Chagos Islands

Debate between Earl Howe and Baroness Whitaker

Thursday 17th November 2016 Lords Chamber

[Earl Howe]

My Lords, it is important to understand that security was not the only consideration that governed the decision that has been made. There are no restrictions on applications by Chagossians to be employed on Diego Garcia. The United States has said that it is committed to hiring qualified candidates as positions become available. Indeed, the contractor is required to recruit people from Mauritius and the Seychelles, provided they meet the necessary requirements. We are aware that some Chagossians have been offered positions working for the US contractor on Diego Garcia over the past two years, but these were declined because of local conditions, which are pretty basic, and the rates of pay.

[Baroness Whitaker (Lab)]

Members of the all-party group, of which I am one, are extremely grateful to all three Ministers for appearing at our meeting yesterday. However, we remain very surprised at the intemperate haste with which the Statement was rushed out before the meeting, when it had been planned for the end of the year. Bearing in mind that respected analysts have estimated that the cost of resettlement would be about £20 million—half of what the Government propose in the Statement for additional compensation—what conditions will Her Majesty’s Government now consider attaching to the renewal of the agreement with the Americans over the base, in the interests of justice and international human rights law?

[Earl Howe]

My Lords, I can only say that we very much regret that the timing of the meeting with the all-party group coincided with the Government’s decision. It would have been improper to have come to that meeting pretending that no decision had been made when in fact it had. As the noble Baroness knows, attempts were made to have the meeting earlier than yesterday, but that did not fit one or both sides.

As regards the costs of resettlement, they were set out with a big health warning by KPMG which said that the costs could vary by up to 50% more than it had estimated. I am aware that the noble Baroness has submitted a paper to my noble friend Lord Bates, and he will be writing to her in response as soon as possible.

NHS: Accident and Emergency Services

Debate between Earl Howe and Baroness Whitaker

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend. The planning assumptions made in north-west London, which is the subject of the Question, are a good example of that, where Transport for London is co-operating actively by producing some sophisticated analysis not only of ambulance transport times but of bus and car journey times to make sure that nobody loses out in any reconfiguration.

[Baroness Whitaker]

My Lords, in the noble Earl’s answer to my noble friend Lord Harris, I did not hear an answer to any of his questions about numbers, who makes the decision and who is accountable. Would it be possible to hear that?

[Earl Howe]

My Lords, I apologise. The Question on the Order Paper relates to north-west London, so I do not have pan-London figures in front of me. The answer to the question is as I gave it in my initial response: those decisions are subject to local determination. That is right, because it is only local commissioners and providers who can assess the situation on the ground properly. As the noble Baroness will be aware, there is a system for escalating decisions—ultimately to the Secretary of State, if necessary, who takes advice from the Independent Reconfiguration Panel in the most extreme cases—but normally, we hope and expect those decisions to be resolved on the ground in the local area.

Health and Social Care Bill

Debate between Earl Howe and Baroness Whitaker

Thursday 8th March 2012 Lords Chamber

[Baroness Whitaker]

I am sorry to interrupt the noble Earl, but before he moves off our amendments, I did not actually hear the words “education services” in his helpful remarks. Could he explain how they will come in?

[Earl Howe]

I was going to come on to that in replying to the noble Earl, Lord Listowel. If the noble Baroness will bear with me, I hope that I will cover the point.

Amendment 238A would require local authorities and CCGs to specifically consult relevant health professionals when preparing the JSNA. As I have said before, in preparing the JSNA and joint strategy, local authorities and CCGs will be under a duty, which the health and well-being boards will discharge, to involve people who live or work in the area. In practice this could well include health professionals. Indeed, I thought that the noble Baroness, Lady Finlay, made a powerful point in this regard, and I do feel that we are broadly accepting the spirit of the amendment.

In relation to Amendment 238AZA in the name of the noble Baroness, Lady Massey, and the noble Earl, Lord Listowel, I should like to reassure both of them that the health and well-being strategy will be a shared, overarching response addressing the health and social care needs of an area identified through the JSNA. In the joint strategy, the board will be able to consider how the commissioning of wider health-related services could be more closely integrated with health and social care commissioning. For example, the board could consider whether and how housing, education or local authority leisure services could affect health and, if they do, how commissioning could be more closely integrated with the commissioning of health and social care services. The model we have chosen for health and well-being boards is designed to enable those wider conversations to take place, and in answer specifically to the noble Earl, Lord Listowel, I genuinely believe that the arrangements in the Bill afford a much better chance of us having joined-up thinking and joined-up services than we have had before. Clinical commissioners will be best placed to work in the interests of children, especially when this requires working with other professionals. There are strong duties on commissioners as to promoting integration, as the noble Earl will be aware.

