Elections Bill

Debate between Earl Howe and Lord Dubs

Lords Hansard - Part 1 & Committee stage
Monday 28th March 2022 Lords Chamber

[Earl Howe (Con)]

I think the point made by the noble Lord, Lord Redesdale, was that a distinction must be made on the register between different types of election, and that that carries a cost; he can correct me if I am wrong in assuming that.

This House is a respected voice that adds depth and, I hope, wisdom to our legislative process. It allows us, as its Members, full participation in the life of the nation. The Government therefore have considerable reservations about this proposed new clause, and I ask the noble Lord, Lord Dubs, to withdraw his amendment.

[Lord Dubs (Lab)]

My Lords, I never thought that so many different sorts of opinions would come out of the woodwork. It has been absolutely fascinating. The arguments have been somewhat different from the last two or three times we debated this issue. I just want to comment on them briefly.

As regards the voting list—this is a technical point—my understand is that there is no obvious way in which when we register we can declare that we are Members of this House. Somehow, in some local authorities, the polling clerks are aware of it but, in others, they are not. I am always mystified by that; it is not clear. I have known of people who have not been debarred from voting and could have gone to vote—they did not do so but they could have—simply because it was not obvious to the polling clerks that they were Members of this House.

On my noble friend Lady Quin’s comment about Members of Parliament, again, it is purely a technicality that they cease to be Members of Parliament during the period of an election campaign. Nobody knows about it except for a few nerds like us—sorry, nerds like me. It just means that they are technically not MPs. However, for all practical purposes, of course they are; they still get representations made to them, constituency casework and so on. Even during the election campaign, they cannot just say, “No, I’m not prepared to do it.”

United Kingdom–European Union Parliamentary Partnership Assembly

Debate between Earl Howe and Lord Dubs

Monday 12th July 2021 Lords Chamber

[Earl Howe (Con)]

My Lords, I thank the noble Earl for his work on behalf of the House in his capacity as chair of your Lordships’ European Affairs Select Committee. He makes a very good point, and one thinks of other parliamentary assemblies that are perhaps analogous in some respects, such as the Parliamentary Assembly of the Council of Europe, the NATO Parliamentary Assembly and that of the OSCE, although their respective functions are of course different and distinct.

[Lord Dubs (Lab) [V]]

My Lords, I hope that I am mistaken in detecting a lack of enthusiasm on the Minister’s part, uncharacteristic of him as that is. Does he agree that, in addition to the bodies that he mentioned, the British-Irish Parliamentary Assembly might represent a good working model for the proposal of an EU parliamentary partnership assembly? Does he agree that it has the following characteristics: it has both Houses, it has all nations and regions and it is resourced by the UK Parliament? Could we make some progress on this, please?

[Earl Howe (Con)]

My Lords, the noble Lord may be aware that, in the intercameral discussions, the interests of your Lordships’ House are being represented by the noble Earl, Lord Kinnoull. I feel sure that he will have heard the recommendations of the noble Lord, Lord Dubs, in this debate.

Child Refugee Resettlement

Debate between Earl Howe and Lord Dubs

Tuesday 10th May 2016 Lords Chamber

[Earl Howe]

It is not a question of the smallest number we can get away with. I hope that I have indicated that we are pursuing this amendment in its proper spirit. We have always been clear that we share the objective of identifying and protecting vulnerable refugee children wherever they are—our efforts to date have been designed to do just that—and we have heard many times about the measures that the Government have taken, particularly in the Middle East.

However, we were very clear that setting an arbitrary target, particularly one as high as 3,000, was the wrong approach. We cannot simply wade in and select some children whom we think would be better off in the UK, especially when some local authorities already care for very high numbers of unaccompanied asylum-seeking children—which in some cases is stretching services to breaking point. That is why we believe that the approach of the noble Lord, Lord Dubs, is the right one. We have to consult with local authorities before we can determine the number that we can accommodate, and we must observe the best-interests principle as well.

[Lord Dubs (Lab)]

My Lords, I very much appreciate the way in which the Home Secretary, the Immigration Minister and Home Office officials have put me in the picture throughout this process. It was gratifying, not in a triumphalist sense, to see the Home Secretary’s name on the amendment in the Commons yesterday evening.

