Health and Social Care Bill
Baroness Wheeler Excerpts(13 years, 3 months ago)
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Baroness Wheeler
My Lords, the hour is indeed late and I have done my best to cut back on bits of my speech. On behalf of the opposition Front Bench, I commend these amendments for beginning the process of retipping the balance of the Bill from its current predominance of measures dealing with NHS structures, governance and competition. Today’s amendments start to explore ways of addressing in the Bill the need for the NHS, public health and social and community care to work together to achieve improvements in quality of services in diagnosing and treating patients. Integration is a means for achieving this and is not an end in itself.
It is worth reminding ourselves of the recent warning from Chris Ham, chief executive of the King’s Fund, of the very real risk in the Bill of integrated care being,
“a sideshow involving small-scale pilots, with competition the main game in town”.
He also said:
“If the Government is serious in its endorsement on the Future Forum's advocacy of integrated care, it must demonstrate its commitment by putting the best civil service brains on the case and ensuring that the mandate given to the NHS Commissioning Board has the promotion of integrated care at its heart”.
We are certainly not at that stage yet, as the contributions in this debate have demonstrated.
The Bill offers the opportunity for the promotion and enabling of integration to be embedded into the work of the Secretary of State, the NHS Commissioning Board, clinical commissioning groups, health and well-being boards and Monitor, and further amendments throughout the Bill will allow for debate and development of these areas. The Royal College of Physicians has referred to these bodies needing to have, under the Bill, an explicit duty of mutual co-operation and collaboration, and this should be the aim. The Secretary of State, the Commissioning Board and Monitor all need to ensure that national policy promotes, not just enables, the supporting context for integration.
We support working towards a strategic definition of integration that encompasses the NHS, public health and social and community care. Nuffield, the King’s Fund, National Voices and the Local Government Association are all undertaking comprehensive work on producing clearer definitions, so there is no shortage of expertise in this area. Our hope is that this work will help lead us to a more coherent approach and ensure that current provisions in the Bill can be strengthened. As we know, the Future Forum is currently consulting on what now turn out to be the non-legislative steps that can be undertaken. But whatever recommendations it comes up with need to be in the context of a Bill which provides the strategic context, framework and direction. The National Voices key principles of integration have much to commend them in taking this work forward.
Amendment 18A has a particular focus on integrating public health with local authorities. We strongly support the proposed role for local authorities for public health and this amendment would help to address fears of some public health professionals that this might lead to public health becoming divorced from the NHS. Amendments 182 to 184 look to clinical commissioning groups having particular regard for outcomes which show “effectiveness and integration” and integrating “assessment and delivery” by those who provide health and social care services. CCGs need to demonstrate that their commissioning plans address the physical health, mental health and social care needs of their local population under the joint strategic needs assessment.
In this regard, one of the major ways of promoting integration will, as many noble Lords pointed out at Second Reading and today, be by strengthening the powers of health and well-being boards. We strongly support giving health and well-being boards the power to sign off the commissioning plans of CCGs and will be supporting amendments to achieve this later in the Bill. If health and well-being boards own the health and well-being strategy, they must also own the plans to deliver it.
Finally, at the beginning of the debate on how we use legislation to promote integration of services and care, as a carer myself perhaps I may endorse noble Lords who have underlined the importance of this issue to carers. Carers, particularly of people with long-term conditions, oversee care packages across the NHS, local authority social care, the independent agency and provider sector and the voluntary sector. Carers are often the principal players in organising the care package and the ones who fight to hold it together. Hours can be spent going over the same information for different parts of the system or ensuring that one part of the system is aware of decisions and developments, and any possible knock-on effects, taken in other parts of the system involved in the care pathway. Joined-up support is the key enabler for people with severe disabilities or long-term health conditions to remain at home and it is crucial that the Bill gets this important issue right.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, all the amendments in this group have the entirely laudable aim of improving the integration of services across health and social care and improving access to services. I agreed strongly with many of the messages which the noble Lord, Lord Warner, delivered in his excellent speech, and with so many of the powerful contributions from other noble Lords. The only person with whom I felt seriously out of sympathy was the noble Lord, Lord Davies of Stamford. I would simply say to him that the Bill contains a number of provisions to encourage and enable the NHS, local government and other sectors to improve patient outcomes through far more co-ordinated working.
