Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Walmsley

Committee stage
Monday 3rd November 2025 Grand Committee

[Baroness Walmsley (LD)]

My Lords, these amendments in the name of the noble Baroness, Lady McIntosh of Pickering, the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, from whom we will hear later, address the details of a licensing scheme, which could, I believe, be better worked out during consultation and are better put in regulations than on the face of the Bill.

I think there are problems with the suggestion that there should be a joint alcohol and tobacco products licence—as superficially attractive as that may sound. This is for two reasons. The first is practical; there are plenty of retailers who sell both ranges of products, but there are plenty who do not, including some small shops and specialist vaping retailers. Let us not overcomplicate this by having several kinds of licence: joint and single.

The second reason is even more serious, because the objectives of the two schemes are not the same. The objective of the tobacco and vapes licencing scheme should be public health. Indeed, that is the main justification for the generational ban and other restrictive aspects of this Bill. On the other hand, public health was not the objective of the design of the original alcohol licence, and things are set to get worse—which I will come to. Therefore, there are issues about putting the two together.

On Amendment 35, there is a case for restricting the density of tobacco and vapes licensed premises in a local area on public health grounds. Local authorities already have the powers to limit the density of fast-food outlets in certain areas, such as near schools, on the basis that the food they sell is often high in fat, salt and sugars, and is energy dense. Why should local authorities not have the same powers for the density of shops selling tobacco and its various products? Therefore, I oppose Amendment 35. Density is better decided by the local licensing authority, which knows and understands its own area. It is not something that should be on the face of the Bill but something that should be considered in consultation.

I turn now to Amendments 30 and 42. The Government have recently launched a rapid consultation on alcohol licensing, led by an industry task force that would see “growth” incorporated as an objective of the revised scheme, rather than public health. Its recommendations have been warmly welcomed by the Government, but I would advise caution, especially in the light of calls for joint tobacco and alcohol licences today. It is true that hospitality outlets can be important for people’s well-being and community cohesion and often provide economic benefits to local communities. However, many of them rely nowadays more on the sale of meals than on just alcohol and provide an opportunity for family outings. The implication by the industry in the recommendations of the task force is that people cannot enjoy themselves unless they are consuming alcohol. That is, of course, a nonsense suggestion. By the way, each of the three working groups was led by a senior member of the industry and there was no representation on the task force from the Department of Health and Social Care or public health bodies, despite public health acting as the responsible authority for local licensing committees.

The task force report defines the core purpose of licensing as economic enablement and sets out a series of mechanisms to promote that approach. The foreword in the Government’s response, written by the Minister for Services, Small Business and Exports, not only describes licensed hospitality as “foundational” to the UK economy but as selling “happiness, creating lasting memories”, and providing

“the glue that binds us together as a society”.

This is language that, if used in alcohol marketing, would probably breach the industry’s own code of conduct.

The task force’s recommendations would undermine the powers of elected local authorities in several ways: first, by the creation of a quasi-statutory national licensing policy framework to direct local decision-making; secondly, by the automatic addition of off-sales permissions to all on-sales licences; thirdly, by the enhanced powers for unelected licensing officers to override decisions of elected officers on licensing committees; fourthly, through the

“Requirement to link licensing to economic development and culture policies”;


fifthly, by a blanket “amnesty” on licensing conditions deemed to be

“outdated in the modern world”—

deemed by whom, I ask—and, finally, by the imposition of a higher evidential bar for objections to licence applications, with adherence determined solely by licensing officers.

That is why there should be no attempt to link alcohol licences under such a regime with tobacco retail licences. There are other ways of helping the hospitality industry rather than undermining the very foundation of the alcohol sales licensing regime by attacking local democracy in this way.

[Earl Howe (Con)]

My Lords, in speaking to Amendments 35 and 42 in my name and that of my noble friend Lord Kamall, I will also express my strong support for Amendment 30, moved by my noble friend Lady McIntosh of Pickering. All the amendments in this group are guided by an important principle. The success of a new licensing regime will depend not only on the strength of the associated enforcement powers but on the fairness, proportionality and practicality with which those powers are exercised.

Amendment 30 is a sensible and fair proposal. It acknowledges that the vast majority of retailers selling tobacco and vape products do so responsibly and already operate under stringent regulatory regimes. Many of those businesses hold alcohol premises licences and are personal licence holders, and as such as are meticulous in complying with the rules and standards legally in force to prevent under-age sales and the supply of illicit goods.

