelling public health case in support of this amendment which we cannot ignore. However, while safeguarding our overriding responsibility for public health, we are clear that the change this amendment proposes should not be seen as an incentive for travel to the UK for the purposes of obtaining free HIV treatment. We will therefore be introducing strong safeguards in our front-line procedures in clinics to address this.

Having said that, the Government support the change that this amendment proposes but I am asking my noble friend to withdraw it for now, for three reasons. First, on a technical point, the proposed change is to secondary regulations. It is not normal procedure to amend such regulations through a primary Act. Secondly, as I have indicated, the amendment includes a six-month exclusion period that we do not support. Thirdly, the department needs some time to finalise the clinical procedural safeguards and monitoring processes that I have set out.

However, in seeking withdrawal, I offer on behalf of the Government an absolute commitment that the department will introduce a statutory instrument to amend the current exemption, so that the exemption from charges for treatment of sexually transmitted infections will include HIV. The change would be effective from October this year, and we would anticipate laying the amending SI before the Summer Recess to achieve that effective date. As my noble friend Lord Fowler said, this makes economic and human sense. I hope that my noble friend will understand and agree to the process that I have proposed as the most effective way of delivering the mutually desired outcome of his amendment, for which he and others have long campaigned.

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Monday 13th February 2012 Lords Chamber

[Baroness Thornton]

My Lords, briefly, we support these amendments and commend the noble Lord, Lord Ramsbotham, and my noble friend for tabling them again because they are indeed important. I got quite excited when I saw the original spelling which was out there because I was thinking, “Is this about TB or HIV? This is a new one on me”. Nevertheless, this is a very important group of amendments because, as the noble Lord, Lord Ramsbotham, and other Members of the House have pointed out over many years, if you do not deal with the communication, speech and language problems of children at an early stage, you are storing up problems for the future. Indeed, Jean Gross’s report on front-line speech therapy for children is a cause for great concern, because it is quite clear that significant gaps are already appearing because of the cuts that have been made to provision.

I point out to the House that the allied health professionals have expressed their very grave concern about these issues by saying that they would like the Bill not to proceed. They are among the many thousands of health workers who, in this case, have been saying that for some extremely good reasons. Perhaps the noble Baroness would like to explain to the House what she is doing to persuade the allied health professionals and the speech and language therapists why the Bill will help them do their job any better, when it is quite clear that the services to children with speech and language therapies are already suffering.

[Baroness Northover]

My Lords, we are very sympathetic to the points that the noble Baronesses, Lady Hollins, Lady Whitaker and Lady Thornton, have just made. The noble Baroness, Lady Hollins, is quite right about the importance of communication skills—or even “communization skills”; my dyslexic son latched on to that one. We are acutely aware that addressing these kinds of areas is critical to the reduction of inequalities.

The noble Baronesses, Lady Hollins and Lady Whitaker, were concerned to ensure that we had flagged up this area. My noble friend Lord Howe sent a letter to the noble Lord, Lord Ramsbotham, who has worked tirelessly in this area. I emphasise that the Healthy Child programme, from pregnancy to five years, is the overarching NHS framework for providing prevention and early intervention for children and their families, and consists of a programme of screening, immunisation and health and development reviews. It is led and delivered by health visitors. It provides regular opportunities after birth for the parents and the health visitor to review together a child’s development, health and well-being, including any concerns about speech and language skills. We are working to improve the coverage of the HCP by delivering the Government’s commitment to increasing the health visitor workforce by 4,200, full-time equivalent, by 2015.

As part of the HCP’s schedule, the review at two to two and a half years includes a focus on speech and language development and is a key opportunity for health visitors to identify any problem and to take appropriate steps to refer a child to speech and language therapy if required. Following the commitment in the July 2011 publication Supporting Families in the Foundation Years, the Department of Health and the Department for Education are working together to develop the two to two and a half year review to become an integrated review, covering both health and education. The Department of Health is also leading a piece of work to develop a population measure—

[Baroness Thornton]

How does the Minister reconcile what she has just been telling us about referring children to that service after review at two and a half years with the fact that 70 local authorities have lost their NHS funding, 25 have lost cash from the LEA and those speech and language therapists are actually not going to be there?

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Monday 19th December 2011 Lords Chamber

[Baroness Northover]

My Lords, these amendments seek to extend compulsory statutory regulation to physicians’ assistants in anaesthesia and clinical physiologists and to make changes to legislation to further provide for the compulsory statutory regulation of clinical physiologists.

