International Development (Official Development Assistance Target) Bill

Baroness Williams of Crosby Excerpts

Friday 23rd January 2015 Lords Chamber

[Baroness Williams of Crosby (LD)]

My Lords, I echo the words of the noble Baroness, Lady Kinnock, in paying tribute to all three parties for what they have done about aid. In particular, I add one name: that of the noble Baroness, Lady Chalker, who I believe persuaded the Conservative Party to become a great champion of aid and changed a great many attitudes by the work she did. She deserves our tribute for that.

I will deal with just two issues, because obviously time is short. The first is the issue of partnership, which was raised by the noble Viscount, Lord Astor, and my noble friend Lady Falkner. One of the ways in which we can most effectively use the Bill is by recognising that there should be in middle-income countries a commitment of partnership towards what is sometimes called in churches, “the option for the poor”. I am thinking about a country such as India, which has now moved statistically into the middle-income group, but which, as many of us know, has huge inequalities and vast areas of poverty, as is also true of China. We need to mobilise, perhaps through the Commonwealth, the concept of joint responsibility; of more partnership between the countries that receive aid for their fellow citizens and those like us who contribute it.

I will give as an example one instance with which I happen to be associated, and which I declare as an interest: namely, the huge efforts being made for continuing and lasting assistance through economic development, for example in northern India. I have in mind a charity called Seva Mandir, which attracted very large sums of money from wealthy and middle-income Indian groups for the sustaining of the concept of rebuilding the old Rajasthan forest, including huge efforts to reforest and to involve children at school in looking after saplings that are handed out to them, which they then become responsible for—the tree almost becoming a kind of pet.

That means that whole communities become committed to rebuilding their own economies, and do so by involving children and young people—and not least, by the by, do so by exchanges of young people from this country and elsewhere, who work alongside their Indian colleagues for months at a time in that effort. The concept of using the growing knowledge of our own schoolchildren and university students in taking part in the physical rebuilding of many of the poorest communities is one which will help to give us a lasting international sense.

The second thing I will mention quickly was raised by the noble and right reverend Lord, Lord Williams of Oystermouth, which is the huge and growing challenge of anarchy in certain parts of the world. We need to recognise that bodies such as ISIL build upon a sense of hopelessness among young people. Again, the Commonwealth could do much more here to associate attempts to rebuild economies that are in desperate plight, and sometimes states that have broken down, by associating us together in a constructive—one might almost say a Marshall plan—approach in some of those desperate countries. South Sudan is one example; tragically, Nigeria is increasingly becoming another.

I have long felt that we do not use the resources we have in the Commonwealth to present good alternatives to some of the areas under the greatest pressure of all. That pressure reminds one, sadly, of the famous lines from the great Irish poet Mr Yeats, who said, as noble Lords may remember:

“The best lack all conviction, while the worst

Are full of passionate intensity”.

The noble and right reverend Lord, Lord Williams of Oystermouth, was absolutely right in saying that we need to work much more widely between departments —and I include in that the FCO, the Ministry of Defence and others—in offering constructive alternatives to the terrible spread of anarchy in our world, and that we should address that as part of our objective of building up the link between ourselves and these other countries.

Finally, it is very important that we recognise that countries which are themselves poor often have an amazing amount to contribute, and we do not recognise that contribution if we are too patriarchal and imperial in our approaches. Therefore, let us say, here and now, that we will use aid not only to credit ourselves for acts of generosity and imagination but to elicit from other countries, including poor countries, the huge contribution they themselves can make once there is a sense of hope for them to build on.

Ebola

Baroness Williams of Crosby Excerpts

Thursday 6th November 2014 Lords Chamber

[Baroness Williams of Crosby (LD)]

My Lords, I echo the comments of the noble Lord, Lord Crisp. The heroism of those who have volunteered from the NHS, and from all over the world, as health medics to work against Ebola is unbelievably impressive and should raise our sense of the possibilities of a human response of the kind that is needed for the desperate position laid out by the noble Baroness, Lady Kinnock.