The Minister put his finger on the right phrase—that the Government intend to accept not only the letter but the spirit of the amendment. I will plead only that, given that we now have officials working with the French authorities, it might be possible to speed up the process of identifying children in Calais who have relatives in Britain and to help them to get to Britain in time for the school term in September. Surely that would be the right thing to do. The Minister cannot make a promise but I hope that he will accept the spirit of what I am saying and that the Government will do their best accordingly.

[Earl Howe]

I can give the noble Lord that assurance. Clearly it would be desirable to ensure that those children who are most vulnerable and in need of help and support can arrive in this country in time for the school year, but he will understand that at this stage of the exercise I cannot give firm undertakings to that effect. All I can do is to say that we will use our best endeavours in that direction.

Immigration Bill

Debate between Earl Howe and Lord Dubs

Tuesday 26th April 2016 Lords Chamber

[Earl Howe]

I do not agree with the noble Baroness, because of the risks that I have already outlined. If we were to go down the path that she advocates, we would put children at additional risk. We cannot possibly do that. We are currently reviewing our family reunion guidance to make clear the sorts of cases that might benefit from a visa outside the rules and will publish that in May.

We have all seen squalid conditions in Calais. That is precisely why we are working closely with the French authorities to see to it that vulnerable children are protected. We are working with the relevant NGOs to ensure that the message that children receive is that it is possible to be transferred to the UK under the Dublin arrangement both from Calais and from social care. I would just say that that can happen in a matter of weeks; it is not a slow process.

Effective communication is of course key. We agree that more can be done to ensure that children are able to access the support they need. The UNHCR already has access to the camps and accommodation centres to inform migrants on the different options of applying for asylum in France and family reunification for those who may have family members in the European Union. That is in addition to the joint UK-France communication campaign in the camps, which informs migrants of their rights to claim asylum in France and gives them information on family reunification.

However, the best way to communicate that is to demonstrate that the system works, and that is what we are already doing. How? One example is our recent secondment of a senior asylum expert to the French Interior Ministry to improve the process for family cases. That has already resulted in a significant increase in the number of children being reunited with family in the UK. In the past six weeks, 50 cases have been formally referred to the UK under Dublin family unity provisions, of which 30 have been accepted for transfer to the UK from France, the majority of whom have already arrived in the UK. Once an asylum claim has been lodged in another member state, we have shown that transfers can take place within weeks.

I think that these results are encouraging, and we are determined to replicate the work of the senior asylum expert in Calais in both Greece and Italy. We are committed to ensuring that the Dublin process works, so that will be in addition to the secondments that we have already agreed and have taken place in both Greece and Italy. We expect to second a further individual to both the Greek and the Italian Dublin units in May.

I have spoken at some length to demonstrate that the Government are committed to making a full contribution to the global refugee crisis—in particular, helping children at risk. The significant aid package within Europe and our practical assistance to front-line member states to ensure that vulnerable children are properly protected where they are in Europe is the correct approach. It is about the children’s best interests. I strongly believe that our drive to resettle children at risk and their families directly from the region will have most impact to safeguard vulnerable children. That is why I am asking the House not to agree to proposed Amendment 87B in lieu.

[Lord Dubs]

My Lords, of course I welcome what the Government are doing in the region. It is good, and no one has criticised it—except possibly for the small numbers, but that is for another day. However, when all is said and done, the Government will still leave thousands of children in Europe: children who are vulnerable, children who are in an unhappy situation, children who are in danger possibly even to their lives and certainly to their well-being. That will not alter, or only at the margin, if the Government have their way. What the original amendment said, and what I hope the spirit of the new one says, is that we will take our share of the responsibility for unaccompanied child refugees—no more, no less. We will play our part along with other countries. That is the way we should move forward. I beg to test the opinion of the House.