I make it clear at the start that healthcare scientists such as clinical physiologists play an important and highly valued role as part of clinical teams, and this is also true of physicians’ assistants. It is a testament to their professionalism that the Department of Health is not aware of any general concerns about the standards of practice of either group. Furthermore, we need to be absolutely clear that the purpose of regulation is to protect the public, not to support the development of a profession.

Given the wider systems of assurance in place such as the Care Quality Commission’s registration requirements, and the vetting and barring scheme, the Government do not consider that the case for compulsory statutory regulation of these groups of healthcare scientists not already subject to regulation, and physicians’ assistants, has been made. However, we agree that there need to be processes to ensure high standards of care, and assured voluntary registration overseen by the Professional Standards Authority for Health and Social Care has the potential to provide this. It will ensure that there are robust standards of conduct and training. It will be open to employers and commissioners to insist on only recruiting staff on voluntary registers. Those doing so would secure many of the benefits of compulsory regulation. Both healthcare scientists and physicians’ assistants already have established voluntary registers and would be well placed to seek accreditation from the authority.

The noble Baroness, Lady Thornton, asked why we were not taking forward the regulation of clinical physiologists as recommended by the Health Professions Council. The recommendations of the Health Professions Council were not based on an assessment of the risk presented by a profession, but rather on whether that profession had already developed processes of assurance which prepared them for professional regulation. There is therefore no evidence that compulsory statutory regulation is necessary to mitigate the risks posed by the professions recommended for such regulation by the Health Professions Council. This is probably why the previous Government did not decide to regulate, although this is an issue that has been flagged up for a number of years. The professions recommended by the Health Professions Council for compulsory statutory regulation will be well placed to join the system of assured voluntary registration that we are proposing.

The noble Baroness, Lady Thornton, asked about research in terms of regulating clinical physiologists. We are not planning on commissioning research into the case for regulating them, but we will review the case for introducing compulsory statutory regulation for clinical physiologists and, obviously, others in the light of experience of assured voluntary registration, and the evidence about risks available.

[Baroness Thornton]

Perhaps the Minister could tell us what sort of timescale she envisages for this, or whether it will have to wait until an accident happens like the noble Baroness, Lady Finlay, recorded and then the Government will deal with it.

[Baroness Northover]

The noble Baroness will be fully aware, because she was a health Minister, that if there is no evidence of there being a risk then you do not choose to regulate. That is presumably why the previous Government chose not to.

The noble Baroness, Lady Finlay, flagged up the position of anaesthetists’ assistants. I had interesting discussions yesterday with an anaesthetist and an anaesthetist’s assistant, and it was very enlightening. As the noble Baroness will know, the anaesthetist is of course ultimately responsible. Assistants must always be supervised by a consultant who needs to be available within two minutes. The issue that the noble Baroness raises is one of quality assurance. As she knows, the Royal College of Anaesthetists runs the training and the registration for those assistants. After they have done a science degree, generally it is 27 months of practice. If the Royal College of Anaesthetists judges that that is inadequate, on the basis of the kind of concerns that the noble Baroness raises, then it is clearly for it to say that there are risks, it has encountered risks, and that needs to be addressed. If this system comes under the quality assurance system that I mentioned earlier, there will be another body looking at whether that kind of training, assurance and registration is adequate. However, there have not been cases flagged up as causing concern. I also point out that there are few anaesthetists’ assistants. They are more generally used in other countries, I gather, but not so much in the United Kingdom. The noble Lord, Lord Alderdice, asked why there is not more statutory regulation. In some ways I think I have addressed that. Although compulsory statutory regulation is sometimes necessary, one has to look at the risks and at what is proportionate.

[Baroness Thornton]

The health Minister Anne Milton said that those professions in which a patient safety case can be made, including that of clinical physiologists, will be considered for statutory regulation subject to a cost-benefit risk analysis. Will the Government carry out that analysis and, if so, when and in what time? I do not particularly want an answer about what my Government may or may not have done or may or may not have decided. The noble Baroness’s own Minister has pronounced on this matter since the general election so it seems to me that she needs to answer the question: when will they do the risk analysis?

