Health and Social Care Bill

Baroness Warwick of Undercliffe Excerpts

Tuesday 25th October 2011 Lords Chamber

[Lord Mawhinney]

My Lords, I want to associate my initial remarks entirely with what my noble friend Lord Newton has just said. The noble Lord, Lord Owen, has given the Committee good advice. I have sat through the whole of today’s debate, as have most of us, and it has been interesting to note how much we have learnt about this Bill simply by talking to and listening to each other. I share the view of the noble Lord, Lord Owen, that the learning process has only just begun and is not nearly complete, so it would be foolish to rush to judgments.

I would say to my noble and learned friend Lord Mackay that he knows there is no one I hold in higher regard than him. The formulation in his amendment is extremely helpful because it encapsulates the legal realities. So if I had to judge on the basis of the legal realities, I think I would favour my noble and learned friend’s amendment.

On the other hand, I should say to the noble Baroness, Lady Williams, that the strength of her amendment lies in the fact that it has 60 to 70 years of continuity. If we are looking for the constitutionally more helpful amendment, it may be that of the noble Baroness. I say that also conscious of the fact that out there, as we keep telling each other, there is a degree of nervousness about this Bill. Some of it is well founded and some of it is scaremongering, a word I have used before. But there is a sense of unease. The continuity of 70 years of using the same language might help to address the issue. That is why I say that constitutionally I lean towards the noble Baroness, Lady Williams, while legally I lean towards my noble and learned friend, and I do not want to make a choice at the moment.

Maybe it is partially because the noble Lord, Lord Newton, and I spent so many years in the other place but, as he said, I too believe that the reality is that out there £128 billion is really rather a lot of money. The idea that when somebody threatens to close the Peterborough Hospital my former constituents are going to settle for the chairman of a quango, no matter how illustrious, experienced or wonderful he is—I do not know the gentleman but I am sure that he is all of those and a whole lot more—is just not in the real world. I tell you that as somebody who can still fairly clearly remember what it was like to be a Member of Parliament. Indeed, I can remember fairly clearly what it was like to be the Health Minister and it is still not in the real world.

The noble Lord, Lord Warner—I promise not to keep doing this—was very helpful to this Committee because he pointed out the Secretary of State’s powers. Unusually, I am not sure my noble friend Lord Newton was quite right when he used Monitor as an example. He was right in the technical sense that the previous legislation set up Monitor apparently free. As my noble friend said that I thought about all the newspaper stories I have read recently about how PFI is falling apart and the mounting debt Monitor is having to deal with because the PFI arrangements for foundation trust hospitals were simply not in the real world. The idea that the Secretary of State for Health is not finding some way to intervene with Monitor—he would have to if Monitor wants more money to offset that debt—shows that the reality of what happens on the ground is extremely important.

I say to my noble friend the Minister that there is one other aspect of this on which, as a simple Belfast boy, I am confused. The NHS Commissioning Board has legal status. As the noble Lord, Lord Warner, reminded us, the Secretary of State gives it a mandate and then it has a legal status. Does that mean that the Secretary of State’s lawyers have to relate to the NHS Commissioning Board’s lawyers if the Secretary of State wants to have some involvement during the course of the year—even if it is only in the context that the noble Lord, Lord Owen, does not like of emergency or failure? We need to have a much clearer grasp of the practical realities of the consequences of this Bill. Whatever the intellectual framework and the ideas that coherently come together to provide esoteric new arrangements, this Bill has to work in the real world. This Committee needs to be encouraged by my noble friend to believe that the Secretary of State is going to be at the heart of making this Bill work in practice.

[Baroness Warwick of Undercliffe]

My Lords, I had not intended to speak but I feel quite anxious that we are contemplating the prospect of not producing an amendment of the kind the Minister suggested he would be willing to accept. I understand the points made by other Peers. I am really conscious of the anxiety that has been expressed in the huge amount of representations, letters, e-mails and so on that we have had.

A point about which I felt strongly at Second Reading is that our own Constitution Committee has indicated anxieties that I think are shared by a large number of people. We need to indicate we are going to take seriously the views of that committee.