Health: Mental Health

Debate between Earl Howe and Lord Dubs

Tuesday 28th October 2014 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what steps they are taking to reduce delays in the provision of mental health treatment.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

Access and waiting times for people with mental health problems are a priority for this Government. We are committed to ensuring that access to services and waiting times are on a par with physical health. That is why we have put in place the first national waiting times standards in mental health.

[Lord Dubs (Lab)]

My Lords, will the Minister confirm that according to the widely respected Health Service Journal in April this year there were some 3,640 fewer nurses and some 213 fewer doctors working in mental health than two years ago? Surely it is unrealistic—not to say verging on the dishonest—to talk about the Government putting in place controls on access and waiting times when there is no prospect of achieving them.

[Earl Howe]

If the noble Lord looks across the piece at the workforce statistics he will perhaps be more reassured than he is at the moment. The £400 million that we are putting into talking therapies, for example, will result in a workforce of 6,000 practitioners trained to deliver IAPT. Health Education England has increased the number of mental health nursing training places by 1.5%. In delivering a multidisciplinary workforce, the aim is to have skills that are transferable between different care settings. NICE will be publishing its authoritative guideline on safe staffing. We have already mandated NHS organisations to publish ward-level nursing with midwifery care staffing levels so that there is an incentive for them to make sure that they have their staffing levels right.

NHS: Hospital Waiting Times

Debate between Earl Howe and Lord Dubs

Thursday 10th July 2014 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what action they are taking to reduce hospital waiting times.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, hospital waiting times are low and stable, but there are pressures from a growing and ageing population, and some patients are not receiving their treatment as soon as we would like. NHS England, the NHS Trust Development Authority and Monitor are working with the most challenged providers and commissioners. Operational resilience guidance, published in June, will help the system prepare for winter and improve waiting times sustainably for emergency and elective care.

[Lord Dubs (Lab)]

My Lords, that is a very impressive Answer. The Prime Minister said some time ago that the test will be to get NHS waiting times down. Judged by that test, will the Minister comment on this morning’s statistics from NHS England which showed that over the past year the number of patients waiting six months or longer for treatment has gone up by 20%? Does that not show that the Prime Minister has failed his own test?

[Earl Howe]

My Lords, I do not believe that that is a fair comment. In the past four years, since the Government came to office, we have substantially reduced the numbers of patients waiting longer than 18, 26 and 52 weeks to start treatment. Those numbers are lower than at any time under the previous Government. However, we need to address the build-up in patients waiting and, as a result, we are directing extra support and money for hospitals to do more than 100,000 additional operations over the next few months to meet the extra demand.

Health: Multiple Sclerosis Nurses

Debate between Earl Howe and Lord Dubs

Wednesday 5th March 2014 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what plans they have to ensure that all persons with multiple sclerosis have access to a multiple sclerosis nurse.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

It is the responsibility of commissioners and local providers to ensure that services have the staff they need to deliver high-quality care for people with multiple sclerosis. Listening to and learning from patients to improve care is a top priority for the Government. We are committed to putting patients at the centre of services. Commissioners are under a legal duty to involve patients and the public in the commissioning of services.

[Lord Dubs (Lab)]

My Lords, that is a bit disappointing. Does the Minister agree that MS nurses provide an invaluable service for patients as regards treatment, advice and access to services? Does he further agree that MS nurses can save costs elsewhere in the health service because they can reduce the pressure on GPs and on hospital admissions? Would it not be sensible for the Minister to say positively, “We need to ensure that every patient with MS should have an MS nurse to provide help and support”?

[Earl Howe]

My Lords, I agree with the noble Lord, Lord Dubs; there is no doubt that MS specialist nurses provide support that is extremely valuable for MS patients and their carers. They help to manage relapses and give advice, they act as a gateway into counselling and physiotherapy, and they help to minimise hospital admissions and reduce the need for consultant appointments. I do not disagree with the noble Lord at all. However, it is worth reminding ourselves that NICE guidelines on multiple sclerosis set out that after diagnosis, patients should be,

“put in touch with … a skilled nurse or other support worker”.

We expect those who work in the NHS to take account of NICE guidance.