[Baroness Northover]

I have already mentioned to the noble Baroness—she is probably totally familiar with this—that the Department of Health does not have evidence of there being a risk in this regard. Clearly, as I mentioned on the earlier group, these issues will always be kept under review. If the concerns that she has flagged up and if the association, which is particularly encouraging the regulation of clinical physiologists—that is fine; it is all part of professionalisation—flags up particular concerns that emerge from other evidence, then of course the department will take that very seriously. However, things need to be proportionate.

[Baroness Northover]

I am very happy to take away what the noble Baroness has said and to discuss the situation further with her.

We expect the assured voluntary registration to be up and running by 2012. Therefore, afterwards that would need to be assessed to see whether anything further is required, as noble Lords have figured might be the case. We are hoping to see how it all works.

The noble Lord, Lord Walton, flagged up various groups which were regulated and he could not quite see why others were not. Given that I used to bump into the noble Lord, Lord Walton, in the Wellcome Library for the History and Understanding of Medicine, I think he will fully understand that the way in which regulation has grown up has not necessarily been logical or consistent. Therefore, I flag up the 2005 Hampton review on regulation which says that it should be proportionate to the risks that it seeks to mitigate and various other provisions. That is what we are seeking to do. Of course, we shall keep under review what we are doing to see whether it is adequate. In the mean time, I hope that the noble Baroness will be willing to withdraw the amendment.

[Baroness Thornton]

My Lords, I thank the Minister, but this is not yet a satisfactory situation. We might be moving towards one but we are not there by any means. If I were on the register of clinical physiologists I would find it slightly offensive for the Minister to suggest that I was asking for statutory regulation as a kind of professional development of the organisation. Physiologists are very clear in all of their briefings that they think that this is important for patient safety. That is why they want statutory regulation and that is why we need to listen to them very carefully.

[Baroness Northover]

I am extremely happy to acknowledge that.

[Baroness Thornton]

I thank the noble Baroness for that. The noble Baroness, Lady Finlay, made a graphic and powerful case. I thank my noble friend Lord Rea, the noble Baroness, Lady Masham, and the noble Lord, Lord Walton, for their support for the amendment. My noble friend Lady Pitkeathley and the Minister are coming at it from a different point of view. It is entirely possible that an arbitrary decision was taken, quite possibly by my Government, that there was enough statutory regulation. It is possible that this Government need to think that that was an arbitrary decision in the history of regulation and that exceptions need to be made.

There are questions about the limits of assured voluntary registration. Do clinical physiologists carry out invasive procedures that could harm patients? Yes, they do. Are clinical physiologists incentivised to join the voluntary register? No, they are not. A small number of NHS and private employers notionally require applicants to be on their register but there is no mandatory requirement for this. Are professionals incentivised to maintain the voluntary register? No, their activities are carried out on a voluntary basis by the chair and other officers. Does the voluntary register empower patients to make formal complaints? No. While the Health Professions Council operates a system whereby anyone can make a complaint about the fitness to practise of a professional on its register, in most instances members of the public are not aware of the existence of voluntary registers. Finally, does the voluntary register have any powers of enforcement? No, it does not. The RCCP operates a disciplinary code and procedure but it cannot protect patients from continuing to be treated by practitioners who have not been registered and who are potentially unfit to practise. I beg leave to withdraw the amendment.

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Monday 5th December 2011 Lords Chamber

[Baroness Thornton]

My Lords, what links the two parts of this debate are the unintended consequences and the need for second and third thoughts about things. My noble friend Lord Patel, the noble Lord, Lord Adebowale, and the noble Baroness, Lady Hollins, expressed concern about this clause. That is frankly good enough for me. It has been suggested elsewhere in the way of things that some enthusiastic civil servants, in the process of tidying up this Bill, have actually brought about what could be serious unintended consequences. The noble Baronesses, Lady Murphy and Lady Barker, also have some important points to make about the amendment in the name of the noble Baroness, Lady Barker. This House spent many hours constructing the architecture through the Mental Capacity Act and the Mental Health Acts, not all of it right. I do, however, remember the duty of co-operation being an important part of those Acts; those rights, protections and duties are very important and we need to check that we have not damaged them through the construct of this Bill.

On Clause 51 stand part, we on these Benches are pleased to support the important amendment put down by the noble Baroness, Lady Finlay, about the problems that might occur when the responsibilities of primary care trusts for the certification of deaths are transferred to local authorities. I do not intend to read out the whole of this note because the noble Baroness, Lady Jolly, has referred to most of it, but we are very concerned that these proposals will mean delay and an increase in cost when people are at their most vulnerable and least able to withstand that. I do not think that anybody in this House would want that to happen. I suspect that the Government would not want to place in jeopardy the trust and confidence in the system as it is, and I think there is a danger that Clause 51 does that. We on these Benches support the amendments in this group.