Clause 16 will impose new licensing obligations, checks and costs. Taken together, for many small independent businesses they will represent a significant administrative and financial burden. My noble friend’s amendment simply asks that the Government recognise the existing history of compliance by allowing a streamlined process for those that have already demonstrated that they meet high licensing standards elsewhere. This would embed efficiency and fairness into the enforcement system and reward good practice. It would save time and cost for retailers and allow enforcement resources to be focused where they are most needed, on those who persistently flout the rules.

Amendment 35 turns to another crucial point of principle: fairness and proportionality in how licensing powers are applied. As drafted, Schedule 1 would allow licensing authorities to impose proximity or density restrictions, in effect preventing a licence being granted simply because a premises happens to fall within a designated zone or is near other retailers that sell similar products. That is an extremely broad and, frankly, concerning power. It risks punishing businesses not because they are non-compliant through choice or negligence but simply because of where they are located.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, I feel it is appropriate that we should have at least a short debate on Clauses 35, 36, 129 and 130, partly because they raise concerns that are very similar to those I had intended to flag when responding to the group of government amendments that were, in the event, not moved. Our debate on that group of amendments must remain a pleasure in store.

However, these clauses together confer on Ministers the power to take over the enforcement and prosecutions of local authorities or other enforcement authorities, either for individual cases or entire categories of cases. The inclusion of these powers in the Bill needs explaining, first, because they appear to go much further than is necessary or appropriate and, secondly, because they raise a number of important questions about the relationship between central and local enforcement and about accountability.

At present, the Bill rightly places day-to-day enforcement in the hands of local weights and measures authorities, which have the expertise, local knowledge and operational independence needed to make these judgments. Under these clauses, however, the Secretary of State or the devolved Ministers could simply direct that those functions are to be discharged instead by Ministers centrally. There is no statutory test to be met before that happens, no requirement for the local authority to have failed or refused to act, and no mechanism for consultation, appeal or review.

By any standard, that is a very wide power to exercise over democratically elected local authorities. In effect, it allows central government to displace local enforcement at will. Inherent in the exercise of this power is a risk that enforcement decisions become politicised. Local authorities act impartially and are guided by the evidential tests and the public interest. One can imagine a situation in which a future Government—I am not saying this one—choose to intervene and adopt an approach of their own when taking over investigations or prosecutions. How will we safeguard the impartiality of decision-making? How will the basis of any decisions be scrutinised or, indeed, challenged?

There is the added issue of proportionality. If these are intended as reserve powers for exceptional circumstances, the Bill should say so. At the moment, there are no thresholds, no published criteria and no requirement even to lay a Statement before Parliament when such powers are used.

We have tabled these stand part notices to probe the Government on several points, and I would be grateful if the Minister could respond to the following questions. First, why does the Secretary of State need these powers at all, given the enforcement architecture already in existence and set out elsewhere in the Bill? Secondly, in what circumstances does the Minister envisage using them? Is this a genuine power of last resort or something that might be used more routinely? Thirdly, what safeguards will there be for local authorities whose functions are overridden? Will they be consulted, or have the right of challenge? Fourthly, how will accountability work once a Minister takes over enforcement? Will there be a published direction, a report to Parliament or any means of scrutiny? Finally, how do these powers sit with the devolved authorities?

We all want effective enforcement of the law, and there may be rare cases where national co-ordination is required. However, I think we need some further and better particulars from the Minister.

[Baroness Walmsley (LD)]

My Lords, I am afraid I do not support the wish of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, to delete Clause 35 and its associated clauses. I do not believe that the backstop, which enables the Secretary of State to take over enforcement from trading standards, is a power grab; it is necessary in case a local authority goes into administration and cannot fund trading standards. Similar measures to protect social services in the case of a local authority going into administration can be found in the Care Act 2014, amended by the Health and Care Act 2022. The Tobacco and Related Products Regulations 2016 recognise that there may be situations where it is more appropriate for the Secretary of State to act rather than local weights and measures authorities.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Walmsley

Committee stage
Thursday 30th October 2025 Grand Committee

[Baroness Walmsley (LD)]

My Lords, on behalf of our Benches, I have added my name to my noble friend Lady Northover’s Amendment 12. I also support Amendment 148, of course, although my name is not on it yet; I have a bit of a track record on changing “may” to “must”, so I am very much in favour of that amendment.