Many of the anxieties expressed may either have been caused by scaremongering or become totemic, but they none the less exist. Some of them seem not to be so ill founded. Other speakers have already referred to the fact that, as the Explanatory Notes state, the commissioning and provision of services will no longer be delegated by the Secretary of State, but will be directly conferred on the organisations responsible. As the Select Committee indicates, the Secretary of State must secure that,

“any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate”.

There seem to be at least grounds there for anxiety that the Secretary of State may be seeking to offload responsibility.

I hope that, however long it takes us during these discussions—after some of the discussion on the previous amendment, I became even more anxious about the role of the Secretary of State—we will be able to find a form of words that satisfies the anxieties expressed. I do not know whether that wording should take the form of the amendment of the noble Baroness, Lady Williams, or that of the noble and learned Lord, Lord Mackay, but we should endeavour to allay that anxiety, because it is undermining an awful lot of interest in and support for other parts of the Bill.

[Baroness Cumberlege]

My Lords, this is the first time that I have entered this Committee debate, so I declare an interest as the executive director of Cumberlege Connections, which is a training company.

I am very grateful to the noble Lord, Lord Owen, for mentioning micromanagement, because a lot of our debate stretches beyond just the accountability of the Secretary of State to the organisations that are going to be set up that will have devolved powers. I can understand some of the concern felt about financial probity and the money that is going to the National Health Service, £80 billion of which will go to the NHS Commissioning Board. I shall try to provide a little comfort to the noble Baroness, Lady Williams, and the noble Lord, Lord Harris, who seemed to imply that this money was going to be shelled out by the Secretary of State and he was then going to disappear, leaving no accountability. However, paragraph 14(1) of Schedule 1 states:

“The Secretary of State may require the Board to provide the Secretary of State with such information as the Secretary of State considers it necessary to have for the purposes of the functions of the Secretary of State in relation to the health service”.

Paragraph 14(2) states:

“The information must be provided in such form, and at such time or within such period, as the Secretary of State may require”.

There is clearly an opportunity here for intervention and for the Secretary of State to make sure that probity is being exercised.

Public Bodies Bill [HL]

Baroness Warwick of Undercliffe Excerpts

Monday 9th May 2011 Lords Chamber

[Baroness Bottomley of Nettlestone]

My Lords, I, too, support the amendments of the noble Baroness. My interest is that I appointed her as chairman of the Human Fertilisation and Embryology Authority all those years ago. One of the first Bills for which I had responsibility in Parliament when I was Minister for Health was the Human Fertilisation and Embryology Act, following the very distinguished report of the noble Baroness, Lady Warnock. I have also served on the Medical Research Council.

The noble and right reverend Lord, Lord Harries, said that umpteen days had been spent debating the Bill. I like that term, and it is absolutely accurate. I, too, when I was a Minister in another place said, “Thank God for the House of Lords”, because, whenever a particularly difficult and emotional issue arose, I knew that words of wisdom could be consulted in the House of Lords. They were a very good touchstone for me when I took on the task.

If ever there was emotion between scientists, clinicians, social scientists, theologians and patient groups, it was then. The fact that it has now become a relatively quiet issue does not mean that it does not have the potential to become once again extremely noisy. It speaks for the hugely effective way in which the HFEA has gone about its work, and the confidence that it has built not only in the United Kingdom among all parties but, as has rightly been said, around the world. If clinicians are irritated by the HFEA from time to time, that makes me even more convinced that there must be something good about it, because there is a distinction between the mind of the scientist and pioneering doctor, and the ethical balance of those calling for slightly more caution, control and constraint. When the area is that of the creation of life outside the body, it is a moral issue: we should never forget that.

The Minister, who is sympathetic, thoughtful and kind, and who listens endlessly to requests from Members of this House, has already been extremely accommodating. He has agreed to coherence and transparency; he has agreed that he will not rewrite the ethical standards; and he has agreed that most of the functions should be kept together. Nevertheless, the Care Quality Commission has a huge agenda of work, as was rightly said by the noble Lord, and most of its activities are of a different nature from those of the Human Fertilisation and Embryology Authority, so can the Minister give us further assurances and find a way to meet the objectives of the noble Baroness’s amendments?