I shall be quick. The first point is that the WHO has now named 15 countries that are on the edge of being likely to slip into Ebola epidemics unless there is preventive action as soon as possible. Those 15 countries are all in Africa, mostly in west Africa. There is also, although we have not mentioned this so far, an instance of an outbreak of Ebola separate from the west African outbreak in, of all countries, the Democratic Republic of Congo. Already, 88 deaths have been attributed to Ebola in that country and are not related to the west Africa epidemic, which is rather frightening—it means that we are now looking at the spotty emergence of the Ebola epidemic.

I want to make a rather larger point. I declare an interest as a member of the board of the Nuclear Threat Initiative in Washington, DC, which is currently supporting the one and only global surveillance of infectious diseases, in a unique international network. It is called CORDS and is doing some remarkable work. This last point is the most important one. In a Question to the Government last week, I raised the issue of whether any thought has been given to calling a special meeting of NATO. I mention NATO following a long conversation that I had with the chief assistant adviser to President Obama, Mr Weber of the Department of Defence, now at the Department of State. He made it clear that he thought the NATO countries should call upon NATO to hold a special summit meeting to consider what help it could give, because it is one of the very few organisations in the West that has the capacity for an immediate response in engineering, construction and medical terms.

I want to make it very clear that, as the noble Lord, Lord Crisp, said, we need the rapid engineering to put up field hospitals and immediate centres to deal with the epidemics in rural areas, where—as in, for example, Sierra Leone—the infection rate is now nine times what it was two weeks ago, according to reports from the WHO. We should seriously consider this possibility, recognising the scale and, even more, the immediacy of the crisis, given the 15 countries that are now seriously at risk.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, I, too, would like to thank the noble Baroness, Lady Kinnock, for securing this debate and for so ably and movingly introducing it. On behalf of DfID, I thank noble Lords for their tributes to the department in this crisis. As I said the other day, if anything shows the importance of aid, both morally and for our self-interest, it is this epidemic. We are all globally linked and noble Lords made that point extremely clearly. I assure the noble Lord, Lord Giddens, and the noble Baroness, Lady Kinnock, that we will be examining the lessons from this crisis. Because of that global linkage, it becomes extremely important that we draw out what we can learn from this.

My noble friend Lord Ridley and other noble Lords are right that the root of this—the cause of the spread of this epidemic—is poverty. Of course, we will need to work internationally to improve and strengthen our international organisations. However, as my noble friend Lord Chidgey says, we need other countries to respond as well, not only to this crisis but to that analysis, and to take forward the ability to respond internationally.

The noble Lord, Lord Giddens, is also right that we need to make huge efforts to contain this in case we should see, as we do not yet see, a levelling off of numbers; obviously, we hope that with the measures we put in place we may be able to detect that. However, if and when we see that, we should not lessen our efforts, otherwise the epidemic will spiral further. He and other noble Lords are right about the economic effect of Ebola. As regards Sierra Leone, the IMF estimates that its GDP growth is likely to be about 6% rather than the 11.3% it had estimated before this crisis. As other noble Lords—the noble Baroness, Lady Kinnock, my noble friend Lord Fowler and others—have emphasised, the health systems we are facing here reflect the fragility of these states, which is why the epidemic has been able to take root.

We are certainly very fortunate in the United Kingdom to have the outstanding staff in DfID who are working both here in the UK and in Sierra Leone. I pay tribute to them as well as to the staff in the Ministry of Defence, the FCO, the Department of Health, from across the NHS and from NGOs who have volunteered their services in one of the most dangerous situations in the world. The audio diary that we hear on the “Today” programme should bring it home to everyone how important, but also how incredibly challenging, their work is. The noble Baroness, Lady Armstrong, spoke of health workers, and the numbers are extraordinary. Some 852 NHS front-line staff and 130 staff via Public Health England have volunteered, which is clearly outstanding.

The Ebola epidemic in west Africa continues to grow. The latest figures from the WHO as of 31 October put total cases in the region at 13,567, with 4,951 deaths. We know that that number is an underrecording. The UK has now committed a total of £230 million to the response in Sierra Leone. As noble Lords know, we are focusing on that country while the United States focuses on Liberia and France on Guinea. That sum includes the commitment to aid-match the first £5 million of the appeal launched by the Disasters Emergency Committee. I, too, pay tribute to the DEC and to the public response to its appeal. We are now the second largest bilateral contributor in this epidemic. We have committed, among other things, to provide over 700 beds. I can assure the noble Lord, Lord Alton, that the first UK 92-bed treatment hospital opened yesterday in Kerry Town. That facility includes 12 beds that are set aside for health workers who are staffing the beds, which will increase to 20. As I said in a previous answer to the noble Lord, Lord Alton, it may well be best, on a case-by-case basis, to treat a case there in Sierra Leone rather than to expose that person, if very sick, to being transported home. The intention is to be able to provide the same level of care, whether it is here or there.