Care Bill [HL]

Debate between Earl Howe and Lord Dubs

Monday 29th July 2013 Lords Chamber

[Lord Dubs]

I am grateful to the Minister. What he says is very interesting but will the review be completed before the Bill completes its passage or will we have to look at it after the Bill has gone through?

[Earl Howe]

Certainly, I anticipate that the results of the review will be available before the Bill has concluded its passage through Parliament. I stand to be corrected on that but I think I am right. In any case, changes to the way in which complaints are handled can be made through regulations under existing legislation, so I think that provides the necessary flexibility.

[Earl Howe]

That might prove helpful but I will take advice on it. We do not want to duplicate powers that already exist in legislation. However, if we decide that changes are needed, we need to make sure that they can be expedited properly. I am advised that the consultation will close in October this year and that the review of complaints arrangements, of which the consultation is a part, will conclude in the winter. Therefore, if changes need to be made to the Bill, they will need to be made in another place.

The noble Lord, Lord Dubs, said that in our response to the Joint Committee it is vital to consider redress. Of course, the principle of that is not in dispute. Our review of complaints arrangements is in line with our response to the Joint Committee’s recommendation, as I hope he acknowledges. In answer to the noble Lord, Lord Warner, I agree with him that there are likely to be teething problems as this system is established. That is precisely why we felt the need to review the current system. We will aim to ensure that any new mechanisms are in place before implementing the new system, as I have already indicated.

With that, I hope that I have provided at least some reassurance to noble Lords opposite that we take this issue seriously. We understand the concerns that have prompted this amendment and will certainly give further consideration to the noble Lord’s idea of a tribunal system in the light of the outcome of the consultation. I hope therefore that for the time being he will feel content to withdraw his amendment.

[Lord Dubs]

I am grateful to the Minister and I am interested in what he has to say. First, I thank my noble friends who have contributed to the debate and for the useful suggestions that they made, some of which, however, have been overtaken by what the Minister has said. My noble friend Lord Hunt talked about a simple, low-cost appeals system. That is very much in line with what the Minister said. The only issue is what chance we have to discuss further the outcome of the review and the Government’s further proposals.

I think the Minister said that either it will be possible in the Commons to consider any proposals the Government put forward as a result of their review; alternatively, it may be done by order, in which case we would all have a chance to look at it. In any case, that takes us quite a lot further. I am grateful to the Minister for what he has said and I beg leave to withdraw the amendment.

NHS: Accident and Emergency Services

Debate between Earl Howe and Lord Dubs

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

Not for the first time, the noble Lord hits on an extremely important aspect of the problem that we are facing. It is the frail elderly who often turn up at A&E with a crisis in their health when that crisis could have been averted. That is why Sir Bruce Keogh has been tasked to look across the piece at the whole system to see how we can ensure that the frail elderly in particular are served better by the health service, not least to prevent the exacerbation of long-term conditions.

[Lord Dubs]

The Minister has suggested that the problems of A&E are going to get worse in future. How will the Government’s attempt to tackle those problems be helped by the closure of A&E departments in many parts of the country? In particular, how will they be helped in west London with the impending closure of A&E departments at Hammersmith and Charing Cross hospitals?

[Earl Howe]

As the noble Lord will be aware, the latter issue is currently being scrutinised by the Independent Reconfiguration Panel, so it would be wrong of me to comment on that. On the question of reconfigurations generally, we are clear that this is a matter for local decisions by doctors, nurses and all those with a stake in the system. It is not for Ministers to issue edicts from the top. We are clear that any reconfiguration of A&E services has to take into account the capacity of the system to absorb any closures of A&E and the capacity of community services to step in where that is appropriate.

NHS: West London Hospitals

Debate between Earl Howe and Lord Dubs

Thursday 28th February 2013 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what are their plans for the future of hospitals in west London, especially accident and emergency departments.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the reconfiguration of front-line health services is a matter for the local NHS. Any decisions regarding changes to services are taken locally and are subject to the four tests for service change. On 19 February, the NHS North West London Joint Committee of Primary Care Trusts decided to proceed with a “Shaping a Healthier Future” service reconfiguration programme in north-west London.