Amendment 9, which is about the establishment of the health research regulatory agency, is even more important to me because it seems to be a prerequisite for the changes taking place. Of course we all believe in what we have now learnt to call a bonfire of the quangocracies. The easiest thing for any junior Minister to do is to make their name by setting up a quango; it is much harder to make your name by shutting down a few quangos, and we know it needs to happen. However, like other noble Lords, I urge the Minister to think very carefully before he puts the HFEA and the HTA at the top of his list.

[Baroness Warwick of Undercliffe]

My Lords, I shall speak to all three amendments in this group. I declare my interest as chair of the Human Tissue Authority, whose work is so much affected by this Bill. At the start of the passage of the Bill, there was much confusion over its purpose and the future direction of travel for many of those arm's-length bodies listed in it. Much progress has been made during the passage of the Bill. The Government have given due attention to concerns raised, thought through the potential outcomes and clarified many issues for all of us. I want to thank the Minister, the noble Earl, Lord Howe, for the attention he has paid to our specific areas of interest: the HFEA and the HTA. I particularly welcome his statement in the letter he sent to my noble friend Lady Thornton in which he recognised the need for our preferred option, which is to keep the functions of the HFEA and the HTA together, and gave a commitment to discuss directly with the HTA any potential movement of our research-related functions to another organisation.

I believe we are nearly there, but I feel that these amendments are necessary and will act as a safety framework for the Bill as it enters the other place and then goes onwards for external consultation. We are seeking a set of reassurances and safeguards from the Minister to ensure that the hard work everybody has done to shape this Bill will not be lost further down the road.

The noble Baroness, Lady Deech, and the noble Lord, Lord Walton of Detchant, have already set out the main arguments in favour of the amendments. I support them and shall not reiterate them. The amendments suggest measures by which the Government could assess the cost-effectiveness of the proposed moves, and I urge the Minister to consider utilising them. In his letter to my noble friend Lady Thornton, the Minister addresses the need for an impact assessment, but he proposes only a partial assessment. I believe that a full and thorough assessment is needed in order to give a true picture of cost-effectiveness. We are all looking for ways in which to reduce costs and bureaucracy and therefore see an increase in cost-effectiveness as the gold standard we should aim for in the public services we provide. If a saving is made in one area only to increase costs in another, that would be unacceptable. It is for this reason that I urge the Government to conduct a full impact assessment, not a partial one.

The HTA is already recognised as an efficient regulator with a clear focus on improving value for money. We are a lean organisation costing only £1 million in government grant in aid and we will reduce that by 14 per cent in cash terms this year. We have reduced our licence fees across all sectors this year, including a 30 per cent reduction in the research sector. I have already raised and evidenced my concerns that any proposals to transfer the HTA's research functions would not achieve either simplification or financial savings. Indeed, we estimate that it would impose additional regulatory and financial burdens on around 200 establishments across various sectors. So I suspect it will not surprise your Lordships to know that I am concerned to ensure that cost-effectiveness is real and not just perceived as an outcome of this assessment.

I now turn to the amendment that deals with setting up the new independent health research agency. As I mentioned, I seek reassurance from the Minister in a set of safeguards. The Government have set out a draft transfer timetable, and have made clear their intention to cause the least amount of disruption to all involved by enacting all transfers of the HTA and HFEA functions at the same time. None of this can happen until the health research agency has a legal basis in its own right and it has been decided whether any HTA functions should transfer to it. Will the Minister therefore outline a more specific timetable for its establishment, and reaffirm his commitment to hold off transfers until then?

In addition, the amendment would require that a separate ethics committee be established within the new agency to undertake the ethical considerations of any functions that are transferred. This would be paramount in ensuring that we do not lose public and professional confidence through this period of change and that we continue to ensure that tissues and organs are used safely and ethically and with proper consent. Finally, therefore, is the Minister minded to establish such a committee and so accept this amendment in full?