As the noble Baroness, Lady Hayman, noted, ensuring safe burials is key to turning around the epidemic. With the United Kingdom’s support, International Red Cross burial teams in the western area, which accounts for approximately a third of Sierra Leone’s population, are now burying 100% of reported bodies within 24 hours. That is a huge improvement over the situation just a few weeks ago.

We are also expanding laboratory capacity and have pledged £20 million to establish, equip and run at least three new laboratories. We are also providing isolation within communities through up to 200 community care centres, which are the most effective way to prevent further spread. The noble Lord, Lord Crisp, noted that that model is innovative and unique and he is correct. The purpose is to have safe, humane isolation as the key to reducing community transmission. The faster we can bring down those transmission rates, the sooner the health system can resume functioning. Noble Lords mentioned the challenges with other diseases, maternal care and so on, which are also being undermined by this epidemic.

Some of the CCCs are to be located within primary healthcare facilities, which will allow rapid separation of patients presenting with fever—suspected Ebola cases—from others, which will allow healthcare workers to continue to offer routine services such as antenatal care, routine immunisation and other essential health services. The noble Baroness, Lady Kinnock, in particular, flagged the concerns of pregnant women who are reluctant to come in for care. Of course, the centres also help to protect healthcare workers, which, again, is absolutely vital.

We are also supporting this with social mobilisation work. I too noted the very interesting report from the BBC World Service on what it is doing to encourage behaviour change. All that work is overseen by a command and control centre to co-ordinate the response.

Many noble Lords have mentioned the weakness of the health systems in Sierra Leone and elsewhere. Of course that is, as I said, part of the root of the problem. Clearly our current priority must be to help tackle this epidemic; but obviously, we will then wish to help Sierra Leone to return to the trajectory it was on before the crisis, which was moving from a fragile state after conflict to a middle-income economy. That, of course, will include the strengthening of its health system. I note what my noble friend Lord Fowler has said about health workers, and I know the efforts that have been made by the NHS to try not to draw upon staff from developing countries such as Sierra Leone.

We are engaging with partners to ensure that other countries in the region are prepared. We are ensuring that our bilateral programmes in high-risk countries actively support national emergency preparedness. It is of course encouraging to see that, in the first instance, Nigeria was able to contain the case that arrived in Lagos, and to see the way in which it ensured that although others were affected, the virus did not spread further. However, we are constantly vigilant, because other cases may develop.

The UK is also playing a leading role in galvanising international support—a number of noble Lords mentioned that. We are very glad that, last Friday, the UK signed an MOU with Norway to establish the deployment of up to 200 Norwegian health personnel in Sierra Leone. We also welcome the Government of Australia’s commitment yesterday to manage and run a 100-bed treatment facility in Sierra Leone. The EU has pledged €1 billion towards that, and we will be meeting with all our partners to discuss bringing aid forward.

We are working closely with UN agencies, for example with UNICEF on social mobilisation, child protection and so on. A number of noble Lords—especially the noble Baroness, Lady Kinnock, and the noble Earl, Lord Listowel—emphasised the dire situation of children. We are working very closely with UNICEF to support the needs of vulnerable children, including those who have been orphaned by Ebola. We do not underestimate the challenges that they face.

[Baroness Williams of Crosby]

My Lords—

[Baroness Northover]

I am very short of time; I will be very happy to speak to my noble friend afterwards, and I will come on to her point about NATO. NATO is following closely the situation through its crisis management and civil contingency functions, and the allies are assessing whether and how NATO would add value at this stage of the response. However, I also note what my noble friend Lord Chidgey said with regard to what the military might or might not be able to contribute.