For example, the reformed system that this Bill will give form to—the provision of high-quality, efficient and fair services—represents the fundamental goals of the health and care service. This clause puts on to a statutory footing the three domains of quality identified by the noble Lord, Lord Darzi, in his next stage review: effectiveness, safety and experience. Every aspect of healthcare quality fits into the Darzi domains, and that is a tribute to the noble Lord’s work in co-producing the quality framework with patients and the professions, and it is also why the domains still provide the framework for quality.
In answer to my noble friend Lady Jolly, or at least to give her a partial answer, we seek to measure success in meeting these fundamental goals through the transparent accountability mechanisms of the outcomes frameworks for the NHS, public health and social care. Integration and access, though laudable objectives that I share with all those noble Lords who have spoken about them, are a means to this end. If integration and access help the NHS to meet the quality and fairness duties—and by fairness I mean reducing inequalities—then integration and access will need to be factored in to commissioners’ plans. Commissioning guidance will set out how best to achieve this based on the accredited evidence of what works best that NICE is developing in its quality standards and other guidance.
The point is often made that high-quality care must surely be integrated care. Integration is not an outcome, it is a possible feature of the process. Where it will improve outcomes and reduce inequalities, integration should most certainly happen, and this Bill provides for that. But we must not sacrifice outcomes for process. I thought the noble Baroness, Lady Armstrong, injected a welcome dose of reality on that theme borne out of her considerable experience, and although I did not fully agree with everything that the noble Baroness, Lady Wheeler, said, she also made some very sensible comments on that point. Indeed, the NHS Future Forum’s Phase 1 report highlights well the practical rather than legislative challenge of bringing about more integrated services for patients. I shall quote from its summary report, which states that,
“legislating or dictating for collaboration and integration can only take us so far. Formal structures are all too often presented as an excuse for fragmented care. The reality is that the provision of integrated services around the needs of patients occurs when the right values and behaviours are allowed to prevail and there is the will to do something different”.
NHS Future Forum
Baroness Wheeler Excerpts(13 years, 5 months ago)
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Baroness Wheeler
To call attention to the extent of the implementation of the recommendations of the NHS Future Forum in the Health and Social Care Bill; and to move for papers.
Baroness Wheeler
My Lords, this is an important debate. It is the first opportunity for the House to discuss the NHS following the First Reading of the Health and Social Care Bill last week. It takes place in the context of the continuing debate, controversy and deep unease over key aspects of the Bill, its incoherence and complexity even in this, its fourth iteration.
When the Future Forum report was published in June, hope sprang eternal among the many critics of the original Bill—patient groups, specialist groups for patients with long-term conditions, medical and other staff, trade unions, carers and Members across both Houses—that the report and the Government’s response to its core recommendations signified a major change of approach and strategy. My noble friend Lord Darzi was among those who recognised this change in the language and approach of the Future Forum and the Government’s response, welcoming the stated main thrust that the quality of service and care should remain the organising principle of the NHS.
We on these Benches welcomed the Future Forum report in the context that it had not covered all aspects of the Bill. We pay tribute to the work that the forum undertook in the eight weeks that it had to consult, deliberate and produce its report. My noble friend Lady Thornton, in response to the Minister’s Statement on the forum on 14 June, recognised that the Government’s proposed changes in response to the forum were indeed significant. Crucially, however, she urged Members across the House not to suspend their critical faculties but to wait for the publication of the revised Bill to ensure that the rhetoric was matched by the reality. We now have the reality before us. Three months on from the Future Forum report, fundamental questions remain about the post-pause Bill. Even after the Committee stage and Third Reading in the House of Commons, we are still no clearer about why this massive upheaval is needed. What is the Government’s future vision for the NHS? Who will be responsible and accountable for making decisions that will benefit patients and improve the NHS?