[Lord Dubs]

My Lords, will the Minister confirm that A&E waiting times are increasing in the areas covered by the four hospitals even before the closures have taken place? There is enormous local concern about a plan to, as it were, reduce services in a series of hospitals more savagely than anything else in the history of the NHS. In particular, the plan includes the proposed demolition of Charing Cross Hospital and its replacement by a handful of beds. Is it not the case that the Minister or the Secretary of State has the final decision and that it is quite possible for the Secretary of State to say, “No, I do not accept this. Think again.”?

[Earl Howe]

My Lords, we believe very firmly as a general principle that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements through the health and well-being boards. To answer the noble Lord’s question, it is entirely possible for a reconfiguration decision to be referred upwards to the Secretary of State by the overview and scrutiny committee of a local authority, and in that event it is customary practice for the Secretary of State to receive independent advice from the independent reconfiguration panel. However, we have not reached that stage yet. We have agreement locally as to what these arrangements should look like and I think that we should wait to see how the plans develop.

--- Later in debate ---

[Earl Howe]

I agree with the noble Baroness that this is most certainly a factor. In the case of north-west London, an independent equalities impact assessment was undertaken to check how the proposed options would affect all strata of local population under the Equality Act in particular. The assessment found that the impact on travel times by car, and indeed by blue light ambulance, would be minimal under all three of the options that were being looked at. The point that I am making is that in any context, it is important to factor in the effect on travel for all patients likely to be affected.

[Lord Dubs]

My Lords, I am shocked that the use of the word “reconfiguration” by the Government has brought into the English language an alternative to “cuts”. Will the Minister not accept that what is being proposed in the four hospitals in the north-west London region are savage cuts which will damage services for local people? That is the bottom line.

[Earl Howe]

No, I do not accept that at all. A reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services that are closer to home and, most importantly, save lives. It is not about saving money.

NHS: Walk-in Centres

Debate between Earl Howe and Lord Dubs

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

My Lords, the noble Lord raises an important point. I am aware that in certain parts of the country there is considerable concern about the length of time that patients sometimes need to wait for a GP appointment. However, that is not the case all over the country. We expect GP practices to configure themselves so as to ensure that the waiting time is kept to a minimum. It is an area on which we are working closely with the profession to resolve.

[Lord Dubs]

My Lords, does the Minister agree that it would be a good idea if more GP practices were open on Saturdays?

[Earl Howe]

In many areas that is an entirely valid observation. Commissioners are saying to GP practices that they expect them to respond to the needs of their local patient populations. If Saturday opening makes sense in that context, they should seriously consider it.

Health: Multiple Sclerosis

Debate between Earl Howe and Lord Dubs

Tuesday 7th June 2011 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government how many multiple sclerosis nurses there are in England and Wales, and what proportion of people with multiple sclerosis do not have access to a specialist nurse.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the information requested is not collected centrally. In England, it is the responsibility of local health bodies to make decisions on the number of multiple sclerosis nurse posts and for local providers to ensure that they have a workforce skilled to deliver these services.

[Lord Dubs]

Does the Minister agree that the majority of patients suffering from MS do not have access to an MS nurse and that the absence of an MS nurse makes it very hard for patients to live independently? Does he further agree that the absence of an MS nurse puts enormously more pressure on consultants and GPs?

[Earl Howe]

My Lords, the Government recognise the very valuable contribution made by nurse specialists. It remains our view that local providers should have the freedom to determine their own workforce based on clinical need as they assess it. The commissioning consortia that will be in place subject to the passage of the Health and Social Care Bill and led by clinicians will recognise that nurse specialists have an essential role in improving outcomes and experiences for patients. That is part of the key to ensuring that these valuable posts remain in place.

NHS Reform

Debate between Earl Howe and Lord Dubs

Monday 4th April 2011 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government why they have reorganised primary care trusts with effect from April; and how that relates to the further reorganisation proposed in the Health and Social Care Bill.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the NHS operating framework 2011-12 set out that, to retain effective management capacity in all PCTs until their abolition in 2013, subject to parliamentary approval, PCTs should form clusters managed by single executive teams. This clustering arrangement will support PCTs in preparing for and transitioning functions to GP consortia.