The noble Lord, Lord Patel, is right to emphasise the need both for treatments and for vaccines. I hope he will be reassured that we are prioritising both. It is immensely encouraging to see the work of the Lister Institute, for example, and the possibility of a vaccine. Clearly, it could be critical to this epidemic if that work was brought forward, but it will certainly be critical in stemming future epidemics. I note very much what the noble Lord says.

An unprecedented outbreak requires an unprecedented response. That is what we have committed to and we are encouraging the international community and all the international players in each country to play their part to ensure that this terrible epidemic is defeated. As noble Lords have said, poverty is at the root of what we are seeking to address here. That is why we have made the commitment to aid to the poorest countries, as the noble Earl, Lord Listowel, pointed out. That is what it is all about.

Women: Rights

Baroness Williams of Crosby Excerpts

Tuesday 4th June 2013 Lords Chamber

[Baroness Gardner of Parkes]

My Lords—

[Baroness Williams of Crosby]

My Lords—

[Baroness Gardner of Parkes]

Is the Minister aware that this country was one of the first to pass an equal opportunities Act, but it was a long, slow process to move on from there to change the culture and attitudes not only in this country but world wide? Female genital mutilation is an example. Does she not think that progress is being made?

--- Later in debate ---

[Baroness Northover]

That sounds like a very good idea. Given that the noble Lord taught me history, perhaps he will take it forward.

[Baroness Williams of Crosby]

My Lords, I thank my noble friend and the noble Baroness, Lady Hayter, for their spirited responses in this brief discussion. I want to ask about one area where, sadly, the move towards equality has been extremely slow—the finance sector. Perhaps my noble friend can say something about what steps are being taken and how successful they are in increasing the proportion of women on the boards of major banks and other finance-sector companies.

[Baroness Northover]

We are pushing very hard to increase that. I note that the number of boards in the FTSE 100 that have no women on them has fallen to six, down from 21 in 2011. We are acutely aware of this.

NHS Mandate: Health Inequalities

Baroness Williams of Crosby Excerpts

Monday 28th January 2013 Lords Chamber

Asked By

[Baroness Williams of Crosby]

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

[Baroness Northover]

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

[Baroness Williams of Crosby]

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

[Baroness Northover]

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

Afghanistan: Women’s Rights and the Education of Girls

Baroness Williams of Crosby Excerpts

Tuesday 26th June 2012 Lords Chamber

Asked By

[Baroness Williams of Crosby]

To ask Her Majesty’s Government whether they will propose at the forthcoming Tokyo conference on support for Afghanistan that at least 25% of aid should be directed to the support of women’s rights and the education of girls.

[Baroness Northover]

My Lords, at the Tokyo conference in July we will be working to ensure that Afghanistan and its international partners reaffirm their commitments to the rights of Afghan women and children, as enshrined in the Afghan constitution. We wish to see long-term financial commitments from the international community in Tokyo matched by promises from the Afghan Government to deliver key services and policy reforms, including in the areas of human rights and equal status and opportunity for women. The Tokyo conference is not, however, the forum for detailed spending priorities.

[Baroness Williams of Crosby]

I thank my noble friend for that Answer. The Tokyo conference is the last occasion, and the best occasion, to try to change the attitude of the Afghan Government towards their handling of what is called the transformational period, the period that follows the removal of ISAF from Afghanistan next year. In the past few weeks we have had very troubling evidence of backsliding on women’s rights, including the poisoning of 120 schoolgirls for daring to attend school. All 120 of them are now in hospital.

Given all that, I ask the Government for two promises. First, will they insist that some part of the aid provided by this country—the $110 million we have committed to Afghanistan—should be devoted to the education, training and advancement of women as a condition of our aid being supplied? Secondly, there should be a transparent account of how that money is spent so that the Afghan Government cannot again escape their responsibilities in the way that, frankly, they have done all too often over the past couple of years.

[Baroness Northover]

My Lords, my noble friend is quite right that the position of women in Afghanistan is not at all as we would wish it to be. They have made a lot of progress, and we must make sure that we secure that progress and continue to make progress. As far as the UK Government are concerned, the way that DfID approaches its support for Afghanistan is underpinned by human rights, and women’s rights are part of human rights. That will continue to be the case into the future. As we look at the transformational decade that my noble friend referred to, that approach will continue as far as international donors are concerned. The protection of women’s rights is written into the Afghan constitution, and that is what is going to be expected of the Afghan Government.