At the heart of the continuing problems are two issues that are fundamental to the ethos of an NHS that is free at point of need and provides a national public service. First, there is the importance of the Secretary of State having a continuing duty to ensure that we have a comprehensive NHS. Secondly, we must address the real concerns over Part 3 of the Bill, which places competition at the heart of the NHS and sets up an economic regulator that still has substantial powers to promote competition in the NHS. The Future Forum was clear on these issues and the recommendations are welcome and straightforward. However, the amendments to the Bill do not reflect that or translate the Future Forum’s intentions into legislation.
The Commons deliberations have failed to resolve the issue of the Secretary of State’s duty and role in relation to the NHS. Indeed, as the noble Baroness, Lady Williams, said in her recent Observer article, “confusion thickens”. My honourable friends in the other place, supported by authoritative legal opinion, have underlined that if the Bill becomes law then the duty to provide a National Health Service would be diluted and lost. The Government argue strongly for greater freedom for clinical commissioners from political interference. However, as the noble Baroness, Lady Williams, has said,
“to throw out accountability in order to tackle petty interference is to undermine democracy itself”.
The health professionals remain deeply concerned, as seen in the letter in last week’s Times from the BMA, the royal colleges of nursing, GPs, midwives and psychiatrists, and the governing bodies for the physiotherapists and occupational therapists. They warn that the new Bill will destabilise the NHS and requires further significant amendments. They say:
“Though the language may have changed, the Government remains committed to opening up the NHS further to market forces as a priority”.
The Patients Association sums up the ever increasing complexity of the Bill and the NHS structure when it says:
“It is unclear how the original commitment from the Government to streamline the NHS and remove bureaucracy will be met by current changes—one layer of bureaucracy being replaced by another”.
How does a Bill which adds more layers and bodies—increasing the number of statutory bodies from 163 to 521—substantially increases costs and fails to provide a clear rationale why it is all necessary succeed in improving quality of care and promoting integration?
At one of the many excellent seminars that noble Lords have had on the Bill at its various stages, we were promised by the Under-Secretary at the Department of Health an organigram of the proposed new NHS. That was perhaps a rash promise in view of the sheer number of organisations it has to include, but its production would at least help us to try to understand how the reforms will work as a whole and how they stand some chance of improving the quality of patient care. We know that there is a very real risk that the increased complexity added to the NHS structure will slow down or prevent decision-making, either through more bodies becoming involved in decisions or where it is not clear which organisation is ultimately in charge. How do these reforms support effective and speedy decision-making?
After the forum report publication, David Cameron said, “We have listened, we have learned and we are improving our plans for the NHS”. Nick Clegg was beside himself with joy when he declared a great victory for his party, with 11 out of 13 demands for change laid down by the Liberal Democrat conference being achieved. However, the reality is that the scorecard result is far more modest, as a number of prominent Liberal Democrats have recognised. The Future Forum made important recommendations which have not been dealt with by government amendments to the Bill, and which the Government have consistently blocked Labour, and a few Lib Dems, from amending.
In passing, as a former chair of the Labour Party conference committee in charge of the conference’s agenda programme, I have been following with interest the attempts to block debates and votes on the NHS at next week’s Lib Dem conference. For what it is worth, in my experience, keeping issues off the agenda usually results in the people affected going straight to the media and getting even more coverage than they would have had anyway, so I shall watch developments with interest and be very thankful that I am not the one defending that position on the conference platform.
In respect of the Future Forum report, I place on record for the avoidance of doubt that, of course, we recognise that the Government have acted positively on a number of its recommendations, including the change to clinically led commissioning and clarity on the wider input from health professionals. They have also clarified some of the accountability issues of clinical commissioning groups and have recognised that the timetable for reform could not be achieved. However, many concerns and issues remain in these areas and we will pursue them as we deal with the Bill clause by clause in the coming weeks.