[Baroness Northover]

My Lords, noble Lords have spoken passionately about the need to support patients who are particularly vulnerable. These are complicated areas, and I am happy to write to noble Lords to clarify what is intended in the Bill and to address their specific questions if I do not answer them in what I say here.

The Bill makes a number of essentially consequential amendments to the Mental Health Act 1983. The Government are also taking the opportunity to remove a few redundant powers and to make a small number of changes to that Act. That is the intention. This is not a major shift; these are meant to be tidying-up changes. However, if they have unintended consequences, it is important that they are flagged up, and I hear what the noble Lord and other noble Lords said.

The principal changes are the change in the responsibility for commissioning independent mental health advocates from the NHS to local authorities and the change in the requirement that a second opinion must be given even where patients on supervised community treatment consent to their treatment. This condition does not apply to patients who are detained in hospital and is contributing to the major difficulties that the Care Quality Commission is experiencing in managing the second opinion appointed doctors service.

The Government are also taking the opportunity afforded by the Bill to make a number of changes to the Section 117 of the 1983 Act. The first amendment in this group, which was tabled by the noble Lord, Lord Patel of Bradford, addresses that. The main change is to transfer the duty on primary care trusts to commissioning consortia, but the clause also takes the opportunity to align the duty in Section 117 more closely with mainstream NHS legislation. That is the intention. For example, it gives the Secretary of State the power to make regulations that say which consortium is to be responsible in any given case. That will allow us to end the current anomaly that sees some PCTs responsible for Section 117 aftercare for patients whose other needs are the responsibility of a different PCT.

Regulations could also say that, in particular circumstances, the NHS Commissioning Board is responsible rather than the consortium. That would allow us to prevent consortia ending up having to commission services that are normally commissioned by the board just because the patient happens to qualify under Section 117. The noble Lord, Lord Patel, spoke very persuasively about the need to avoid this clause having unintended side effects, and I can confirm that that is certainly not the Government’s intention. I am very happy to meet the noble Lord to discuss these issues further.

On co-operation with the voluntary sector, we need to consider consistency with other services that CCGs will commission in order not to give in some way a distorted picture of when CCGs should work closely with the voluntary sector. Nevertheless, I am happy to have further discussions on this point.

On charging, which is clearly a significant concern of the noble Lord, the Bill does not change the current situation. Patients will not have to pay for any care under Section 117. I hope that I can reassure the noble Lord on that point.

The second amendment in this group was tabled by my noble friend Lord Marks and is about access for children who come under the 1983 Act to the services of an independent mental health advocate. Section 130C of the Mental Health Act 1983 already gives the same right of access to such an advocate to all qualifying patients, including children. Making special provision for minors might give the impression that other qualifying patients should have lower priority for access to such services. Our aim is that every vulnerable person who comes under the major provisions of the 1983 Act and wants the support of an advocate should have one. That should, of course, include every child and young person, but it should also include everyone else as well. The current law not only supports the aim of this amendment in respect to children but does so for all vulnerable people of all ages.

Health and Social Care Bill

Debate between Baroness Thornton and Baroness Northover

Wednesday 16th November 2011 Lords Chamber

[Baroness Thornton]

The Minister is giving a list—and there are at least two further lists in Clauses 8 and 9. I cannot see why my list should not be in there, too.

[Baroness Northover]

I can see the temptation. The list in the Bill is indicative. These lists are always subject to much debate about what goes in and what stays out. I fully understand why the noble Baroness wishes to add her list. However, we would resist adding to the list in the Bill, which is, as she knows, indicative. We appreciate people's contributions to what needs to be covered in these areas. I point out to her that the list—no doubt we will spend many hours debating the regulations—includes all sorts of things, such as mental health services and dental public health services. I will not read out the whole list. If noble Lords think that something is on it that should not be there, or that other things that are not on it should be, I am sure that we will consider those points as we debate the regulations.

I noted a response to the noble Baroness, Lady Hollins, but I think that I may be referring to a previous debate. She is absolutely right to emphasise that we have to make sure that everything we do is patient-centred. All the changes must focus on that. It is a challenge for everybody. Perhaps people have tried to do it before. No doubt we will have problems trying to do it ourselves, now and in the future, but that has to be the focus. Therefore, we have to remember the diversity of the patients that we are talking about. I am sorry; that answer belonged in an earlier debate.