Health and Social Care Bill

Baroness Williams of Crosby Excerpts

Monday 5th December 2011 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I have a number of amendments in this group as well, in particular Amendments 238, 237B, 237C and 237D. It is, as always, a pleasure for me to follow the elegant moving by the noble Lord, Lord Patel, who speaks from the Cross Benches. He spoke in a very restrained way about the need to try to create a co-ordinated response to any emergency. I would like to pursue this a little further in my own amendments.

The first of the amendments that we put down supplements the proposal of the noble Lord, Lord Patel, that local authorities and the CCGs should,

“have regard to any document published by the Secretary of State”.

On thinking about that, I assumed that any responsible clinical commissioning group certainly would have regard to a document from the Secretary of State. I thought that, in the event of an emergency, especially where a co-ordinated response among the CCGs was required in the way suggested by the noble Lord, Lord Patel, we would need a little more than simply to have regard to a document produced by the Department of Health. So, along with my colleague the noble Lord, Lord Marks, I put down Amendment 238, which requires rather more, as it requires consultation with the Secretary of State.

On further consideration, looking very closely at Clause 43, we were not sure that even that was quite enough. Clause 43 deals not just with local emergencies but with emergencies wherever they may come from. I must say to noble Lords that I am inclined to agree with the noble Lords, Lord Newton of Braintree and Lord Mawhinney, who in a debate last week specifically said that they felt that, in the event of an emergency, it would be very difficult indeed for the Secretary of State not to be brought into the response, notably if a co-ordinated response was required perhaps at regional or even at national level. When we thought about recent emergencies of this kind—for example, the danger of swine flu in the United States some 10 years ago and, more recently, the danger of avian flu, which was moving very rapidly through Asia, with outbreaks of avian flu being established within days in areas which had not at first been affected by it—it seemed more and more clear that it was impossible for the Secretary of State to divorce himself from responsibility for emergencies. As the noble Lord, Lord Newton of Braintree, put it, the public will expect nothing less.

So we found ourselves back with our old friend in this Bill, namely the relationship of the Secretary of State with what are, in the NHS Acts of 2006 and 2009, direct responsibilities that rest eventually in Westminster and Whitehall, and specifically with the man or woman who is the Cabinet Secretary responsible for health. With the best will in the world, I cannot see how the Secretary of State can effectively remove himself from those responsibilities. I am therefore very worried about the early parts of Clause 43. In this Bill, there is a specific reference removing the Secretary of State from the title of new Section 252A of the NHS Act 2006 inserted by Clause 43. The new cross-heading refers directly to him, but the section heading immediately following removes him, leaving reference to the board and the CCGs. Noble Lords who look at Clause 43 will see exactly what I mean: the preliminary lines are followed by a different heading, in which the phrase “Secretary of State” is simply removed from the heading, leaving only,

“Role of the Board and clinical commissioning groups”.

Constitutionally I consider this to be very unhelpful. It is quite central, above all in an emergency where that emergency is not a minor one but a major or national one, for the Secretary of State not to be able to step away from responsibility. I do not mean ultimate responsibility when there is a failure by the Clinical Commissioning Board or, for that matter, by Monitor, but at the point at which the emergency breaks out.

--- Later in debate ---

[Lord Patel]

My Lords, I thank noble Lords who took part in this debate. As I said in my opening remarks, the amendment seeks to clarify the responsibilities of the local authority in situations that arise as an emergency, either locally or nationally, and within that the role of the public health director. I realise that the Bill says that the Secretary of State, through Public Health England, will be involved, but there is still a lack of clarity in the Bill. Apart from saying that local authorities will produce documents about their preparedness to deal with an emergency, it does not say who will take charge. Further clarification may be required, and the Minister might undertake to look at the amendments again to see whether there is some need to clarify this in the Bill.

[Baroness Williams of Crosby]

I thank the Minister. I will spend many happy hours working my way through every possible legal complexity and a number of different Bills. I am grateful for her explanation.