[The Lord Bishop of Guildford]

My Lords, I support both this amendment and the two related amendments that follow it. They would guarantee in one way or another that the enormously valuable work of precisely the present ethics committee of the two bodies is continued. I speak in general, so far as a Bishop can ever speak, for the Christian churches and for other faith communities for whom the human embryo and human tissue have moral significance. That is not to say that the present ethics committee is in the pocket, so to speak, of the Bishops or of any faith community leaders. It is not, and the range of views and commitments of its members is and should be wide. However, it would be a serious mistake not to have an ethics committee or expert body specifically to weigh the moral as well as the medico-scientific questions that are involved in this very proper research, not least into the tragedy of infertility.

Also of great significance for me is the serious support of the relevant professional bodies, so I urge the Government to consider these amendments very favourably.

Public Bodies Bill [HL]

Baroness Warwick of Undercliffe Excerpts

Monday 28th March 2011 Lords Chamber

[Baroness Thornton]

The noble Lord, Lord Willis, makes the point extremely well and much more eloquently than I was able to. It underlines the point that I have been trying to make. Taking the powers to break up the HFEA and the HTA, as it were, is not the way to start that process. The noble Lord makes exactly the right point. The Minister should recognise that there is a great deal of good will to make this happen across the House but not starting here. I beg to move.

[Baroness Warwick of Undercliffe]

My Lords, I declare my interest as chair of the Human Tissue Authority. I and my authority remain concerned about the impact of the Bill on public and professional confidence in the safe and ethical use of human tissue, as has already been raised by my noble friend. My first question to the Minister is to seek reassurance that the HTA’s functions will not be divided. A division of our functions into three or possibly four different parcels would, in my view, risk undermining the legislation that the HTA was set up to implement, increase the regulatory burden on the sectors we regulate and damage public confidence that has been so hard won.

We must not forget that the HTA was established as a result of scandals at Alder Hey and Bristol Royal Infirmary. Those events caused profound grief among affected families, outrage amongst the public and a crisis of confidence. Those events are still recent. The Human Tissue Act, which set up the HTA and was subject to more than 100 of hours of parliamentary scrutiny, was passed in 2004. The HTA began regulating as recently as 2006. In a relatively short period, it has successfully turned around that crisis of confidence. When people know there is effective regulation, they are more confident in donating their tissue for medical research, their organs for transplant and their bodies for medical education and training. Increased public confidence should mean more donation; more donation should increase professional confidence, thereby creating a virtuous circle beneficial for all. More lives are saved; more people are given back their quality of life; and there is more research and surgical skills training for the benefit of the public.

The Government’s arm’s-length bodies review sets out proposals for transferring the HTA’s functions across three or four different organisations. I fear that separating the HTA’s functions would risk undermining the progress that has been made in building public and professional confidence. Leading thinkers have voiced profound concerns about dismantling the HTA. Senior legal academics have said in the Sunday Times:

“The proposals to abolish the Human Tissue Authority—HTA and the divisions of its functions among larger, non-specialist regulators—risk confusion and error in the implementation of the Human Tissue Act 2004, which in turn will erode public confidence”.

In addition, earlier this month, senior consultant surgeons writing in the Guardian said that moves to break up the HTA would,

“undermine professional and public confidence in the area of medical consent”,

and urged,

“the government to think again and stop trying to operate on things that aren't broken”.

I hope that the Minister will listen to these voices.

The Minister has said that the HTA’s health-related functions should transfer to the Care Quality Commission. I am still not clear about the fate of the HTA’s organ donation and research functions. The ALB review does not suggest a home for its organ donation approvals and suggests that its research functions should transfer to a single research regulator.

With regard to organs, the Human Tissue Act requires board approval of highly sensitive and ethically complex cases of organ donation from living people. If this were to be placed with the CQC, how would the Minister meet the statutory requirement that at least three authority board members who are specifically trained in this area review such cases?

With regard to research, the new regulator for health research will provide a potentially helpful way forward for streamlining medical research in the UK, simplifying life for researchers and increasing the quantity and quality of research. The Minister stated at Second Reading that the purpose of this Bill was to streamline the process of regulation and to reduce costs and bureaucracy. I do not see how the proposal to transfer the HTA's research functions to this new regulator would achieve simplification; nor do I believe the proposals would save money. The sectors that the HTA regulates are interrelated and interdependent, and although it regulates a separate research sector, the licensing framework also allows establishments in the post-mortem, patient treatment and anatomy sectors to store tissue for research as well as for other purposes.

