National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013
Debate between Baroness Williams of Crosby and Lord Davies of Stamford(11 years, 7 months ago)
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Baroness Williams of Crosby
In this particular set of regulations we are giving statutory underpinning to Monitor in a way that will mean, as it did previously, a much greater opportunity to deal with most objections on the spot and not have them carry on into the courts at great expense to the taxpayer and to patients. If we turn it down tonight it will leave us without that structure altogether and we will go back to where we were.
In conclusion, while I have very strong sympathy with the view of the noble Lord, Lord Owen, that the National Health Service of the 1980s was a more true state service than anything today, I am afraid we cannot go back; we are where we are. The best thing we can possibly do is to make patients’ interests the very centre of what the NHS is all about and to recognise that this new route is the way we are going. It could, however, be very exciting and it would lead to a very much more accountable NHS than we have had in recent years.
Lord Davies of Stamford
We have had a very thorough and memorable debate on this important subject, and that is not a bad thing. It is striking that the House should be so full on this occasion, because the NHS is very close to all our hearts and to the hearts of the whole of this country. We had a very powerful speech by the noble Lord, Lord Owen, and against that we have had attempts by a spokesman on behalf of the coalition, and by the noble Lord, Lord Walton, to whom we always listen with great respect on these occasions, trying to reassure us that things are not quite as alarming as they appear to be—not quite as alarming as the BMA, which the noble Lord, Lord Walton, once presided over in a very distinguished fashion, appears to think.
Before we accept those blandishments and reassurances, we need at least four very specific assurances from the Government tonight. One is on the matter very well raised by my noble friend Lord Hunt. Clause 5 is extremely weak in providing any protection against the absoluteness of the requirement for CCGs to go out to tender. It simply says that they do not have to do so if in fact there is no other party able to provide the relevant service. As the noble Lord, Lord Hunt, very clearly said—and he is absolutely right—in a large urban area such as London or the West Midlands, there will always, or almost always, be somebody else who is technically capable of delivering the service, so that is extremely weak protection. I am not very reassured by what the noble Lord, Lord Walton, said on that subject. It is no use saying “We’ve got guidance”. We are now passing the law, and guidance cannot override the law. What is more, when we have changed the law you can be absolutely certain that an awful lot of lawyers and some very aggressive companies will be waiting to use this law to try to force open a business opportunity.
Health and Social Care Bill
Debate between Baroness Williams of Crosby and Lord Davies of Stamford(13 years ago)
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Lord Davies of Stamford
My Lords, I find it not entirely surprising that a number of us this afternoon have found it difficult to know at exactly what point we should be making the contribution that we wanted to make, because of course there is an immense overlap between the themes that all the clauses we have been reviewing today have brought forward.
All those clauses, and most of the amendments to them, necessarily derive from a single decision by the Government. This was the decision that they wanted to distance the Secretary of State from the operations of the health service and superimpose a set of bureaucracies and regulators that would in future take on the responsibility that the Secretary of State has had until now. That was a decision that has had, and will have, a lot of consequences.
Three consequences in particular are very unfortunate. The first is that there will inevitably be a lack of transparency. You may impose on Monitor the obligation to produce the annual report and occasional statements on the decisions it takes, and impose on clinical commissioning boards, foundation trusts and other bodies within the NHS an obligation to try to relate to the local public and have meetings and report to them and so on. However, you will never get the degree of close oversight that you can get in Parliament when the important decisions are taken by the Secretary of State in Parliament, where they are subject to a weekly or, when necessary, daily scrutiny. That does not apply to the functional decisions, which I will come to in a moment. That is the first inevitable cost of this proposal by the Government.
The second consequence is the cost to democracy. People will no longer feel that the health service is being delivered by their democracy, or is part of their democracy. It will increasingly be delivered by relatively remote and autonomous bureaucracies which will no doubt be staffed by the most high-minded people—a sort of platonic mandarinate who will certainly deliver the best they can for the human beings in their care. However, that is a very different concept from the democratically driven concept of the National Health Service on which a lot of us were brought up and which was, of course, the vision of Beveridge and Bevan.
The third consequence, to which I turn in specific detail, relates directly to the clause and amendments before us. Many contradictions and conflicts of interest will be created in the organisations and bureaucracy that take over the Secretary of State’s role. Until now the Secretary of State has been responsible for taking those decisions that are properly political decisions in the true sense of the word. They involve priorities, value judgments, trade-offs and strategic decisions for the future, which have properly been decisions of the Secretary of State up to now. Many of them will now be taken by someone else, particularly Monitor, which will take over from the Secretary of State the job of making sure that the whole system works. I have no doubt that the Government hope that that will work out well, but I repeat that I think that the effort, the initiative, is misconceived.