[Lord Walton of Detchant]

Before the Minister writes to the noble Lord, Lord Ribeiro, with a definition of emergency, could she clarify whether we are talking in this Bill about medical emergencies, such as serious epidemics, or whether we are also talking about terrorist attacks, floods and natural disasters, all of which may require the deployment of medical resources? It is important that that should be clarified.

Health and Social Care Bill

Baroness Williams of Crosby Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Warner]

My Lords, before the noble Earl responds, may I offer him a little piece of advice, as a former Health Minister who had to take controversial legislation through this House? I would say to him that if I had been confronted with this situation, I would have gone to my boss, the Secretary of State for Health, and asked him to facilitate the passage of this legislation through the House by making this information available to the House.

[Baroness Williams of Crosby]

My Lords, I, too, wish to ask the Minister one additional question. Can he give any idea of how quickly the proceedings that he mentioned in his recent letter to Members of the Committee will take? He showed in that letter that there needed to be discussions with other ministries and that there needed to be consideration of whether an appeal should be brought. I know that he appreciates, as much as the rest of the House does, that our debates in many areas would be very much affected by knowing what is in the risk register, and in particular, perhaps, those parts of it that the noble Baroness, Lady Thornton, suggests could be made available. Can he give the House any idea of the probable timetable, as we are all conscious of the fact that the debates might have to be repeated all over again if the information in the risk register is relevant to the things that we are talking about?

[Lord Campbell-Savours]

My Lords, I read the report the other day and it seems to me that the Government are refusing to publish because they have got something to hide. We want to read this document. The Information Commissioner’s report is a fascinating document which repeatedly, under a number of paragraph headings, states that the Government should publish this document and act in a transparent way in the public interest. That phrase is repeatedly referred to in the course of the document. It is quite incomprehensible that the Government should have taken this very silly decision—a sort of ostrich in the sand approach to these matters.

--- Later in debate ---

[Earl Howe]

I am grateful to my noble friend and I did mean to make specific reference to his speech, which I found very impressive. He is of course absolutely right. There is no doubt that the commissioning of specialised services in recent years has improved in many areas but it is still variable. I do not believe I am misrepresenting those who champion the cause of patients with rare conditions by saying that they welcome the fact that the commissioning of specialised care will now fall to the NHS Commissioning Board. In other words, the commissioning will be done once and not, as at the moment, very frequently 10 times at strategic health authority level. It is absolutely clear that for all sorts of reasons greater consistency and better quality need to be injected into the commissioning of specialised care. The points my noble friend made were ones that we certainly subscribe to.

[Baroness Williams of Crosby]

When the noble Earl was talking about the relationship between health and well-being boards and the local commissioning groups, he said that consultation would be expected but that in the last analysis if there was no agreement there would be no question of the health and well-being board having to approve of the CCG’s plans. In the event of a serious difference of opinion, for example, about provision for the homeless or provision for special needs in a community, would there be any possibility of referring the matter up to the board or would it just be left to them to try to reach the best agreement they could?

[Earl Howe]

Part of the function of the board is to support decision-making at a local level if that is ever required. If there were a serious disagreement of the kind my noble friend describes, I envisage that the resources of the board could be made available to the decision-makers at local level to try to find a way through whatever disagreement had occurred.

--- Later in debate ---

[Lord Warner]

My Lords, my noble friend raises a very important point. I can see some differences of approach here. Today, I am speaking on the rather narrow issue of helping the Secretary of State to be a powerful influence in improving public health. Of course, it is for your Lordships' House to debate further, as we progress through the Bill, whether we want Clause 1 to go a little further than the Government seem to want in terms of the Secretary of State’s responsibilities. I have sympathy with my noble friend in seeing a slight confusion on the part of the Government in some of these areas.

[Baroness Williams of Crosby]

My Lords, I wish to express strong support from these Benches for the amendments spoken to by the noble Lord, Lord Warner. Perhaps I could mention one or two points. It is clear that the emphasis on public health, important as it is at the national level, must also be reflected at the local level. I say again, therefore, that the amendments about expecting clinical commissioning groups to have at least one board member with public health experience are important in reflecting the kind of things about which the noble Lord, Lord Warner, has spoken.