I return to the second major area of concern: competition and the role of Monitor. The forum raised strong concerns about promoting competition as an end in itself. Recognising the problems with the original Bill, the report recommended that it should be changed to make it very clear that Monitor’s primary duty is not to promote competition but to ensure the best care for patients. Specifically, it recommended that Monitor’s powers should,
“promote choice, collaboration and integration”.
This is still missing from the Bill. The Government have also ignored the spirit of the Future Forum recommendations that sought a greater balance between competition, and co-operation, collaboration or integration. Compare and contrast the 90-odd clauses of the Bill on the regulatory regime for competition with the woolly references to organisations having to,
“act in an integrated way”,
with no definition of integration.
The Bill remains as lopsided as ever and, for a Health and Social Care Bill, there is actually precious little about social care. However, that is a whole debate in itself.
The Future Forum further recommended that the Bill be changed to clarify that Monitor be a sector regulator for health, not an economic regulator. While the duty to “promote competition” has been removed, it has been replaced with a new duty of “preventing anti-competitive behaviour”. This flipping of the language does not substantially affect how Monitor carries out its duties, its cost and its reach across the whole NHS.
Moreover, although the Bill moves away from referring to economic regulation, Monitor is still to be given sweeping pro-competition powers, including concurrent powers with the Office of Fair Trading under the Competition Act 1998 and the Enterprise Act 2002. These powers, alongside the power to license every provider to the NHS, have not been changed by the amendments. Monitor therefore remains an economic regulator in all but name. How will the Government address these concerns and issues? How will the issue of the role of the Secretary of State and the role of Monitor be resolved so that the service does not face constant legal challenges in the future about who is ultimately responsible and accountable for decisions, or about how commissioning has been undertaken and contracts awarded?
There are other issues. On transparency, the Future Forum recommended that all providers of NHS-funded services should hold their board meetings in public. The Government rejected this recommendation in their response to the Future Forum. This means that decisions about NHS services will be made in private, and could be marked “commercial in confidence”. The Government have similarly failed to bring greater transparency to clinical commissioning groups and foundation trusts by allowing substantial loopholes and leeway. There is a get-out clause for CCGs that want to avoid meeting in public. The wording of the Bill states,
“except where the consortium considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting”.
Foundation trusts can exclude members of the public from a meeting for special reasons with no explanation about what these are. This leaves this clause open to abuse.
There is also the important issue of the private patient cap and cherry picking by private providers. Professor Field, the Future Forum chair, admitted that the issue of the private patient income cap was not looked at by the forum and stated that,
“the feeling was that the private patient cap should actually stay”.
The Government have tabled no amendments to the clause abolishing the private patient cap. The implications of the abolition of the cap and increasing financial constraints that the service is operating under are already beginning to be seen. The Government’s amendments on cherry picking in the Bill only require that a provider be transparent in how it chooses its patients, and do not deal with preventing providers from picking the easiest and most profitable patients. All in all there is a very mixed and confused picture of implementation and translation into the Bill of the forum’s recommendations.
Finally, I come back to the Future Forum itself, as we now learn that its work is to continue with listening exercise mark 2—this time on education and training, integrated services, public health and information. Can the Minister give us more details of this? How does he envisage that this work will be fed into the Bill and what impact it will have on its parliamentary passage? Are we to have further amendments to, for example, the integration and information clauses? How long do the Government envisage the role of Future Forum continuing? Is it to be a permanent listening body—another body to be placed on the much awaited organigram? If so, when will the normal rules of public appointments and declaration start to apply to its membership? Are we to have further “pauses”?