Two types of conflict will inevitably be structurally hardwired into Monitor. There will be the functional conflicts to which I have already referred. Monitor has specific, specialised responsibility for licensing and overseeing foundation trusts and making sure that problems are ironed out. That is one particular sector on the provider side of the equation. It now has a whole lot of responsibility for everyone else on the provider side and for the supplier side. There are some inherent conflicts.
There are also philosophical conflicts. Monitor is being given very many criteria. Clause 59 sets out what probably most of us would write if we were asked to write the most important targets of the health service on the back of an envelope. However, there is no attempt to establish a hierarchy and there will be conflicts between them the whole time. In the short term at least there could be serious conflicts between increases in efficiency, for example in access and improvement in care, and in all the other virtuous objectives set out in that clause.
The noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Finlay, have brought forward their own solution. They say, “Well, let us take one criteria, make that the overriding criteria and then Monitor won’t have a conflict any more”. That is how I understand the logic of what they propose. Perhaps I may disagree for a moment with the noble Baroness, Lady Finlay. It is not right to say that she builds on the suggestion made by the noble Lord, Lord Clement-Jones, because her proposal comes under different criteria. The noble Lord thinks that the safety of the patient is the most important thing, and the noble Baroness thinks that it is not to place too great a burden on providers. Both are admirable considerations, but by definition they cannot both be the overriding determining consideration where there is otherwise a conflict between desirable objectives. That will occur the whole time. These two amendments highlight the problem created by the way that the Government have decided to approach the future of healthcare in this country.
I turn now to the Government’s answer to the problem that I have set out. It is quite extraordinary. Clause 63(2) states:
“Monitor must act so as to secure that there is not, and could not reasonably be regarded as being, a conflict between”,
its responsibilities, which in this case are foundation trusts, and the rest. How can Monitor possibly act as if there is not conflict if there is a conflict? You cannot just pretend that there is not conflict and think that that means that the conflict has disappeared. That does not work at all. The same thing applies to subsection (3), which states:
“Monitor must ignore the functions it has under sections 109 and 111 when exercising … its functions under Chapter 2 … and Chapter 4”.
What exactly does that mean? It cannot be ignored. Of course, Clause 109 is about when a foundation trust runs into difficulty. When that happens the Government cannot wish away the fact that the foundation trust has a difficulty; they have a responsibility to resolve it. Perhaps they mean that there will be a department looking after the foundation trust’s problems but that it will not be allowed to speak to the departments with the general responsibility that Monitor exercises across the rest of the health service.
If that is what the Government are saying, perhaps they should say it explicitly. But if they are going to set up two separate departments which will not be allowed to talk to each other—there is a kind of negative synergy in an organisation having two functions of that sort—why not have two separate organisations? What is the logic for having Monitor at all if it will have to operate in this extraordinary way? I have intervened because the Government need to tell us clearly, before we agree Clause 63 and accept this Bill into the legislation of this country, exactly how they propose to grapple with the serious problems that their decision has created. I do not think that we will accept in this House that their decisions can simply be wished or thought away.
Baroness Williams of Crosby
My Lords, I can address my Amendment 274ZB very quickly. I have to admit that it arises from a fog of misunderstanding. Frankly, I do not know what this subsection means. Under Clause 63(3), there can be a Monitor intervention in a situation where Sections 109 and 111, which address themselves to various aspects of foundation trusts, can be completely waived without any regard to the fact that they are looking at competition and pricing as regards profoundly sensitive subjects. I wish that I could say that I know what it means but I do not. Instead I have put down an amendment which simply proposes leaving out that subsection. If the Minister can enlighten me, perhaps I will put it back in again. At the moment, I simply do not know what I would be putting in or out. I apologise to the House for such absurd and detailed ignorance, to which I confess with great humility. But I hope that the Minister will be able to enlighten me because so far no one else has been able to do so.
European Union Bill
Debate between Baroness Williams of Crosby and Lord Davies of Stamford(13 years, 7 months ago)
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Lord Davies of Stamford
My Lords, I have the greatest regard for the noble Baroness, but I think no one has spoken from this side of the Committee recently. The noble Lord, Lord Flight, will not be surprised to learn that I rise to speak on the other side of the argument and do not support his Amendment 47A. However, I rise in support or Amendments 45 and 46 and against Schedule 1 standing part. Before I do that, perhaps I could give a word of personal explanation to the noble Lord, Lord Howell. I did say to him that I would not be able to take part in today’s proceedings and I regretted that. I assure him that I made that comment entirely in good faith because, as I explained to him, at the time I had an engagement that I thought I ought to attend but I have managed to extricate myself from it. I hope he is not too disappointed to find that I have returned to the fray here.