I also believe that the noble Lord has put forward in Amendment 68 a very interesting idea that ought to give a higher profile to public health advice on how to deal with diseases and illnesses in the population as a whole. Obviously I share the views expressed by the noble Baroness, Lady Jay, on the importance of putting the Secretary of State squarely behind these issues, and I shall give one example of that. The Bill provides for extensive redress on issues related to smoking and alcoholism, and perfectly properly so. People are perhaps more reluctant to point the finger in relation to some of the serious public health issues arising from the food industry, issues which have great implications for the food industry's relations with the overall economy. There has over many years been a very slow response to growing evidence that certain foods, particularly foods directed at children and young people, have a substantial impact on health. If one looks at the ways in which those foods have been advertised, with an emphasis on how attractive they are, not only so that people will taste them but so that there will be a certain addiction to them, one will see an issue on which there should be a major consultation between the Department of Health and that industry. So far that has largely been limited to issues such as labelling, which is sometimes so complex that the ordinary consumer would not easily pick it up.

There is a continuing emphasis on, for example, foods that attract young children but which contain high levels of salt, sugar and so on, which is all the more serious in a country such as ours which, sadly, has a growing problem of obesity. I strongly suggest that the Government should look closely at Amendment 68 and the idea of establishing a standing advisory committee on public health. I would also point out the importance of assigning responsibility all the way up to the Secretary of State to ensure that these negotiations with industries and special interests which are crucial to the nation's health are conducted at the highest level and that public health is recognised as a full companion to all the other aspects of health. In that respect, I am very pleased indeed that the Government have put emphasis on the independence of the public health area and allowed public health to be taken out of the Department of Health and given its own status. That is a very long step forward.

--- Later in debate ---

[Lord Northbourne]

I beg the Committee’s pardon. I was trying to withdraw the amendment before having moved it. I beg to move.

[Baroness Williams of Crosby]

My Lords, I am not quite sure whether the amendment is before us or not, but I shall make a brief assumption that it is and then I will allow the noble Lord to decide whether to sustain or withdraw it.

As we all know, the noble Lord has made a very distinguished contribution to the whole issue of the status and well-being of children and it is fair that we should recognise that. In particular, he has gone to a great effort to underpin the importance of early education and such things as the Sure Start programme. I want to add two points. The first is that, as a former Secretary of State for education, I remember working very hard to try to persuade my colleagues in the educational world that there should be an emphasis on education in parenting.

It is perfectly true that the early stages of a child’s life are vital, but as the noble Lord, Lord Northbourne, has pointed out, research shows that the link between what a child becomes and its parental inheritance is very close indeed. One of the more disturbing pieces of recent research shows the close link between an abused child and an abuser. Many young people who are abusive parents are in fact the children of abusive parents. Tragically, this dreadful tradition can move on from generation to generation. I simply want to make the point that it is not just a case of Sure Start for the child, it is also a case of proper education and training for the parents.

I have often felt that we should try to link sex education with parental education to bring out above all the extraordinary responsibility that a human child is because it takes so long to grow up compared with the young of most other species. A human child is dependent for many years, and I believe that we should put more emphasis on that than we do. However, it is not fair to make the Department of Health the sole responsible power for addressing this difficult subject. It requires a degree of working between departments, including education and other departments. I simply want to put on the record before the Minister replies the importance of securing co-operation between the Department of Health and the Department for Education, and for that matter social care on this particular set of issues.

My last point is quite straightforward. One of the aspects of training children in parenthood is to allow them to see what it is like to care for a young child. Some teenagers at school will not necessarily have younger siblings. Long ago when I was the prisons Minister—I should have talked about this when the noble Lord, Lord Ramsbotham, was in his place—I introduced a group of offenders, all young boys, to the task of helping in the care and support of children with Down’s syndrome. That relationship had an amazing effect on both parties. The young offenders suddenly realised that they were responsible for someone much younger than themselves who was dependent on them, while the Down’s syndrome children suddenly had older brothers who were devoted to them and to whom they could address their huge capacity for affection. There is a lot of room for bringing young people together with children and teaching them something more than we know now about what it is to be a parent and the huge responsibilities involved in that role.

[Baroness Thornton]

I should just say how pleased I am that the noble Lord, Lord Northbourne, has brought his great experience and commitment to the children and the family into this debate. I urge him to remain in his place for the debate that we are going to have very soon on children.