I take the post-mortem sector as an example. The proposal would result in at least one-third of post-mortem establishments needing to be licensed by an additional regulator if they wished to store material for research. A similar proportion of establishments storing tissue for patient treatment would also need to be licensed by an additional regulator. The regulatory burden on an estimated 200 establishments would therefore increase, not decrease. So can the Minister explain what impact this proposal will have on the regulatory burden on these establishments? Can he explain who would be responsible for producing the statutory code of practice on consent and who would be responsible for ensuring consistently high standards if the HTA’s functions were divided?

My noble friend Lady Thornton raised concerns about the ethical dimensions of the work being lost in the rush to amend the mechanical processes. I share these concerns. This is a complex ethical landscape. The HTA has the professional expertise to respond to emerging forms of communication such as Facebook and Twitter. These are now being used as conduits for patients looking for organ donors. We are launching consultation on this very issue in May, and this is a good example of how agile and sensitive the authority can be. Can the Minister assure me that the credibility that lay and professional board members bring to the HTA will not be lost in the Care Quality Commission, when the CQC has only a small number of commissioners? An advisory group has been mentioned. If that model is proposed, can the Minister say what guarantee there will be of its independence?

I apologise for raising so many issues at this late hour but there are many issues still to be resolved. In summing up, I say only that the reason the HTA was established has not gone away and there is still work to be done. My argument is not against the Government’s intention to simplify the regulatory landscape; rather, I want to avoid putting at risk the substantial gains that the HTA has made by splitting its functions across a number of different organisations and losing the overall coherent approach which has been so successful in supporting public and professional confidence and ensuring that tissues and organs are used safely and ethically and with proper consent.

I have one final plea. David Thewlis and Stuart Taylor, both parents affected by the events at Alder Hey, brought it all home to me recently when they said:

“All the effort and soul searching that went into the establishing of the Human Tissue Authority cannot afford to be overthrown by abolishing the HTA and splitting its functions”.

I urge noble Lords to take this on board when deliberating the future of the HTA.

[Lord Willis of Knaresborough]

My Lords, I apologise to the noble Baroness, Lady Thornton, for missing her opening remarks in introducing the amendment.

The fact that so many noble Lords wish to speak to the amendment at this hour indicates that this is an issue of significance to your Lordships’ House. In Committee, my noble and learned friend Lord Mackay ended his remarks by saying that he had helped to give birth to the baby that was the Human Fertilisation and Embryology Authority but that perhaps it was now time to let the child move out, or words to that effect. Before a child moves out into the world, it is important that a responsible parent—and I think that the House should regard itself as a responsible parent—knows that it is safe to do so. However, the reality is that during the passage of the Bill, and in particular during the Committee stage and in the clarification given since then, many questions asked on behalf of the HFEA and the HTA, as the noble Baroness has just indicated, have not been answered. That is regrettable. I think that the House accepts that what the Government are trying to do has a great deal of merit; it is just that it requires organisations to be properly set up before the functions are transferred.

As I have said on two previous occasions, I am not against what the Government are ultimately trying to do. However, before we get rid of two organisations in which the public have great confidence and whose operation is tried and tested, we should be absolutely clear about what will happen to their functions. Although the Minister has made tremendous attempts to satisfy inquiries from noble Lords on all sides of the House, I think that his letter of 22 March to the noble Lord, Lord Warner, raises more issues than it resolves. I am sure that the noble Lord will go through that letter in great detail and therefore I do not intend to do so. However, some of the comments in it indicate that two organisations appear to be in the running to inherit most of the functions of the Human Tissue Authority and the Human Fertilisation and Embryology Authority —the Medical Research Agency and the Care Quality Commission. I was delighted that the Chancellor made it clear in his Statement last week that the Medical Research Agency is going to be set up but, as many noble Lords have said, that announcement was made literally only a week ago. We know nothing about the way in which the organisation will work, other than the report of the Academy of Medical Sciences suggesting that an agency overlooking the whole of medical research would be a good thing.