I know that we will return later to debate alcohol. I hope that noble Lords will not press the amendments in this group.

--- Later in debate ---

[Baroness Thornton]

My Lords, I rise to comment on these excellent amendments, and to support my noble friend Lord Beecham who has his name against Amendment 71. Amendment 71 is one of those very small amendments that changes “may” to “must” but it is actually at the heart of this discussion. What we are talking about here is how national campaigns will be linked to local action, and how they will be funded.

I start by reminding the Committee of some of the key components of this Government’s health policy on the harmful use of alcohol: banning the sale of alcohol below cost price; reviewing alcohol taxation and pricing to ensure that it tackles binge drinking without unfairly penalising responsible drinkers, pubs and important local industries; overhauling the Licensing Act; local authorities having more powers to remove licences and refuse grants that are causing problems; allowing councils and police to shut down establishments; doubling the fines for underage alcohol sales; and local councils being able to charge more for late-night licences.

My noble friend Lord Brooke put his finger on it, as did my noble friend Lord Turnberg, when he expressed scepticism as to the efficacy of these when you link them to the responsibility deal pledges on labelling. As part of the public health responsibility deal agreed with the Government in March 2011, UK alcohol beverage companies have pledged—that is an interesting word to use in this context—to implement a health labelling scheme to better inform consumers about responsible drinking. This pledge is in line with the industry’s response to the Department of Health’s consultation in May 2010 on options for improving information on the labels of alcoholic drinks to support consumers in making healthier choices in the UK. I do not think this is going to work.

Will the Government be reviewing their national campaign on alcohol and the misuse of alcohol in the light of this Bill? We have a national policy and a campaign, presumably run and directed by the Secretary of State for Health through the public health agency within the department. We have to look at what will actually happen on the ground and indeed address the dangers or risks that are posed by this Bill. A key question is the distinction between primary prevention and secondary prevention, which is complex in relation to the prevention of alcohol misuse. It is a concern when interventions cannot be clearly delineated as primary and secondary prevention. It seems that the reforms being proposed here will make that worse, not better.

Multiple commissions across one therapy, such as alcohol misuse, may cause uncertainty over who is responsible for funding services considered for both primary and secondary prevention. The worst case scenario is that neither the directors of public health nor the GP consortia commission secondary prevention services because the directors of public health are focused on primary prevention, awareness and information, the GPs are focused on treating the physical complications and harms relating to alcohol, and the hospitals are mopping up the people who turn up needing treatment for alcohol abuse.

If we are to tackle the fact that the number of hospital admissions was over a million in the last year, and that it is estimated to cost the NHS £2.7 billion a year—almost twice the equivalent figure for 2001, with the costs to society being even greater—there has to be co-ordination between national and local, and some direction about how these programmes will be carried through at local level. On these Benches we are therefore very sympathetic to what we see as a series of rather modest and focused amendments. We hope that the Minister will be able to look upon them with some sympathy.

[Baroness Northover]

My Lords, Amendments 71, 71A, 72, 74A, 202, 328, 329 and 331, make alternations to local authorities’ new duty for public health. In introducing this group, the noble Baroness, Lady Finlay, has made a very powerful case, as one would expect from somebody who has campaigned for a very long time in this area. Clearly, the harm caused by alcohol is unacceptably high, and everyone has to play a role in reducing its harmful use. She is absolutely right in her campaign on this. As she says, 1.1 million hospital admissions were alcohol-related, out of a total of 14 million admissions, at a cost of £2.7 billion. It is of course extremely striking that 13 per cent of 11 to 15 year-olds reported drinking in the last week. I am acutely aware of the particular vulnerabilities of children and young people in this regard. The British Crime Survey suggests that alcohol is linked to half of all violent crime, so you can see the significance of what we are talking about here.

Can I assure the noble Baroness, Lady Masham, that indeed, we are very acutely aware of how many prisoners have alcohol problems, as well as drug and mental health problems? As a Whip in the Ministry of Justice, I can assure the noble Baroness that we regard this as extremely important and that we are seeking to tackle it.