[Lord Dubs]

My Lords, does the Minister not agree that too much reorganisation is more than the health service can stand? What on earth is the point of abolishing PCTs and re-establishing them in clusters two years before they are going to be abolished? It makes no sense at all unless the Government are going to change their mind about the main legislation.

[Earl Howe]

My Lords, when we went out to consultation on the White Paper last summer, concerns were raised that the transition could lead to too much disruption and a decline in the quality of services, as well as a loss of accountability, so the department decided to expand the approach to managed consolidation of PCT capacity and establish the clusters nationwide. That has been done already in London and the north-east and will pave the way for the NHS commissioning board to develop its roles. It will maintain accountability and grip during 2011-12 and the subsequent year, once strategic health authorities have been abolished. We are using existing legislative powers and it will help to oversee delivery in the coming two years.

Health: Multiple Sclerosis

Debate between Earl Howe and Lord Dubs

Wednesday 2nd February 2011 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. There are two drugs, Cladribin and Fingolimod, which are oral treatments but they have not yet received licences. The trial results for Fingolimod are promising, but it is premature to say that the treatment will remove the need for the drugs in the risk-sharing scheme. Clearly, oral treatments are likely to have advantages over alternative treatments given by injection or infusion, but some concern has been expressed about possible side-effects and the likely cost to the NHS.

[Lord Dubs]

My Lords, does the Minister agree that many patients who are on those drugs also need the support of MS nurses, of which there are very few? Indeed, in some parts of the country there are none at all. What can be done about that?

[Earl Howe]

In recent years the number of specialist MS nurses has increased—I understand that the number has almost doubled—partly as a result of the risk-sharing scheme introduced in 2002. However, we hear anecdotal reports that the numbers are dwindling, which is a matter of concern. Under the new NHS architecture, which will be characterised by clinically-led commissioning responding to the health needs of the local area, we will see that the workforce planning that will emerge will lead to the training of more of these specialist nurses.

Health: NICE

Debate between Earl Howe and Lord Dubs

Wednesday 14th July 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness makes a very important point about dementia. She will be aware that when the Alzheimer’s drugs were appraised by NICE some years ago, there was disquiet that the role played by carers had not received adequate attention in the appraisal process. It is an issue of great importance to many people, but it is very complex. Given the finite, overall health budget, if we give greater weight to one factor, such as carers or getting people back to work, we automatically, by default, give less weight to others, such as people at the end of their lives. We need to look at this, but it is complex. We shall not let it go, but I cannot give the noble Baroness a definitive answer today.

[Lord Dubs]

My Lords, I wonder whether the Minister can do better than the Prime Minister did in Prime Minister’s Questions earlier today, when he declined to give a guarantee that the 14-day period, within which cancer patients should receive hospital treatment, would be upheld. Can he confirm that the Government will stick to the 14-day period?

[Earl Howe]

My Lords, that target of a 14-day referral period has a definite clinical underpinning. There are certainly no plans to abolish it.

Health: Isle of Man

Debate between Earl Howe and Lord Dubs

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, I am afraid that I cannot help my noble friend as I have not had access to the papers relating to the previous Administration. However, I can tell him that very cordial discussions and negotiations are proceeding at the moment, and the devolved Administrations will be consulted.

[Lord Dubs]

My Lords, the Minister in an earlier answer referred to the United States as being a parallel, but does he not agree that what we are after is that British tourists who go on holiday to the Isle of Man feel that they are covered at least as well as if they had gone on holiday to France? Does he agree that that is not the case and, unless insurance arrangements change, our people will suffer, as will Isle of Man people? Surely the right thing to do is to keep these reciprocal arrangements going.

[Earl Howe]

My Lords, if a UK resident were to travel to the Isle of Man, as I have said, and were to fall ill and need emergency care, they would receive that care free of charge. That is what the agreement currently covers. It was extended by the previous Government in March and will last until the end of September. We are using that window of opportunity to negotiate with the Isle of Man Government and, as I have said, these discussions at official level are proceeding very cordially.