As my noble friend said, the tobacco industry sits on a rich source of data that would help public health planners and practitioners to plan and deliver public health smoking cessation services in a granular way. That could help to reduce inequalities, so my noble friend’s Amendments 12 and 148 are no-brainers for the Government in the fight against health inequality, which I know they are in favour of winning. As the noble Lord, Lord Crisp, pointed out, if you have the data, you have a powerful weapon; the industry uses it and the Government should have it.

The data would also shine a light on the massive profits of the tobacco companies, which saw the writing on the wall about the decline of tobacco smoking and shifted part of their business model to hooking young people and existing smokers into being addicted to their nicotine vaping products instead. They then surrounded them with brightly coloured packaging, attractive-sounding flavours and masses of expensive advertising. One has to wonder why they spend so much money on advertising and the attractive displays in my local village shops. Ah, yes—it must be because that enables them to hook people to their profitable products for life.

These profits are addressed in Amendment 192 from the noble Lord, Lord Young of Cookham, which is supported by my noble friends Lord Rennard and Lady Finlay of Llandaff, and in my noble friend Lord Russell’s Amendment 194, which I also support. Both amendments propose a levy on the profits of tobacco companies. Tobacco and the nicotine it contains are uniquely harmful products, which is why they should be treated in this way. They are highly addictive for some people from their very first use, by the way; that is sometimes ignored. Tobacco kills more than 76,000 people in England every year—that is almost as many as were killed by Covid in just one year, in 2020—and the four manufacturers that are responsible for most of the UK’s tobacco sales make excessive profits that require regulation. It has been said that they make an estimated profit of £900 million a year in the UK, with an average net operating profit margin of about 50%; as my noble friend Lord Scriven pointed out, most manufacturers of other goods are quite satisfied with an average of 10%. Yet those companies currently pay very little corporation tax in the UK. The tobacco tax of £6.8 billion that they pay does not even scratch the surface of the harm they do; as has been pointed out, that tax is paid by the consumer and not by the producer.

In other areas of society, polluters are required to avoid and minimise pollution and to pay to clean it up. Tobacco companies make no effort to do either. In other monopoly situations, such as energy supply, the Government intervene, yet tobacco companies get away scot free, despite the fact that their products cost the NHS £1.82 billion annually and the ill health caused by them causes major suffering to individuals and families; they also have a major effect on productivity and the economy, costing society in England £43.7 billion a year.

Given this Government’s objectives on growth, I would have thought that a “polluter pays” tobacco levy would be very popular with them, as it is with the general public, 76% of whom support the policy. It could raise up to £700 million per year to fund vital smoking cessation and wider public health activities, as my noble friend Lord Russell suggests in his amendment. It could prevent industry manipulating prices to undermine the health aims of tobacco taxes. A levy would make tobacco less profitable in the UK and reduce industry incentives to lobby against government actions to achieve a smoke-free country. I know that they are very clever lobbyists. Although I trust that this Government will resist such lobbying, this would ensure that the cost burden of taxes is not shifted to consumers because a levy alongside a cap on manufacturer pricing would prevent manufacturers passing the costs on to consumers.

Smoking remains the leading cause of preventable death in the UK, alongside obesity caused by poor diet. Investing in the resources raised by the levy to help smokers quit, as in Amendment 194, will support the Government’s ambitions to halve the difference in healthy life expectancy and shift healthcare from treatment to prevention, an ambition outlined strongly in the Government’s 10-year health plan.

These amendments are very much in line with what the Government want. I hope that they will have the courage to accept them. The key principle is that the revenue to tackle the harms of tobacco should come from the industry, not the poor, addicted and often sick consumer, and the cost of the damage caused by tobacco should certainly not come from the taxpayer.

[Earl Howe (Con)]

My Lords, this group of amendments addresses common themes: the regulation of the tobacco industry, its profits and its reporting obligations. Collectively, these raise important questions about transparency, fairness, proportionality and the limits of state intervention.

Beginning with Amendments 12 and 148, tabled by the noble Baronesses, Lady Northover and Lady Walmsley, these concern the provision and publication of information by tobacco manufacturers and importers. We recognise the intent behind these amendments: to improve the quality and availability of data so that public health policy can be better informed. Data, transparency and evidence-based policy-making are essential to an effective tobacco control strategy. However, would these amendments enable us to achieve that? Requiring every manufacturer and importer to publish detailed quarterly sales data broken down by product type, brand and region would give us more information, but how useful would it be? The Department of Health and Social Care and the Office for Health Improvement and Disparities already have access to significant data from HMRC such as market surveys and other reporting systems. The question usefully begged by this amendment is whether there are any gaps in that data that could usefully be filled.