Local directors of public health in local authorities will have a key role in tackling alcohol harm. Can I assure the noble Baroness, Lady Finlay, that this will need to be addressed at every level of the health service and public health? That is why it receives such prominence in the paper that I referred to earlier. Again, I refer to the fact that public health, itself in the past very much a Cinderella service, is now at the front and centre of these changes. We hope that the involvement in local authorities will help to change this.

There are a number of steps that need to be taken; I would like to flag up some that the Government are taking at the moment. The noble Baroness, Lady Thornton, made reference to a number of these, and we are fully aware that this is a range of things, and that neither this Government nor the previous one, in all the range of things that we have undertaken so far, have made a dent in this problem. We recognise that this problem is driven by economic and social change, and it needs to be addressed in that regard, and understood very fully. In terms of relevant things which are happening, local directors of public health and local authorities will have a key role in tackling alcohol harm. We know that engaging with those drinking above the lower risk guidelines early on, and providing advice or referral for treatment for those who need it, does work, and that that is helpful.

While the health services have made improvements, much more needs to be done to identify consistently early signs of drinking above the lower risk guidelines, and to offer advice whenever and wherever the opportunity arises. I know how difficult this is with teenage children.

The coalition’s programme for Government, to which the noble Baroness, Lady Thornton, referred, committed to a ban on the sale of alcohol below cost. It also committed to review alcohol taxation and pricing to ensure that it tackles binge drinking. The Treasury published its review of taxation on 30 November 2010 and set out changes to duty on beer.

I hope that the noble Lord, Lord Turnberg, will be reassured that we will bring together the Government’s approach in an alcohol strategy, which is to be published towards the end of this year. We are reforming the Licensing Act via the Police Reform and Social Responsibility Act to enable local communities to ensure responsible retailing of alcohol. Also mentioned was the consultation on the public health outcomes framework.

--- Later in debate ---

[Baroness Northover]

I note what the noble Lord has said in regard to his Government. I would be astonished if those working on this strategy were not bearing that in mind, but I will check. I can assure the noble Lord that, in the unlikely event that they are not, I will bring the review to their attention so that they can factor it in.

The noble Lord, Lord Rea, asked whether the current spending on alcohol is included in local authorities’ funding for public health. I can assure him that that is the case and that what is being spent by PCTs on commissioning alcohol services will be reflected in the resources transferred to local authorities.

Amendments 66 and 72 would add,

“providing services for the prevention and treatment of harmful drinking and alcohol dependence”,

to the list of steps that the Secretary of State and local authorities may take under new Sections 2A and 2B. However, the Bill already gives the Secretary of State and local authorities the ability to take appropriate steps to address harmful drinking. The new public health responsibilities in this Bill give local authorities a ring-fenced grant to ensure that local authorities have the resources to deliver their public health responsibilities, including alcohol misuse services. Obviously, there was discussion of that ring-fence grant previously. I think it is a move forward that, instead of public health being part of the overall NHS and subject to being raided, there will be a ring-fenced grant.

Clinical commissioning groups are already under a duty—under Section 3 of the NHS Act, as amended by Clause 10, and under new Section 3A—to commission services as they consider appropriate as part of the health service or to secure improvement in the physical and mental health of their population. Given the scale of the problem, it would be astonishing if that was not part of how they see their responsibility.

I can further reassure your Lordships’ House that the importance of services which reduce alcohol-related harm will not be overlooked. The Secretary of State will set the strategic direction of the NHS through the mandate to the NHS Commissioning Board. This should be the route for highlighting priorities for the health service and I have no doubt that debates in Parliament, such as this, and in the wider sphere will help to influence that.

Amendments 328 and 329 would require joint strategic needs assessments to include an assessment of alcoholism in the local population and the involvement of representatives from alcohol services in the preparation of the joint health and well-being strategy. While we fully support the principle that the joint strategic needs assessments need to be comprehensive, we do not feel that it is necessary to include this amendment in the Bill. The scope of this assessment will naturally include the needs related to harm from alcohol. However, we have retained the power for the Secretary of State to issue guidance on the preparation of the joint strategic needs assessment. We will ensure that it covers the need to consider alcoholism, which I hope will reassure noble Lords.

Amendment 329 would require local authorities and clinical commissioning groups to,

“involve representatives from alcohol services”,

in the preparation of the joint health and well-being strategy. While there is no representative of alcohol services in the local area on the health and well-being board, it would still be able to involve experts as appropriate or invite them to be members of the board. On Amendment 331, which would require health and well-being boards to include,

“a representative from alcohol and drugs service”,

the same point applies: they could be a member of the board or their advice could be sought. The legislation sets out a minimum membership for these boards—

[Baroness Thornton]

I am slightly disturbed that so far the Minister has given us lots of coulds and maybes and “there is no reason why they should not”. Given the scale of this problem, I think that the Government need to look carefully at what goes on the face of this Bill and what is put in regulations about the problem of alcohol abuse.