Noble Lords will recognise that I set great store by getting the promised organigram. I am really looking forward to receiving it. When it comes, I will be asking myself three key questions. First, is this the structure to take the NHS forward into the future and provide the integrated care pathways that people with long-term conditions must have? Secondly, how will this help the NHS to deal with the Nicholson challenge of £20 billion savings over five years? Thirdly, will it now be easier for patients to find their way through the system and be clear who has responsibility for making decisions about their care? I think I already know the answers.
Baroness Wheeler
My Lords, this has been an excellent debate. I thank all noble Lords for their contributions, particularly the update from the noble Baroness, Lady Jolly, on the Liberal Democrat conference programme. As noble Lords have said, this is a timely debate; it is a precursor, an overture or a limbering-up for the debates that we are about to have. I am sure that we are all looking forward to that in the coming weeks. With that, I beg leave to withdraw the Motion.
Health: Stroke Care
Baroness Wheeler Excerpts(13 years, 7 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what actions they will take to address geographic variations in stroke care identified by the Royal College of Physicians and detailed in the National Stroke Audit Report 2010.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the 2010 audit shows ongoing improvements in stroke care in England. To achieve the high-quality care described in the national stroke strategy and the NICE quality standard, the NHS is continuing to implement the accelerating stroke improvement programme. This aims to go further and faster in delivering improvements in stroke care across England.
Baroness Wheeler
I thank the Minister for his response and his recognition of the tremendous progress that has been made in the past three years with the national stroke strategy. I am sure that he agrees that progress has been most marked where strategic health authorities have provided strong leadership to drive forward strategy. With their abolition, how will the new system, through the subnational elements of the NHS commissioning board—the clinical senates—help facilitate the necessary improvements, and where will accountability lie? Also, I am concerned that the future of the stroke strategy team at the Department of Health seems to be uncertain. I have heard that the national clinical director for strokes will shortly stand down. Will the Minister confirm this and explain, if that is so, who will be responsible for providing strong leadership on stroke improvements at national level both in the short term and under the proposed new system?
Health: Alcohol Minimum Pricing
Baroness Wheeler Excerpts(13 years, 11 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what is their assessment of the impact of minimum pricing policy on the level of alcohol-related conditions and admissions to hospital.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Home Office review of pricing policy found that increases in alcohol prices are linked to decreases in alcohol-related harms. The review also highlighted that this is a complex issue. The Government intend to ban sales of alcohol below the rate of duty plus VAT. This is a pragmatic first step towards setting the lowest level at which different strengths of alcohol can be sold. We estimate that it would mean about 1,500 fewer alcohol-related hospital admissions per year.
Baroness Wheeler
I thank the Minister for his response. However, two leading advisers from the Department of Health’s own network of experts recently wrote in the Lancet that the Government,
“lacks clear aspiration to reduce the impact of cheap, readily available, and heavily marketed alcohol on individuals and on society”.
They estimate that failure to tackle drink-related problems could cost 250,000 lives over the next 20 years. How will the Minister ensure that in future the health, well-being and recovery of people with drink-related problems take precedence over the lobbying of the drinks industry?
Earl Howe
My Lords, I make it clear that we neither have nor intend to have any sort of cosy arrangement with the drinks industry. The view that we have taken is that the food, drink and fitness industries, together with charities and public health experts, all have a huge role to play in improving our health. The industry has enormous influence in its own right. However, more than that, we believe that we have a collective responsibility to do something about this problem. That is why the industry has joined the Government in a partnership to promote and empower us all to adopt a healthier lifestyle. Through the public health responsibility deal, we are challenging industry to take action that will help consumers to live healthier lives in some areas where it is not possible or effective to regulate.
Human Fertilisation and Embryology Authority/Human Tissue Authority
Baroness Wheeler Excerpts(14 years ago)
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Baroness Wheeler
My Lords, I, too, thank my noble friend Lady Thornton for initiating this debate, as well as other noble Lords who have spoken with much experience and in-depth knowledge on this matter. It is particularly timely as the Government consider their response to the major concerns about the inclusion of the HFEA and HTA among the bodies to be abolished under the Public Bodies Bill, whose Committee stage discussions we are set to resume.