This brings me to Amendment 148, also tabled by the noble Baroness, Lady Northover, which seeks to change Clause 95 so that the Secretary of State “must” rather than “may” make regulations requiring producers and importers to provide information about their products. I would like an answer to my earlier question before I jump one way or the other on that amendment. I appreciate the spirit in which she has tabled it. Having more data would certainly be useful, but we need to know exactly what data before we compel companies across the board to do one thing or another. It is generally better to provide Ministers with flexibility, allowing them to act where there is a clear and proportionate need, without imposing automatic or universal obligations on every business regardless of its size or nature.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Walmsley

Committee stage
Monday 27th October 2025 Grand Committee

[Baroness Walmsley (LD)]

My Lords, we were talking about the issue of one person almost the same age as another person having less freedom of choice. The point is that once you are addicted to nicotine, your freedom of choice is extremely limited, as we have just heard from my noble friend Lady Northover. She gave the example of her nephew, who found it extremely difficult to give up. My late mother-in-law was in the same position. She tried to give up smoking until she died—and she died of smoking, sadly.

It is very important that we have a robust system of enforcement. I look forward to hearing the Minister telling us about it, and what future measures the Government might take to reduce the number of illicit cigarettes—although I am told that it has declined by about 90% since 2000. One or two noble Lords mentioned the case in Australia. The fact is that it was a lack of robust enforcement that caused the problem in Australia. Despite that, the amount of people smoking has indeed gone down—but I agree with noble Lords who say that we need strong enforcement. When it comes to a smoker who, let us say, is my age, or who will be my age in many years’ time, who needs to provide some kind of ID, as long as it is not absolutely mandated, I am sure that some form of ID will be devised by clever people for those aged 82, and it will not be very difficult for them; they will just be able to do it, and that will sort that problem out altogether.

As noble Lords might have gathered, I support the Government’s generational approach to reaching the point of a smoke-free Britain. It is a public health crisis, as is obesity, on which the Government also need to take action. Lots of amendments are coming up about various aspects that have been mentioned today, such as age-gating, which we will discuss in greater detail. This has been a very extensive and passionate debate. I must say that I find myself a little surprised that so many of former Prime Minister Rishi Sunak’s party are so against what the Government are trying to do achieve his ambition. However, I shall leave it at that.

[Earl Howe (Con)]

My Lords, I thank my noble friend Lord Murray for bringing forward the amendments in his name, because he has allowed us to begin this Committee by engaging with one of the central and, dare I say, most controversial pillars of this Bill: the generational smoking ban. It is fitting that we start with this big policy issue, because the clause goes to the very heart of what the Government are seeking to do in creating what they describe as a smoke-free generation.

Before I turn to the points made in the debate, it is worth reminding ourselves of the context in which we are discussing the Bill—and a number of noble Lords have underlined that context. Smoking remains the single biggest entirely preventable cause of illness, disability and death in our country. It kills some 80,000 people each year. It costs our NHS and social care systems more than £3 billion annually. Someone is admitted to hospital because of smoking almost every minute. It shortens lives, it devastates families, and it deepens inequality. Yet, as we debate this issue, we can recognise that, happily, the direction of travel is positive. Smoking rates have been falling: in 1990, nearly one in three adults smoked, but, today, that figure stands at just above one in 10. The number of children who smoke is falling as well.

Those are not arguments for complacency or for not legislating, but nor are they arguments for legislating carelessly. My noble friend Lord Murray asked some pertinent questions for the Minister to answer, in particular on the Windsor Framework and the dangers of a burgeoning illicit market, but, more generally, he was surely right to challenge the Government to explain exactly how the generational ban will operate. I say that he is right, because the proposal will represent a profound shift in how the law treats adults. It will, for the first time, make a permanent legal distinction between two adults, based solely on their dates of birth. One person aged 35, say, will be permitted to buy a legal product, while another person aged 34 will put a tobacconist in criminal jeopardy for selling him precisely the same product.

I emphasise that I pay tribute to my right honourable friend the former Prime Minister. Nevertheless, serious practical questions arise from that distinction, quite apart from the questions around discrimination throughout this Bill, to which we need—I say this to the Minister—to face up. Some of those questions have already been foreshadowed by my noble friends Lord Murray and Lord Moylan but, as a starter, let me pick up the question of enforcement, which came up in the contribution from the noble Lord, Lord Scriven. How exactly do the Government intend these measures to be policed? How much responsibility will fall on shopkeepers, how much on trading standards and how much on the police?