[Baroness Northover]

I think that that point comes through loud and clear from this debate. I note what the noble Baroness said about what goes into the Bill or in regulation. She will know, from her experience of government, that generally speaking you do not put this sort of thing into the Bill. However, I take on board very much what she said about regulation, and I will take that back to the department.

The noble Baroness rightly focused on the joint strategic needs assessment and analysis of the current and future health and social care needs of an area. This would include the health and social care needs that are alcohol-harm related. Health and well-being boards would be able to involve people as necessary. As I said, noble Lords have made a very strong case for tackling alcohol abuse, which is very much economically and socially driven by the changes that underlie why this has come about. I have no doubt whatever that this issue will continue to dominate our debates, whether over regulation or over the Secretary of State’s mandate. This is a difficult area to tackle, as we know and as the previous Government knew, and it is best tackled as a cross-party attempt.

If only putting such matters into the Bill was a panacea. However, I am sure that the noble Baroness recognises that that is not the case. We realise that a range of measures must be taken, and I can assure the noble Baroness, Lady Thornton, that we constantly review the effectiveness of what we do. If we did not, I am sure that noble Lords would ensure that we did. I hope, therefore, that the noble Baroness will agree to withdraw her amendment.

Coroners’ Inquests

Debate between Baroness Thornton and Baroness Northover

Tuesday 12th July 2011 Lords Chamber

[Baroness Northover]

The noble Baroness is absolutely right that this is a very difficult process for any family to go through, and anything that we can do to expedite inquests while holding them thoroughly is of key importance and should help the families. Section 16 of the Coroners and Justice Act 2009, which was introduced in response to the noble Baroness’s amendments, did place a duty on a senior coroner, when an investigation has not been completed within a year, to pass that information through and for there to be a register of that. As she knows, the plan is that the functions under that office will be transferred to the Lord Chancellor. This area will indeed be addressed. With the spotlight on military inquests and with the delays that used to occur, it is notable that things have improved enormously, so there is a lot to be said for getting things out into the open.

[Baroness Thornton]

My Lords, my noble friend Lord Bach and I have been campaigning together on this issue, and I won the toss to explain how disturbed we are on these Benches. The Royal British Legion, which has campaigned tirelessly about the inadequacies of the coroners’ service, has been in touch with me about this matter. It is bitterly disappointed with the proposals outlined by the Secretary of State on 14 June, where he says that he intends to persist with the abolition of the office of chief coroner. Given the overwhelming support for the chief coroner across this House, led by the noble Baroness, Lady Finlay, during the passage of the Public Bodies Bill, and indeed the overwhelming support from all parties for the reforms to the Coroners and Justice Act 2009, why are the Government persistently denying bereaved Armed Forces families a reformed, effective and well led coronial system that would provide them with the respect and support they need when they are at their most vulnerable and are grieving?

[Baroness Northover]

As I have just mentioned, military inquests have improved over the past couple of years or so, and that is very welcome. The noble Baroness refers to the position of chief coroner and to the actions of the noble Baroness, Lady Finlay, in defending it. It was clear that there was great concern about this in your Lordships’ House. Many of the provisions in the Statement of 14 June were negotiated with concerned parties, including the noble Baroness, Lady Finlay. They move most of the functions to the Lord Chancellor and the Lord Chief Justice but the position of coroner has not been abolished. It will be reintroduced in the Public Bodies Bill in the Commons so that it is there as a backstop. If the transfer of responsibilities to the Lord Chancellor and the Lord Chief Justice does not work, the provision can be reverted to. However, I make the point that in our current economic situation it was not possible—

General Social Care Council

Debate between Baroness Thornton and Baroness Northover

Wednesday 11th May 2011 Lords Chamber

[Baroness Northover]

As I say, other bodies have already been set up. The College of Social Work is being established and will help take this forward, as will the social work task force and various other organisations. In the light of what the Munro report and other reports have said, it is extremely important that the profession takes forward how best to protect the most vulnerable in our society. Separately, we have to make sure that the regulation of the fitness to practise of those who are working in this area is carried out properly.