As for the Care Quality Commission, it is itself an organisation in its infancy and learning how to do its business. Indeed, there are significant complaints about the Care Quality Commission. That is not an overarching criticism. It is inevitable that when a new organisation sets itself up, particularly one that inherited so many problems from its predecessors, there will be difficulties, yet here we are, saying that we will lump another major piece of work with it.

In Committee, the Minister made it clear that the existing personnel would be transferred en bloc into the new organisations, yet in the letter to the noble Lord, Lord Warner, there is no mention of key personnel being transferred into the Care Quality Commission. I understand that staff are seeking posts elsewhere. They will move out of the organisation. If we are not careful, there will be nothing to transfer and we will be looking for new personnel in these key posts. Will the Minister clarify that issue?

The new Medical Research Agency will not be set up until the latter part of this Parliament at the earliest. The Minister floated the idea that some of its functions could be transferred early using the Public Bodies Act—regulation and inspection of clinical services could go to the Care Quality Commission, for example. There is a further suggestion that all but the research functions of both the HTA and the HFEA could be transferred under the Public Bodies Act, as it will then be, with the final process completed following the setting up of the Medical Research Agency. Such hypothetical and confusing scenarios to break up two well-respected and well-worked regulators will do little for public confidence in either of these two areas. It will do little for clinician confidence and will certainly do nothing for research community confidence either. It is important that the agency is set up, properly staffed and has clear terms of reference agreed with both Houses of Parliament before we transfer these key functions to it.

One function that has been set out by the Academy of Medical Sciences, which is a clear pathway, is an ethical structure. We argued when we were looking at the draft Bill and your Lordships in this House argued during the passage of the Human Fertilisation and Embryology Act that we ought to have some form of parliamentary ethics committee. At least the Academy of Medical Sciences has said that there ought to be an overarching ethics committee to look at both areas. But if clinical ethics are not dealt with by that organisation, who will deal with them? Where within the Care Quality Commission are the sort of important ethical considerations that are necessary if we are to transfer all these functions to that body?

I can see the attraction of a method of transfer of functions to avoid primary legislation. I understand why the Minister would want to go down that road, particularly given the enormously strong public scrutiny over legislation concerning the Human Tissue Authority and embryology and stem cells over the past five years, but the idea that if the scrutiny is only in both Houses of Parliament it will be less severe does not hold up. There are 200 new MPs in the other place who were not party to any of this legislation when it went through. It is highly optimistic to believe that there will not be very detailed scrutiny of any new arrangements. I suggest to the Minister in all humility that he accepts the amendment before us tonight or makes some provision to satisfy our concerns. He should seek a comprehensive solution to the problem that the Government have created for themselves. I for one—and, I suspect, many of your Lordships—would agree that there is a way forward from this. The Medical Research Agency is a good idea. There is a possibility of transferring some of the functions to the Care Quality Commission, but it needs to be done en bloc, rather than piecemeal, so that there is a danger of undermining two excellent regulators, which have public confidence, the confidence of most clinicians and the confidence of the research community.

Human Fertilisation and Embryology Authority/Human Tissue Authority

Baroness Warwick of Undercliffe Excerpts

Tuesday 1st February 2011 Grand Committee

[Baroness Warwick of Undercliffe]

My Lords, in congratulating my noble friend on the timeliness of this debate, I must declare my interest as chair of the Human Tissue Authority.

As my noble friend said, the authority was set up as a result of the organ retention scandals at Alder Hey and Bristol. The retention of children's organs—including in some cases their hearts—without the consent or knowledge of their parents, rightly created outrage. It resulted in a crisis of public confidence. At the time, David and Hazel Thewlis, representatives of those affected, said:

“The Human Tissue Act has provided a new foundation for the people of this country ... consent was the cornerstone of the Act, and this must colour all of the work of the Human Tissue Authority”.

The authority has put informed consent at the centre of everything it does, and by doing so it has ensured the safe and ethical use of human tissue. I can confidently say that it has turned around the crisis in public confidence. However, it would be misguided to be complacent. The improvement is by no means universal or fully embedded. The reasons why we were set up have not gone away.

I am not hidebound or precious about which bodies should do the work, nor are my authority members. What we are concerned about is ensuring that the advances we have made are not lost, particularly the hard-won confidence of the public in the proper use of organs and tissue. We believe that the current proposals to transfer our functions to three or possibly four different organisations risk undermining the progress that has been made.