Then there is the impact on retailers. How will small and independent retailers be supported to implement the new age checks and avoid inadvertent breaches of the law? Are we just going to leave them to cope as best as they can? Importantly, there is also the question of public understanding. How will the Government communicate to the public, especially younger adults, that some people of more or less the same age may face entirely different legal restrictions?

Can the Minister confirm one point of detail, which we discussed in our meetings on the Bill ahead of Committee? Will a person born on or after 1 January 2009 be permitted to sell tobacco products to someone born before that date? In other words, will someone who is themselves legally prohibited from purchasing tobacco still be able to serve or sell such products to others who remain entitled to buy them? That may seem a minor question, but it is one of the many practical questions that shopkeepers and retailers are already asking. The answer will affect staffing and hiring practices. What age will an employee of a tobacconist have to be to handle tobacco sales? Those are not arguments against the generational ban, but I hope that the Minister can address these concerns in her reply.

Health and Care Bill

Debate between Earl Howe and Baroness Walmsley

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Walmsley (LD)]

In the case the noble Earl has just mentioned, could not the coroner have obtained the information by another means?

[Earl Howe (Con)]

My Lords, I am afraid I do not know the answer to that. I can, of course, find out and let the noble Baroness know, if those details are available.

I know there have been concerns that inquests can seem to be adversarial, and that protected material passed on to the coroner could be used in them. Inquests are, by definition, designed to be inquisitorial; statute prohibits inquests from determining criminal and civil liability, and interested persons are prevented by the inquest rules from making submissions on the facts. Coroners seek to obtain the objective truth—how and not why someone has died. I submit that not allowing coroners to see relevant safe space material could prevent justice being done and seriously undermine public confidence in the coronial system.

I turn to the important issue of funding, raised by Amendment 123, although I do not know that noble Lords have spoken to that. The noble Lord is shaking his head so, to save time, I will not cover that point.

Finally, let me just say that an independent HSSIB is an excellent concept that has wide support. In my submission, it would be a terrible pity if noble Lords rejected it because of doubts about how well it would work. I believe that it will give patient safety a valuable boost and hope that the House will support it.

Health and Care Bill

Debate between Earl Howe and Baroness Walmsley

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Earl Howe (Con)]

I am grateful to the noble Lord, Lord Crisp, for bringing this debate before the Committee. I have listened to him and other noble Lords with care. Before I turn to the detail, it may be helpful if I explain the reason why Clause 54 is in the Bill.

Clause 54 originated as a legislative proposal made by NHS England and NHS Improvement to the Government in 2019. In making this recommendation, NHS England, under the leadership of the noble Lord, Lord Stevens, worked closely with representatives of the foundation trust sector. The key principle behind this clause is a recognition that the interests of the whole system should be prioritised in decisions about capital spending while also respecting the freedoms and accountabilities of NHS foundation trusts.

The noble Lord, Lord Crisp, asked whether it was our intention that the power in the clause would be a last resort—absolutely yes. Clause 54 is a reserve power to be used only in extreme circumstances to avert the risk of a foundation trust pursuing its own private capital objectives—if I can put it that way—that are not prioritised at a system level. I say to my noble friend Lord Lansley that that is the potential mischief that the clause is trying to address.

The control will operate in the context of the new NHS capital regime, introduced in 2020-21, at ICS area level with planning at a system level to take a holistic view of the local healthcare needs and balancing the allocated operational envelope for providers at that level. Having a power to set capital spending limits for NHS foundation trusts, as can already be done for NHS trusts, ensures an equitable distribution of capital to better enable the investments with highest priority and that achieve the greatest benefits for patients.

At this point I will push back, in the nicest possible way, at the noble Baroness, Lady Walmsley, about the actual level of capital spend. At the spending review 2021, capital spending was set to increase over the Parliament to £32.2 billion for the period from 2022-23 to 2024-25. That includes a £5.9 billion capital investment for the NHS to tackle the backlog of non-emergency procedures and modernise digital technology. As a result, the Department of Health and Social Care’s core capital budget will reach its highest real-terms level since 2010.

[Baroness Walmsley (LD)]

Governments always tell us how much money they have spent, but the question is always: has it met the demand? The money that the Minister has just mentioned is to try to cover the backlog of elective procedures; it does not cover the backlog of repairs.