On Amendment 238H, in the name of the noble Lord, Lord Beecham, we believe that health and well-being boards will provide an opportunity to build strong relationships with an open culture of peer-to-peer challenge. The JSNA and joint strategy will provide all members with a common understanding of local needs and priorities. However, giving boards a power of veto over commissioning plans would undoubtedly undermine that relationship. I am afraid that we are firmly against that idea.

We are in agreement on that matter with the Future Forum and the Local Government Association, both of which recognise that placing a duty on CCGs to agree commissioning plans with the health and well-being boards would confuse lines of accountability and be unworkable—confusing and unworkable were the words of the Future Forum. CCGs are ultimately responsible for their budgets and to give the health and well-being boards the right to make decisions that might incur costs for commissioners without taking responsibility for expenditure would be wrong.

I hope that I have been able to reassure noble Lords adequately—although I know that I will not have reassured the noble Lord, Lord Beecham—and they feel able not to press their amendments.

Finally, I should like to speak to the government amendment in this group, Amendment 239, which is a minor technical amendment in relation to Clause 195. The purpose of this amendment is to clarify that a local authority may delegate any functions exercisable by it to the health and well-being board. I hope that it will receive the support of the House.

Health and Social Care Bill

Debate between Earl Howe and Baroness Whitaker

Wednesday 16th November 2011 Lords Chamber

[Earl Howe]

My Lords, noble Lords who tabled amendments in this group have drawn attention to the particular needs of children. I am in total sympathy with their wish to highlight the importance of children's health in all its facets. The noble Baroness, Lady Wilkins, mentioned Sir Ian Kennedy's report, Getting it Right for Children and Young People, published last year. Sir Ian emphasised that the NHS does not always get everything right for children. He gave us some hard-hitting messages. I say again what I said in my letter after Second Reading: we are determined to build in children's health explicitly and clearly throughout the new system. The NHS reforms are designed to put firm foundations in place to secure improvements, and the Health and Social Care Bill contains sufficient levers to ensure that the new NHS will work better for children.

I thank the noble Lord, Lord Ramsbotham, for his very compelling contributions today and at Second Reading, when he raised questions on speech and language therapy. I commend his work as chair of the All Party Parliamentary Group on Speech and Language Difficulties. I also thank the noble Baroness, Lady Wilkins, for her extremely constructive remarks. I share the commitment of the noble Baroness and the noble Lord to ensuring the early identification of speech, language and communication needs among pre-school children. What can we do about this? One thing that we can do and are committed to doing is beefing up community health resources targeted at the well-being of children and families. In that context, I reassure noble Lords who spoke to these amendments that we are committed to increasing the health visitor workforce by 4,200 by 2015.

We are equally committed to improved delivery of the healthy child programme, which includes a development review at the age of two to two-and-a-half. That provides a huge opportunity, and we are clear that it has to be seized. Everything that has been said by noble Lords about child development in the early years is absolutely to the point. The noble Baroness, Lady Armstrong, rightly referred to the family nurse partnership programme, which has done a tremendous amount, as she explained to us, to address the needs of what were traditionally considered hard-to-reach families.

In his absence, I would also like to thank the noble Lord, Lord Northbourne, for his earlier remarks. I will take the opportunity to address his specific concerns. The Bill as drafted would already allow the Secretary of State or local authorities to provide services to parents or prospective parents where that was a step whose primary purpose was improving health. We recognise that the health and well-being of women before, during and after pregnancy is a critical factor in giving children a healthy start in life and laying the groundwork for good health and well-being in later life.

How can we do this better? The Health and Social Care Bill will, we believe, provide the basis for better collaboration and partnership working across local government and the NHS at all levels. The drivers of the integration in the NHS will be the CCGs and the NHS Commissioning Board. Both have new duties to promote integrated working by taking specific action where beneficial to patients. In addition, the Bill gives each health and well-being board a duty to encourage integrated working between health and care commissioners to advance the health and well-being of the people in its area. That would include children and young people.

The key NHS and public health contributions to speech, language and communication needs are these: first, early identification of pregnant women who may themselves have had the same kinds of difficulties and who would benefit from enhanced support in preparation for parenthood; secondly, building the capacity of universal services working with young children to provide the support required in the early stages, enabling speech and language therapists to focus their support where it is most needed; thirdly, early identification of children with speech, language and communication needs, where enhanced health visitor capacity and better delivery of early years reviews at the age of two to two-and-a-half will be a focus; fourthly, local planning and commissioning for speech and language therapy services through clinical commissioning groups; and, fifthly, consideration of how high-cost and low-volume provision should be commissioned in the new system.