Paula O’Leary, of the Alder Hey parents’ support group PITY II, said recently:

“We fought hard for 10 years … who is to say this is not going to start up all over again?”.

Roger Goss from Patient Concern said:

“Dividing would be diluting. That would be going back down the hill in terms of protecting patients' rights to exercise informed consent”.

The best way of making sure that does not happen is to maintain a clear focus on the safe and ethical use of human tissues and organs across all our sectors. To do that, we need to keep our functions together. That way, we maintain a consistently rigorous approach to consent, and guarantee an individual’s right to decide, in life and in death, what happens to their bodies and the bodies of their loved ones.

The HTA is a small organisation with a broad remit. Our activities are interdependent. There are pathologist researchers, and researchers treating patients with tissue. Researchers study organs to improve the success of transplants. They are all regulated by the HTA and the ethical issues are common to all the sectors that we regulate. The gift of organs and tissues is a special one, giving rise to special ethical considerations. During the passage of the Human Tissue Act, consent was described as the golden thread through all our activities. That is why there is a single set of core standards across all the sectors that we regulate under the Act.

We are a lean organisation. The money that we get from the Department of Health is £1 million a year, about one-sixth of our total cost. We have to earn the rest. What we do makes a difference. Last year, we approved 1,100 organ donations from living people. Since we began regulating, these numbers have increased year by year. We work to give more people the gift of life offered by organ transplants. When tissue is used in medical treatments—such as the use of bone marrow stem cells in cancer treatments, or skin for burns victims—people can be confident that they are safe and good quality and have been donated with consent. If stem cells are collected from umbilical cord blood for potential future use, we safeguard the safety of mother and child and the quality of the cells. Our regulation of mortuaries means that individuals and their families can have confidence that their loved ones are treated with dignity and respect. In research, too, people can know that tissue will be kept only with their consent or the consent of their family, so they can be confident that their wishes will be respected.

I have no quarrel with the Government’s intention to simplify the regulatory landscape. My plea is simply that we do not jeopardise the gains that the HTA has made by spreading its functions across a number of disparate organisations and losing the coherent overall approach that has been so successful in promoting public and professional confidence in the safe and ethical use of tissues and organs.

Human Fertilisation and Embryology: Regulation

Baroness Warwick of Undercliffe Excerpts

Wednesday 13th October 2010 Lords Chamber

[Earl Howe]

My Lords, I recognise, as will the House, the noble and right reverend Lord’s experience in these matters. At this early stage, we will look very carefully at the design of systems to ensure that the expertise and the scrutiny functions, which we associate so well with the HFEA, are not diluted or lost in any moves that we make in this area.

[Baroness Warwick of Undercliffe]

My Lords, I declare my interest as chair of the Human Tissue Authority. Just as with the HFEA, the HTA works efficiently and effectively to ensure public and professional confidence in the regulation of human tissue, and to ensure that it is used safely and ethically and with proper consent. Does the Minister agree that it is crucial in any transfer of functions that the confidence of both the public and professionals is maintained; that consent, respect and dignity are maintained; and that any disruption to well-regarded regulation is kept to a minimum?

[Earl Howe]

My Lords, again, I thank the noble Baroness for the work that she does with the HTA. The answer is yes in every case.

Queen's Speech

Baroness Warwick of Undercliffe Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Warwick of Undercliffe]

My Lords, I will focus my comments on the impact of the Government’s programme on higher education. I, too, welcome the noble Earl, Lord Howe, in his ministerial role for health. I cannot think of anyone better qualified in terms of knowledge, commitment and sensitivity. He is also pretty good behind the footlights.

Although I am no longer chief executive of Universities UK, my passion for higher education remains undiminished. I am anxious that investment in higher learning should not be an unintended casualty of the Government’s determination to reduce the deficit. Several proposals in the Queen’s Speech have a potential impact on higher education. Among them are the Academies Bill, the education and children’s Bill and the health Bill. The Government also propose to put a cap on non-EU immigration. I also wish to touch on the dismantling of the system of regional development agencies.