[Earl Howe (Con)]

There will be money to address the backlog of repairs within that total.

Of course, it is our intention that a capital limit would be imposed by NHS England only if other ways of resolution had been unsuccessful. I will take the Committee through some of the detail, because it is important.

Amendments 188 to 192 would further restrict how the power can be applied. Amendment 188 would modify the clause by inserting “individual trust”. This modification is unnecessary because new Section 42B already ensures that an order relates to a single trust.

Amendment 191 would limit the order to one financial year, but, instead of that, the guidance prepared by NHS England will set out that any capital expenditure limits will apply to individual, named foundation trusts. We envisage that most will apply for the period of budget allocation, which is a single financial year.

Amendment 189 would insert steps that NHS England must take before applying the control and limit when an order may be made. The amendment also links the power with the capital planning function held by ICBs in new Section 14Z54. That plan may not always relate to a single financial year and can be amended in year; for example, for big capital projects, the plan could be set for several years, and in such a scenario it would be difficult to determine whether a foundation trust exceeded the plan in the early years. Amendment 189 would undermine the ability to impose the limit in a timely way and would mean that any limit could realistically be applied only when an overspend had already occurred or was committed to. That would risk funding being unfairly taken away from other areas.

Amendments 190 and 192 contain a requirement to lay a report before Parliament alongside a statutory instrument containing the order. That would cause significant delays in the power’s application. There is already a requirement in the Bill for NHS England to publish any orders which place a capital limit on a foundation trust and for guidance to set out the circumstances in which it is likely to impose a limit. We expect the guidance will also state that representations made by the trust will be published by NHS England.

As I mentioned, it is our strong view, supported by NHS England, that the powers and safeguards in the Bill create a proportionate and fair balance. These measures will ensure that if a foundation trust were actively to pursue capital expenditure that is not aligned with local priorities or affordable within local budgets, there is a means to prevent this as soon as possible.

Health and Care Bill

Debate between Earl Howe and Baroness Walmsley

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I am certainly with the noble Baroness, Lady Finlay, on the issue of outcomes. Like her, I am a member of the All-Party Group on Cancer, and I was right behind our former chairman John Baron’s attempt to get a clear focus on outcomes. I am delighted to see how successful that has been.

My Amendment 8 is very simple. It would prevent the Secretary of State tinkering too often with the mandate. As others have said, the mandate is the primary instrument through which the Secretary of State provides the Government’s direction to the NHS. He is right to do so, since the NHS uses the most enormous amount of our money and is of vital concern to every voter and taxpayer—those whom the Government represent.

However, the NHS is a little like the “QE2” in that it is absolutely enormous and takes quite a while to change direction. Indeed, a great many levers have to be pulled for it to do so. Chief executives, boards and professional staff need time to set new plans, targets and employment policies—to say nothing of moving the money around—to comply, as they must, with changes to these mandatory directions from on high. It is therefore highly undesirable for a Secretary of State to change the mandate too frequently. As the noble Baroness, Lady Thornton, said, even when it happens, adequate notice and reasons must be given.

Other amendments in this group deal with other aspects of the mandate, but I want to be fully assured that, given the difficult tasks we set our NHS, its outline instructions and targets are not unfairly changed too often. I feel justified in having this concern, because the evidence of clauses later in the Bill indicates to me a tendency by the Government to want to meddle where meddling is inappropriate and could have negative effects. I refer, of course, to the Secretary of State’s attempted power grab, which we will discuss later in Committee.

Can the Minister assure me that there is already some effective measure that would prevent the mandate being changed more than once in any financial year, which would make it very difficult for the NHS to comply?

[Earl Howe (Con)]

My Lords, I am glad to be able to respond to these amendments relating, in their several ways, to the NHS England mandate. I will cover each in turn.

I begin with my noble friend Lord Lansley’s Amendment 4. I confess that I am not in the least surprised that he, of all noble Lords, should have reminded us of the key importance of the NHS outcomes framework. Amendment 4 would require the Secretary of State to specify objectives that will help NHS England achieve improvements in the outcomes provided for in the NHS outcomes framework. As he and I remember clearly, the NHS outcomes framework is a set of indicators that provide for national-level accountability for the health outcomes that the NHS delivers. The first version was published in 2010 to inform the first mandate to what was then still known as the NHS Commissioning Board. In essence, it looks at long-term health trends across various domains, including quality of care and patient experience. It is a valuable resource and, as my noble friend knows, remains an important tool for measuring the NHS’s contribution to improving outcomes over the long term.