The Government are also committed to tackling obesity and to the continuation of the national child measurement programme. Now in its seventh year, this is a trusted source of world-class data, providing annual information on levels of overweight and obesity in primary school children in their reception year and in year 6. The government amendments in this group amend the powers of the Secretary of State in paragraph 7B of Schedule 1 to the NHS Act 2006 so that he can make regulations about the processing of the full data set of information relevant to this programme. This would include both information resulting directly from the weighing and measuring activity and other relevant data held by local authorities. The amendments also ensure that he can require persons exercising functions in relation to the programme to have regard to guidance about the processing of that information. Our proposals aim to ensure that this important programme can continue to operate in full effect once it transitions to local authorities, along with other public health functions, from April 2013. I hope that the Committee will support the amendments.

I have discussed the vital importance of a focus on children’s needs throughout the NHS, but in our view it would not be appropriate to anticipate priorities in future mandates by enshrining in legislation the inclusion of objectives relating to particular sections of the population—a point I made earlier to the noble Lord, Lord Northbourne, while he was in his place—nor would it be appropriate to impose requirements on CCGs to exercise their functions with reference to specific patient groups or treatments. What you do not emphasise, you can serve to downplay.

CCGs are already under a duty to exercise their functions with a view to procuring that health services are provided in an integrated way for all patients where they consider this will improve the quality of health services and outcomes and reduce inequalities in outcomes and access. The duty also applies in relation to the integration of health services with the provision of health-related and social care services. Where education and children’s services are health or social care-related, they would therefore already be covered by this duty.

The noble Baroness, Lady Wilkins, and the noble Lord, Lord Ramsbotham, tabled a series of amendments concerning the role of health and well-being boards. I fully support the need to ensure the effective assessment of need and access to professional advice on education and children’s services. However, although extremely well intentioned, the amendments are unnecessary and also run counter to the principle of local areas being best placed to assess local need and to access appropriate local expertise. I hope that noble Lords will not press those amendments.

On Amendment 91A, on our second day in Committee we discussed a group of amendments on the topic of integration. There were numerous extremely valuable contributions from many noble Lords that ensured that we had a very informative debate. However, it may be helpful to the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Wilkins, if I briefly mention that the requirement the Bill places on the board and the clinical commissioning groups to promote integration when commissioning services is very germane in this context. Clauses 20 and 23 contain new Sections 13M and 14Y which create duties for national and local commissioners to promote integration across health and social care. I am thoroughly supportive of the intention behind this amendment. Better integration of services will undoubtedly lead to high quality and better care for patients, and that is why we have asked the NHS Future Forum to consider in more detail how we can ensure that our reforms lead to better integrated services. I am very much looking forward to receiving its recommendations which will be published before the end of the year. I hope that the noble Lord and the noble Baroness will feel reassured by that.

I think the tenor of the question from the noble Baroness, Lady Thornton, was about whether all children’s public health services should be commissioned at a local level from the outset in 2013 to avoid fragmenting the delivery of programmes and care pathways. We believe that the commitment to secure a 50 per cent increase in the number of health visitors and thereby ensure associated improvements in support for families is best achieved through NHS commissioning, and we have therefore retained our original proposal that the NHS Commissioning Board should lead commissioning in this area in the short term. However, we wish to engage further on the detail of the proposals, particularly in respect of transition arrangements and the best way to begin to involve local authorities in local commissioning of these services in partnership with the NHS.

The noble Baroness also referred to the important issue of safeguarding children. Local authorities will continue to lead on safeguarding children arrangements under the Children Act 2004. The board and CCGs will be members of local safeguarding children boards. I have already spoken about the national child measurement programme, and I hope that I covered the noble Baroness’s questions adequately on that topic.

The noble Baroness asked why the government amendment allowed any other information to be prescribed. The amendment will maintain the Secretary of State’s powers to regulate the processing of child measurement data after local authorities undertake the measurement programme, in the same way that PCTs currently deliver the programme. It would not be appropriate to set out the full national child measurement programme data set in primary legislation, as she will understand. The power also gives flexibility to make changes to the data collection that will be needed going forward, and that will allow the Government to ensure that the national child measurement programme remains fit for purpose. Of course, the introduction of any new data would need to be set out in regulations, subject to public consultation and the negative parliamentary procedure.

I hope that that covers the ground adequately. Once again, I thank noble Lords for their contributions. I can now see that the noble Baroness, Lady Whitaker, wishes to ask me a question.

[Baroness Whitaker]

It is the same question. In the noble Earl’s very comprehensive answer, did I miss whether speech, language and communication problems were within public health? I do not recall hearing him answer that question.

[Baroness Thornton]

While the noble Earl is collecting questions that we feel were not answered, I asked specifically about the risk register, whether it is 100 per cent of children and where the weighing and measuring is taking place.