As has been stated, we on these Benches can speak with some authority on this matter, having, as the House will be aware, closely examined the case for merging the HFEA and HTA into a single body just over two years ago while we were in Government. We came to the firm conclusion that two distinct independent regulatory bodies needed to be retained to oversee the areas of human tissue and assisted reproduction.
As the BMA has stated, the UK has been well served by the HFEA and the HTA, and both have been used as models for other jurisdictions in dealing with extremely technical and legally complex areas of practice. The RCN has said in respect of the HFEA that the current high level of expertise and experience within the body is extremely valuable and that it would not be in the public interest to transfer regulatory functions to other organisations, as this knowledge might be lost to the detriment of patient safety. The HFEA’s chair, Professor Lisa Jardine, has described areas covered by the HFEA as the most controversial area of medicine apart from assisted dying, the most morally difficult and carefully legislated-for area and the most tightly regulated.
The HTA, born out of the terrible events at Alder Hey and Bristol hospitals, and the crisis in public confidence over unauthorised retention of babies’ organs and tissues, has in our view established hard-won trust and respect among the public and professionals. My noble friend Lady Warwick is right to express concern that this will be lost if the current clear focus of the HTA is diminished in the transfer of its functions and role.
This does not mean that we do not recognise the scope for review and change within either body, or how the regulatory framework may be developed in the future. Both bodies themselves acknowledge this. We also recognise that many in the key professional groups involved are supportive of such changes as bringing all medical research regulation, including embryo research, within the remit of a single medical research regulatory authority, as recommended by the Academy of Medical Sciences. However, time and space would be needed for independent examination and review of this and the broader issues of how functions should be delivered in future and the risks, benefits and costs, rather than just the current focus on how functions are to be transferred.
We are concerned that the Government’s process is to transfer functions to bodies that are as yet undeveloped and untested in this area of expertise. The Care Quality Commission is very much an organisation in transition and development, as it plans to take on a range of new duties and work envisaged in the Health and Social Care Bill. The role and possible functions of the new medical research body, and of the health and social care information centre, need much more work and development. All this is in the context of the Department of Health having its work cut out, taking on a huge volume of work, responsibilities and functions that will come its way from the abolition or reorganisation of many of the other bodies due to be axed in the Public Bodies Bill.
This is also at a time when the Government themselves are committed to large-scale staff reductions in the Department of Health. There are also key issues of accountability and independence at stake. Professional bodies and clinicians directly regulated by the HFEA, for example, of course have a key view of the changes needed, but they are not the only stakeholders, as speakers in this afternoon’s debate have underlined.
Dismantling the HFEA and HTA, diluting their accountability and handing over their powers to Ministers and civil servants on such sensitive issues needs public involvement and stakeholder conversation, as speakers have pointed out. How would the new organisations be independently scrutinised and accountable? How much money would be saved from transferring the functions of the HFEA and HTA to the CSQ and new bodies? Will the Minister explain in more detail the timetable that he is currently working to for consultation and development of the new framework?
We on these Benches again urge the Government to reconsider their position and remove the HFEA and HTA from the bodies to be deleted under Schedule 5.
Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]
Baroness Wheeler Excerpts(14 years, 3 months ago)
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Baroness Wheeler
My Lords, I, too, begin by paying tribute to my noble friend Lord Morris of Manchester, for his tenacious and tireless work in campaigning on the issue before the House today. Indeed, no one reading back through the reports of the debates on the Bill in its previous passage to Third Reading in the House, as I have done in preparing for today’s debate, can fail to admire and be very humbled by his continued determination to ensure that the plight of those whom he has described as,
“arguably the most needful minority in Britain today”,—[Official Report, 23/4/09; col. 1607.]
is fully recognised and properly financially compensated.