Universities have invested considerable effort and resources into building closer links with schools in order to break down the social barriers that act as a barrier to participation in higher education. This has been supported by the previous Government’s commitment to measures aimed at increasing social mobility. We must take care that the close links between schools and universities are not damaged by the administrative changes that the new Government are bringing forward.

Similarly, not everyone will be aware of the extent to which changes in NHS structures can have a major impact on higher education. Education for nursing and allied health professions in England is provided through contracts with strategic health authorities and universities. The proposals to establish an independent NHS board to allocate resources and provide commissioning guidance will directly affect this link. I urge the Government to ensure that this is borne in mind as the proposals are developed.

On the issue of migration, I understand that the non-EU cap will not apply to students. I warmly welcome this decision. A quarter of a million international students studied at our universities last year. Of course, they make a substantial contribution to the financial sustainability of universities, but their economic impact is a great deal wider than that. They will go on to become the economic and political leaders of the future, taking with them established links to the UK.

Higher education is an international market where the UK can be proud of its leading role. Eighteen UK universities are in the top 100 in the world. The ability of our universities to recruit the best researchers and teaching staff from around the world is a key factor in maintaining this leading position. Any moves that make it more difficult to recruit the best staff can only limit our ability to compete in this global education market.

I turn to the future of regional development agencies. Often, universities are among the largest businesses represented on the boards of RDAs. The economic impact of universities at a regional level is substantial. In my region of Yorkshire, for example, there are almost 28,000 full-time-equivalent jobs in higher education, and a similar number that have been created by secondary means elsewhere in the economy. Universities’ research and innovation can pay enormous dividends in terms of future economic development. I share the concern of university vice-chancellors that we risk damaging the capacity for cross-regional collaboration if RDAs are replaced with bodies that cover much smaller areas, and which perhaps will focus on more parochial concerns.

Beyond the measures outlined in the Queen's Speech, I will address the wider issue of the future funding of higher education. Many arguments that I would put were made by speakers across the House in the excellent debate on higher education initiated by the noble Lord, Lord Baker, on 25 February this year, and I commend these points to the Government. They reflect my concern about the sustainability of our hard-won excellence if higher education faces again, as it did two decades ago, relentless underfunding.

The new Government face a difficult job in navigating the UK to sustained and sustainable economic growth: all noble Lords in this House have acknowledged that. I hope that the Government will recognise the vital role that higher education can play in securing economic recovery. The higher education sector already faces £1 billion-worth of cuts announced last December. The Chancellor's statement of two weeks ago added a further £200 million to the tally. Against this background, the noble Lord, Lord Browne, is conducting a review of future higher education funding and student support. This is the elephant in the room for the coalition; and, given the length of the Session before us, it could become a very restless elephant indeed. We know from the coalition agreement that the Liberal Democrats have an opt-out should the noble Lord, Lord Browne, propose an increase in tuition fees. This is hardly surprising, since virtually all of their Members in another place—including the Deputy Prime Minister and the Secretary of State for Business, Innovation and Skills—signed the NUS pledge not to support an increase in fees. However, is it credible to imagine Dr Cable abstaining on legislation sponsored by his own department?

My fear is not the immediate cuts to universities, tough though they will be, but that in the June Budget and the autumn Comprehensive Spending Review, higher education will find itself cut back further in ways that will undermine the teaching excellence that produces the highly qualified people that we so desperately need, and will undermine the world-class research that will give us the best advantage in emerging from the economic doldrums.

I do not know what the proposals of the noble Lord, Lord Browne, will be. He is charged with finding a sustainable way to fund universities. If the Government will not fully implement his proposals, universities will not have the freedom to respond to the increased financial pressures that they face, and higher education will not be able to play the role that it could in securing our economic future. I hope that, in replying, the Minister will be able to reassure me on this vital point.

The new Minister for Higher Education, David Willetts, knows the university sector well and is widely respected within it. I, with others, welcome the noble Lord, Lord Hill of Oareford, to this House and to his education role. He adds a further formidable brain to the two that Mr Willetts is said to have. All three will need to be applied to the task if they are to steer our universities through the challenges ahead so that they maintain their world-beating position.