I shall speak directly to these amendments, particularly Amendment 46, but before I do I must repeat that the whole progress of this Committee has thoroughly reinforced the conviction which I expressed at Second Reading: that the effect of this Bill, if it becomes law, will be twofold. First, there will not be any referenda. The idea that we are going to have referenda asking the British public to decide on moving from the ordinary to the special legislative procedure in relation to something involving the procurator-general is absurd. It was never going to happen and still less do I think it likely to happen that we are going to have 10, 20 or 30 referenda. The Government, in response to my Second Reading speech, said in desperation that these referenda would be grouped but you cannot possibly ask the British public to answer 10 questions of that kind in the course of one referendum, so there is no doubt about it: there is no intention to have any referenda and there will not be any.
The intention must therefore be, as I have said before, to adopt what I call a frozen policy in the EU. It is quite frightening that this country should adopt a frozen policy in any international organisation of which it is a part. It is not only deeply destructive of the national interest but not at all in accordance with public opinion in this country. Public opinion may well be sceptical in many ways about the European Union but it expects the Government to respond flexibly, pragmatically and intelligently to the challenges of the hour, not to adopt frozen policies.
This schedule has a whole list of absurdities in it. If I dealt with them all, although I should be delighted to do so in many ways, I would take up much too much of the Committee's time. Perhaps I might focus on two, because I want to illustrate how misconceived the approach encapsulated in the Bill is. The first item in Part 2 of Schedule 1 is:
“Article 19(1) (measures to combat discrimination based on sex, racial or ethnic origin, religion or belief, age or sexual orientation)”.
If one looks up the relevant reference, Article 19 goes as follows:
“Without prejudice to the other provisions of the Treaties and within the limits of the powers conferred by them upon the Union, the Council, acting unanimously in accordance with a special legislative procedure and after obtaining the consent of the European Parliament, may take appropriate action to combat discrimination based on sex, racial or ethnic origin, religion or belief, disability, age or sexual orientation”.
It is, unfortunately, not impossible that there should be problems with discrimination in the European Union, particularly racial or religious discrimination. Racial discrimination is, sadly, not absent from any part of the human race and we have had some disturbing incidents and tendencies in the European Union, for example in Romania and Hungary—and, surprisingly and rather shockingly, in France—in relation to the Roma. We have had racialist remarks made by members of the current ruling party in Hungary and by prominent members of parties in Poland and Latvia who are now partners of the British Conservative Party in the European Parliament.
It seems to me that there would be a great advantage in moving from the special to the ordinary legislative procedure in this area of discrimination, so that once we had done that it would not be possible for one member state to hold out against a clear declaration, legal statement or piece of legislation that made it impossible to discriminate against people on those grounds. There was horror when the French Government suggested that it was a greater priority to get illegal immigrants out of France if they were Roma than if they were anything else. That is exactly the kind of problem that all of us, surely, have an interest in ensuring does not arise and does not disgrace or besmirch the European Union, to which many of us are committed. Therefore, if one had a problem involving a country there would be a real danger of a veto under the special legislative procedure.
I cannot for the life of me think why a British Government who are composed of a Conservative-Liberal Democrat coalition should want to exclude the use of qualified majority voting without the block, which we know will never be overcome, of a threatened referendum. So it seems a thoroughly perverse consequence of the Government’s policy in this area.
Let me take another, very different, example, which shows how we are shooting ourselves in the foot if we pass this Bill. It is an area which I know a bit about, having been Minister for defence procurement for a while before the general election. The penultimate item in the list under Part 2 in Schedule 1 is:
“Article 346(2) (changes to list of military products exempt from internal market provisions)”.
In the relevant governing article in the Lisbon treaty, Article 346 states that,
“any Member State may take such measures as it considers necessary for the protection of the essential interests of its security which are connected with the production of or trade in arms, munitions and war material; such measures shall not adversely affect the conditions of competition in the internal market regarding products which are not intended for specifically military purposes … The Council may, acting unanimously on a proposal from the Commission, make changes to the list, which it drew up on 15 April 1958”.
What the Government are saying is that they cannot change that and move from unanimity to qualified majority voting without a referendum. Let me explain what this clause does. It is a derogation from the single market in relation to military goods. It is a protectionist measure, which I believe was insisted upon by France at the time the original treaty of Rome was signed. For many years it was Article 46 of the treaty, but it has been overtaken by events. It is contrary to the interests of the British defence industry, which is the largest—that is not a value judgment but a fact—by volume of any defence industry in the European Union and, I think, the most competitive. It therefore suffers from this protectionist measure, which in my experience and to my own knowledge has often been abused.