[Baroness Thornton]

My Lords, the Department of Health has admitted that the abolition of the General Social Care Council is not down to its performance, and I hope that the Minister will confirm that that is the case. As my noble friend has said, the Health Professions Council has no experience of social care. Therefore, is it not the case that this is driven by an ideological need to abolish arm’s-length bodies that is so overwhelming that the Government are prepared to put at risk such important work?

[Baroness Northover]

I must say that I disagree. It is as though the noble Baroness were to set in aspic. I can see why the noble Lord, Lord Hunt, thought that this was the best way to go forward in 2000, but we are now 11 years on from when that process was set up. The profession of social work has, fortunately, progressed and developed, and it must progress further. At the same time, we must make sure that the regulation is fit for purpose. Our proposal does this far better. I am sure that the noble Baroness would expect the Government to scrutinise and to work out the best way of taking the matter forward, and to propose a better way of regulating. There has been tremendous support for that decision.

NHS: Hospital Patient Maltreatment

Debate between Baroness Thornton and Baroness Northover

Wednesday 16th March 2011 Lords Chamber

[Baroness Thornton]

My Lords, the noble Baroness, Lady Knight, and I have talked about the malnourishment of elderly people. Age UK and Mencap have expressed concern about this issue. It will cost more if people who can no longer cope are taken into hospital because they do not have decent food. Will the Government monitor the results of cuts in the provision of meals to the elderly, the vulnerable and the disabled in the coming years following the cuts that local councils are having to make?

[Baroness Northover]

I should point out to the noble Baroness that the previous Government put in place arrangements to improve nutrition and to try to cut dehydration. That has not tackled this problem. I do not think that this is a problem of funding; I think it is a problem of culture.

Health: Hydrotherapy

Debate between Baroness Thornton and Baroness Northover

Tuesday 23rd November 2010 Lords Chamber

[Baroness Northover]

My Lords, I am well aware of the report in the name of the noble Lord, Lord Walton. It is a most impressive report that had an effect on the then Government. We are doing our best to take that forward. One thing that struck me when I looked at the research in this area was its paucity. The Department of Health can do so much, but clinicians can do a lot more. It is worth bearing in mind that the use of hydrotherapy is a matter for clinical judgment. By and large, clinicians and patients must take this forward. Therefore, it is very important that clinicians undertake research with larger groups of patients than has been the case heretofore. Anything that the noble Lord can do to promote that would be extremely welcome.

[Baroness Thornton]

My Lords, I say to the Minister that this is also a matter of resources. Is she aware of the potential benefits of hydrotherapy for people with long-term conditions, such as stroke, Parkinson’s disease and multiple sclerosis? How will she ensure that hydrotherapy treatment is both continued and expanded for key groups when funding is transferred from PCTs to GPs, and how will the Government support GPs in the effective commissioning of these expensive rehabilitation and reablement treatments for people with these long-term and progressive conditions?

[Baroness Northover]

As the noble Baroness will recognise, the provision of this treatment up and down the country has been an ongoing problem. It is something that the previous Government tried to tackle, and the emphasis then, as now, was very much on local decision-making. However, the national commissioning board will be looking at the provision of specialised services and will try to ensure that, where there is this kind of need for a small group of patients, provision is catered for. At the moment, as the noble Baroness knows, the Department of Health is assessing the results of the consultation on the White Paper, which has just closed, and proposals on specialist commissioning will be brought forward. However, it is extremely important to recognise that this is not a new problem and it is not an outcome of the proposed changes.

Disabled People: Independent Living

Debate between Baroness Thornton and Baroness Northover

Tuesday 22nd June 2010 Lords Chamber

[Baroness Northover]

I could not agree more, from personal experience. It is extremely important that the right information is available. Certainly, the previous Government made progress in this regard, and we intend to take this further. It is extremely important that this is looked at from the point of view not of the provider but of the individual. Looking at it from their point of view will help to change the way in which these services are provided.

[Baroness Thornton]

First, I am sure that the whole House will wish to welcome the noble Baroness to her new position. I know how she must be feeling.

The Minister is concerned about individuals, but the recently announced cuts to local government grants will have a direct impact on the Supporting People budget and will make it more difficult for vulnerable people such as the disabled to live independently in their homes. Is the department monitoring this matter? Personal choice is fine but if your local authority has cut that budget, it does not matter what your personal choice is because the money will not be there to support you.