I quite agree with my noble friend that progress against outcomes is vital. That is why we have included Clause 3 in the Bill. One of the main advantages of a longer-term mandate is that it will allow us to take a longer-term view of progress against outcomes that can be measured meaningfully only across a number of years.

The noble Lord, Lord Patel, asked who will be responsible for improving outcomes. The answer is that NHS England and ICBs have duties in relation to improving the quality of services. I can assure him that we will hold them to account for doing so. Having said that, we are moving now to a system-wide approach. That entails the need to measure shared outcomes across health and the wider social care and public health system. Some of these outcomes are led by the NHS but many are system-wide, so the business of measuring patient and service-user outcomes will inevitably become more sophisticated.

We want to ensure that our system is flexible and able to adapt as those system approaches develop and mature. I hope my noble friend therefore appreciates why we would not want to enshrine the NHS outcomes framework in the mandate in statute, in a way that might limit or compromise our ability to explore broader system approaches as we go forward. However, I seek to reassure him that the NHS outcomes framework will continue to be a vital tool to look at long-term trends in health outcomes and the NHS’s role in supporting health outcomes. That basic role for the NHS outcomes framework will not change.

I fully understand the concern of the noble Baroness, Lady Thornton, in her Amendment 7 that the mandate should not be revised unnecessarily and without good reason. I completely agree with that sentiment; again, it lies behind our desire to look at the mandate over a longer timeframe than has hitherto been possible. My concern is that her amendment goes much further than, I suspect, she intended, because it would prevent the mandate being revised at all in anything other than an urgent or unforeseen situation. That would be unhelpful, because it would wholly prevent planned changes to reflect, for example, evolving strategic priorities, emerging evidence of need or even a planned general election.

The purpose of Clause 3 is to strengthen the role of the mandate by enabling the Government, where appropriate, to set a mandate that can endure, rather than having an annual use-by date. Looking back to our debates on the Health and Social Care Bill in 2011, the noble Baroness will remember that it was always the intention that the Government should set a multiyear mandate, and Parliament agreed. In practice, that intention has been hampered by the inevitability of an annual review of the mandate to a fixed deadline—a deadline that does not neatly align to a number of events and strategic processes, including the Budget, spending reviews and general elections. Clause 3 addresses this. I seek to reassure the noble Baroness that there is no intention to revise mandates unnecessarily at the drop of a hat, as it makes no sense to do so.

I am grateful to the noble Baroness, Lady Walmsley, for highlighting a similar set of issues to those raised by the noble Baroness, Lady Thornton. Her Amendment 8 would prevent the Government revising our mandate for NHS England more than once in the same financial year, for any reason. As I said to the noble Baroness, Lady Thornton, I completely understand her concern that the mandate should not be revised so frequently that NHS England is unable to plan for or deliver government priorities effectively. This is why I reassure her that this will not happen, except in the most exceptional of circumstances. I hope she accepts that reassurance, because it cannot be in the interests of any Government, or of patients and service users, to set a mandate that changes NHS priorities too frequently. I expect any such revisions to be very rare. As I have indicated, though, one can imagine that they may be necessary to respond to unforeseen events, to reflect the result of a general election or to signal future shifts in priorities at a point when the NHS is planning ahead. The Government need the necessary mechanism to deal with these and other similar eventualities.

The noble Baroness will see that Clause 3 already contains an explicit safeguard in respect of reasonableness: NHS England will not be obliged to revisit a business plan that it has already published, should the Government revise the mandate within a year of its issue. The Government will also have a continuing duty to consult NHS England before making any revision. I believe that, in combination, these two safeguards work together to fully answer the point that the noble Baroness made.

Jimmy Savile: NHS Investigations

Debate between Earl Howe and Baroness Walmsley

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

I understand the point made by my noble friend. At the same time, it is clear from the executive summary of Kate Lampard’s report that Stoke Mandeville is by far the most important and salient element of the report and I had hoped that that would have guided readers’ attention towards the section of the report that deals with Stoke Mandeville. Nevertheless, I am sorry that my noble friend has found it necessary to say that and I understand why he has.