Member states have argued that vehicles used for military purposes are military equipment and therefore have to be manufactured in that particular country—Italy, in this case. There are arguments the whole time about whether something is genuinely military equipment. This can sometimes be resolved, but the effect is a major derogation in the single market. I thought that it was a matter of consensus in British politics—certainly involving all three major parties—that we are in favour of a single market and we want to get rid of obstacles to it. Yet this Government are placing an obstacle in the way of extending the single market. This Government are using a referendum to block the removal of a derogation from the single market legislation. In effect they are supporting a restriction on the possibility of the British defence industry expanding its exports within the European Union. This is a crazy, crazy policy, there is no doubt about it. I do not know whether the Government have thought this one through. If they have, I hope that at this 11th hour they will think about it again.
I am proud that, as defence procurement Minister, for the first time I abolished protectionism. I said that Britain should buy the capability it needed, where it could get it best and at the cheapest price. I made that absolutely plain. There are certain areas where for defence purposes and strategic security reasons we would not buy military equipment. We would not buy from Russia or China, for example, because we would not know what was in it. If there was any software, we would have to be very wary indeed of allowing it into the country. Nevertheless, where security and defence considerations did not apply, we would buy equipment from the best and cheapest source.
I placed a contract for an armoured vehicle, the Warthog, in Singapore and I am glad I did. I have a record, if I may say so, of being liberal in defence procurement and it is deeply shocking to me that we have a Government who are trying to go against that liberalism and damage an important British industry. The defence industry, probably together with pharmaceuticals, is the manufacturing area in which we have the greatest international competitive advantage.
I hope that, as a result of the debates in this House—unfortunately these matters will not be explored properly in the House of Commons—the country as a whole, including, in this case, the manufacturing and defence industries, will be alerted to what is going on here. If the arguments that we bring forward from these Benches, and those of others with reasonable views on Europe on the other Benches, do not prevail, maybe the voice of British industry might be heard. If it is not heard soon, a very important piece of damage will be done. It will be extremely difficult for us to find a rational solution to this problem if we continue to have enforced unanimity in this area of single market legislation, because that is what it is.
Baroness Williams of Crosby
I shall quickly follow the noble Lord, Lord Davies, but I shall not detain the Committee for more than a few moments. I plead particularly to those Members of the Committee who are women. Article 19, the provision to which the noble Lord, Lord Davies, referred, concerns discrimination on the grounds of sex, religion, sexual orientation and so forth. The effect of what we now see in Schedule 1 is that a referendum would be needed to move from unanimity to qualified majority voting. I ask my colleagues to give a moment’s thought to a position where the discriminator is one of the members of the Council.
That was exactly the example in the case of the Czech Republic when it sought to join the European Union. It discriminated viciously against the Roma; in some cases they were assaulted in small Czech towns and, in one or two cases, burnt. The attempt to say to the Czech Republic that discrimination against the Roma must end would have been impossible had there been a requirement for unanimity—in other words, no movement towards qualified majority voting. In those European Union members where there is clearly discrimination against women—Romania is one example of that—it would be possible for that country effectively to veto an attempt to rule out such discrimination. I cannot believe that that is what the Committee wants to see.
Essentially, one of the great achievements of the European Union—one that the noble Lord, Lord Pearson of Rannoch, totally fails to recognise—was the extension of human rights and democracy to central and eastern Europe. It is an astonishing achievement. In any country except Britain it would be recognised as such. The consequence of that, in practice, is that the Copenhagen criteria—laid down in 1993 at the European Council meeting in the Danish capital—specifically said that for a country to join the European Union it must meet requirements about human rights, democracy, the independence of the courts and the proper, non-corrupt provision and maintenance of the rule of law, all of which are fundamental pillars of democracy. All of these depended on the wishes of these countries to join the European Union, and the requirement on them to meet those political conditions in order to do so.
The success, in extending democracy to that huge part of Europe, has a great deal to do with the respect that many of us have for the European Union. I spent nine years as the head of an organisation based in Harvard University called Project Liberty, which argued time and again with the Governments of eastern European countries that they could not join the European Union unless they put right laws that were discriminatory and corrupt. I know this because I was involved at first hand. It was an extraordinarily powerful weapon.
I conclude by saying, first, that nobody in this Committee should underestimate the astonishing impact that Europe has had on democracy in this continent and beyond it. Secondly, to try now to limit opposition to discrimination by obliging it to be unanimous would be a huge step back for the European Union, and one for which I, for one, would hate to see my country be responsible.
Middle East and North Africa
Debate between Baroness Williams of Crosby and Lord Davies of Stamford(13 years, 10 months ago)
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