We recognise the important and continued role played by him and other noble Lords who have spoken in today’s and previous debates. I refer particularly to the independent inquiry report of my noble and learned friend Lord Archer into NHS-supplied contaminated blood and blood products, which received widespread all-party acclaim, and whose report recommendations form the core framework of the Bill. Like him, we welcome the consensus in the House that victims have suffered for too long. We also value his insights into his report from the perspective of events that have followed its publication. Finally, I endorse the admiration expressed across the House for the work of the Haemophilia Society and the close support that it has provided to the people infected, their carers, widows and dependants.
The debates in this House and in the other place last week recount the very personal and tragic experiences of patients, their families and those who have died. Haemophilia sufferers were plunged into a nightmare of failing health, pain, suffering, financial hardship and social deprivation. The support and campaigning work of the society over the past three decades have helped to provide solace and constant, practical everyday support, and have led to real improvements in care and financial support.
However, we readily accept that there is much more to be done. This is unfinished business from the previous Government and we regret that we were not able to respond formally to the High Court judgment and to the related recommendations in the report of the noble and learned Lord, Lord Archer, before we left office. Despite the sense of frustration at this and the belief that much more should have been done by successive Governments, the House will recognise the work undertaken by my noble friend Lady Thornton to progress through the Department of Health vital improvements such as in the administering, handling and safety of blood products and in developing further best practice and improvement in service provision for the ongoing treatment of haemophilia sufferers.
On behalf of these Benches we welcome the review announced last week by the noble Earl, Lord Howe, following the announcement and debate in the other place. It is a very positive step that will, I hope, take this matter forward towards achieving the closure that is desired in the House.
We welcome the inclusion in the review of the commitment to look at ex gratia payments made to those infected with hepatitis C, including financial support for dependants, issues surrounding the arbitrariness and injustice of cut-off dates for eligibility of the current scheme, and comparison with ex gratia payments made in the UK to those infected with HIV and their dependants. We also welcome consideration of the provision of life, mortgage protection and travel insurance for those infected in light of similar access available to other groups. As we have continually found, there is often a real difference between what insurance companies promise will be their actions on such issues, and what they actually do when considering individual cases.
In respect of prescription charging for those infected, noble Lords on both sides of the House will be aware of the previous Government’s commitment to introduce free prescriptions for people with long-term conditions, which would have included people infected by contaminated blood. I therefore ask the Minister what impact the announcement under the Government’s CSR that the free prescriptions programmes will not now be taken forward will have on the review’s consideration of this matter. Will the Government no longer honour this commitment to people infected by contaminated blood?
We also endorse the inclusion in the review of the provision of, and access to, nursing and other care services in the community for those infected. We hope this will lead to improved NHS and local authority service provision, coproduction and co-operation.
We welcome the Government’s commitment for the review to make recommendations to Ministers for their consideration by the end of the year. As noble Lords have stressed during this debate, it is crucial for this review to be conducted with the utmost expedition. I look forward to hearing further details from the Minister on who is to lead it, how it is to be undertaken, the relevant expert groups and external groups that were referred to in the other place by the Under-Secretary of State for Public Health, Anne Milton, and how the views of those infected, their relatives and carers, and other representatives will be sought and taken into consideration.
The Minister emphasised her desire for the review to be dealt with,
“openly and honestly, with clarity, without party politics, with humility and with empathy”.—[Official Report, Commons, 14/10/10; col. 568.]
We wholeheartedly agree and look forward to it proceeding without delay. Will it include an overview of all the different compensation funds established to administer payments to people infected by contaminated blood to ensure consistency of approach and decisions?
Finally, on the question of continued government funding to the Haemophilia Society, can the noble Earl confirm that the current level of funding will not be affected by the changed basis for voluntary sector funding?
In closing, I again congratulate my noble friend Lord Morris on bringing back the Bill to this House and his dedication, determination and persistence—once again so much in evidence today. We look forward to working on the Bill in its future stages in the House.