[Baroness Walmsley (LD)]

My Lords, the Statement referred to inadequate systems and the need for a culture change. Does the Minister accept that many people are of the view that what we have is inadequate law and not only inadequate systems? I do not know whether my noble friend heard the “Today” programme this morning in which Mr John Humphrys, in interviewing a lawyer acting for one of the many Jimmy Savile victims, was astonished to discover that there is no offence of ignoring knowledge of child abuse that has been reported. Indeed, a majority of the British public think that it is already the law but the Minister knows that it is not.

I welcome the commitment to a public consultation that resulted from an amendment I tabled to the Serious Crime Bill, but several months have passed since that commitment was made by the Government and we still do not know which department will lead the consultation. Will it be the Home Office, the Department of Health or the Department for Education, or will it be a combination? I heard that in another place the Minister undertook that the consultation would be complete and the Government’s response given within 18 months of the Bill becoming an Act. Can the Minister confirm that that undertaking stands and say whether there has been any progress on which department will lead on this consultation?

[Earl Howe]

My Lords, I cannot give a specific undertaking on the timescale that we envisage for the consultation or on any legislation that might ensue from it because that raises the question of whether any legislation is necessary. That is what we want to know from the consultation process. However, I can tell my noble friend that the Home Office will be leading the consultation in conjunction with all the other relevant government departments.

Tobacco: Packaging

Debate between Earl Howe and Baroness Walmsley

Thursday 28th November 2013 Lords Chamber

[Earl Howe]

It most certainly is relevant, which is why we are taking the legislative opportunity in the Children and Families Bill to drive home that very point. My noble friend is right.

[Baroness Walmsley (LD)]

My Lords, I congratulate those in your Lordships’ House on their persistence in keeping this issue before the Government, including my noble friend Lady Tyler of Enfield. I also congratulate the Government on their determination to base policy on evidence. However, if the Government, in the fullness of time, use their regulatory power to introduce standardised packaging, will they keep a watching brief on the tobacco companies? In the past, whatever procedures we have brought in, they have been extremely clever in finding ways round them to lure young people into starting smoking. Therefore, will the Government watch the situation very carefully and try to make sure that the tobacco companies do not get round standardised packaging, thus continuing to attract young people to a habit that will kill them?

[Earl Howe]

My noble friend makes a very important point. She is, of course, right that the tobacco companies protect their commercial position with great vigour. We will indeed keep an exceedingly close eye on the actions of the tobacco industry and, should we decide to introduce regulations, we will do all we can to ensure that they are watertight.

Organ Transplantation

Debate between Earl Howe and Baroness Walmsley

Monday 27th February 2012 Lords Chamber

[Earl Howe]

No, my Lords, and that is part of the problem.

[Baroness Walmsley]

Will the Minister accept that it can be very difficult for doctors to approach a bereaved family to ask about organ donation? I know this from personal experience, because doctors did not approach me when I lost my late husband; I had to raise the matter myself. It is understandable that they do not want to upset the family. However, can it not be even more upsetting for a bereaved family who have not been asked about donation to realise some time later that they have missed the opportunity for their loved one to give life to other people?

[Earl Howe]

My noble friend raises an extremely important set of issues. This was one issue identified by Chris Rudge when he took up the post as National Clinical Director. A great deal of work has been done in the NHS to increase the number of organs available to patients and to have the kinds of conversations with families that are necessary but very delicate. There has been an increase in the number of specialist nurses for organ donation who are of course highly trained in that area, and appointments of clinical leads for organ donation have also helped.

Health: Children and Young People

Debate between Earl Howe and Baroness Walmsley

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, the outcomes framework that I have just referred to should assist in the latter regard. I think the noble Baroness would agree that the system we have at the moment is not sufficiently joined-up, and in that sense does not adequately serve the needs of children. The approach we have taken to the proposed NHS reforms is to promote the importance of the integration of care and service provision for everyone, including children. We believe that strong partnerships at a local level, supported by professionals and local leaders, are the way forward, not top-down direction. The health and well-being board provides the forum for repositioning the joint strategic needs assessment into a truly joined-up strategy for local people.

[Baroness Walmsley]

I welcome what my noble friend the Minister has said about getting the views of children, but does he think that giving the commissioning of the excellent Healthy Child programme to local authorities is going to bring about the universal dissemination and delivery of that programme?

[Earl Howe]

The role of local authorities will be pivotal in this because it is at local-authority level that public health, social care, and indeed the discussions that will go on in the health and well-being board context will bring together policy in a way that informs NHS commissioning. I think that the approach we have taken has been widely welcomed, and we are absolutely determined that all sectors of society, including children, are included in these processes.