Smoke-free (Private Vehicles) Regulations 2015

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 3rd February 2015 Grand Committee

[Earl Howe]

My Lords, I am very grateful to all noble Lords who have spoken and I am grateful for their universal welcome for these regulations. I begin by referring to the remarks of my noble friends Lady Tyler and Lord Ribeiro and the noble Viscount, Lord Simon, all of whom reminded us why we are doing this—the noble Viscount from a very personal perspective. Three million children are exposed to second-hand smoke every year and we want to protect them. Existing smoke-free legislation is popular, as has been said, and has a very high rate of compliance. Personally, I credit the public with more willingness to follow the law and therefore protect their children from second-hand smoke, rather than thinking of elaborate ways to break the law.

The noble Lord, Lord Hunt, asked about public attitudes in relation to these regulations. We know from the responses to the consultation that there is widespread support for protecting children from the harms of second-hand smoke. I do not expect people to go to great lengths to carry on smoking in cars when they know that it is an offence to do so. As has been said, legislation can be instrumental in driving behavioural and cultural change. That has certainly been true in other areas of regulation in the past. Of course, we have to inform the public in a reasonable way before these regulations come into force.

More generally, we agree that education is essential in informing people of the harms of second-hand smoke, particularly to children, and we recognise the importance of social marketing campaigns. The department and Public Health England will continue to protect children from the harms of exposure to second-hand smoke by encouraging voluntary action through social marketing. Previous campaign results illustrate that such campaigns have been effective both in changing behaviour and in driving quit attempts. Of course, I agree with the noble Lord, Lord Hunt, that our ambition as a nation should be to drive down the prevalence of smoking to the maximum extent that we can. We are going to monitor progress in respect of these regulations by assessing the reduction in the number of children who are exposed to second-hand smoke in cars from the current level of 26%, and it is possible to do that.

As I said, I agree with my noble friend Lord Ribeiro about the importance of building public awareness of these health harms. Once again, I pay tribute to all his efforts in this sphere of activity. I also add my thanks to the noble Lord, Lord Foulkes, for his welcome for these regulations, and I acknowledge his far-sightedness in this context, even if he felt like a voice in the wilderness for a number of years. He expressed concern about the enforcement of the regulations—in particular, in view of his perception that the police do not go to great lengths to enforce the mobile phone laws. In fact, my advice is that the police assure us that they endeavour to enforce mobile phone legislation, as they would any law. In fact, in 2012 more than 90,000 fixed penalty notices were issued for mobile phone offences. We estimate that considerably fewer fixed penalty notices will be issued for smoking in private vehicles—possibly around or slightly above 2,000 each year.

The noble Lord, Lord Foulkes, also questioned whether the £50 figure was sufficient. The regulations were drafted following discussions with the police and others to provide for effective enforcement. As I said, the police have confirmed that they will enforce these regulations in the same way as they enforce other laws, such as those relating to seat belts and the use of mobile phones. It is for individual police forces to decide how enforcement will be carried out locally. They have advised that this can be taken forward by local police officers in conjunction with their wider functions on road safety. For example, when running an operation to check compliance with the laws on seat belts or child car seats, the police would also check for anyone smoking or discuss the offences with the driver if there was tobacco in the car. A fine of £50 is consistent with the existing smoke-free legislation, but that level of fine could certainly be subject to review when the regulations as a whole are reviewed.

[Lord Foulkes of Cumnock]

Was any consideration given to putting points on licences? That would be a much greater deterrent. My understanding is that people feel very worried about having any points added to their licence because of the effect: once it tots up, they could lose their licence. I understand that this is being dealt with as a public health matter but in my view smoking while driving creates a bit of a danger, just as mobile phone use while driving does. I wondered whether that was considered as likely to be a more effective deterrent.

--- Later in debate ---

[Earl Howe]

I am grateful to both noble Lords. In answer to the noble Lord, Lord Foulkes, on the question of points on the driving licence, this avenue was considered but rejected because it would be inconsistent with current legislation. However, I take the point about road safety. As he will be aware, if police judge that a driver is driving unsafely, they have powers to take action under different legislation.

With regard to the position in Wales, smoke-free legislation is a devolved matter, as the noble Lord, Lord Hunt, is aware. I am advised that the Welsh Government have consulted on similar provisions, and we are working with them to co-ordinate our approach where possible.

[Lord Foulkes of Cumnock]

I am sorry to come in again. Will the Minister confirm whether that is also the case in Scotland?

[Earl Howe]

My Lords, I am aware that there is legislation before the Scottish Parliament that seems to seek to introduce similar provisions, but I am not aware of the proposed timing that the Scottish Government envisage.

I was asked about the implementation date by the noble Lord, Lord Hunt. He put forward the suggestion that 1 July might have been a better date than October. We chose the common commencement date of 1 October because we judged that we would need that length of time to achieve a sufficient level of public awareness, and indeed for the police to be adequately prepared for their enforcement role.

Care and Support (Business Failure) Regulations 2014

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 3rd February 2015 Grand Committee

[Lord Foulkes of Cumnock (Lab)]

My Lords, if the Minister is going to correct my noble friend, could he say what the combined effect will be in percentage terms?

[Earl Howe]

I shall have to take advice before answering, but I will be happy to answer the question as soon as I receive inspiration.

Implementing the Care Act will be a challenge for local government, and takes place in the context of competing policy and financial pressures. However, we have already announced £470 million in total for the cost of the new duties in the Care Act which come into effect in April 2015. We have made substantial revisions to our impact assessment, following work with local authorities, to reflect changed assumptions on costs. This will mean acknowledging greater costs for carers in 2015-16 and beyond. We have recognised that.

In the first year, we will create a new carers grant to target this funding where it is most needed. As a result of this work, we believe that implementation of the Care Act will be affordable to local authorities in 2015-16. We will take further steps with the LGA and ADASS to agree a process for monitoring the costs in-year during 2015-16, to check on our assumptions and to provide evidence for the next spending review. Affordability is not just about the overall funding. We are also investing in a large suite of materials to help councils implement the Act effectively.

As regards the question posed by the noble Lord, Lord Foulkes, I am advised that the calculation that he seeks is not a simple one. I will need to write him a letter. I hope that he will allow me to do that. I shall try to be as explicit as I can in that letter.

[Lord Foulkes of Cumnock]

It is certainly not a simple calculation, and I think my noble friend was near the mark. Would the Minister send a copy of the letter to all the Members present?

[Earl Howe]

I will be very happy to do so.

The noble Baroness, Lady Wheeler, referred to the closure of the Independent Living Fund, and asked for the Government to provide guidance in the light of that. In response to the views of stakeholders during the consultation, we have provided guidance on how local authorities should manage the transition to social care for people previously receiving ILF funding. The guidance is included in the Care Act guidance that has now been published.

Both the noble Baroness, Lady Wheeler, and the noble Lord, Lord Lipsey, questioned the words “significant impact on well-being”. In particular, they expressed concern that there might be a variation of interpretation of that phrase. One of the core principles of the Care Act is that the person is central to the new care and support system, and that support is built around their needs and the outcomes they want to achieve. Considering the impact on the person’s well-being in deciding on their eligibility will make the determination personal to them. This recognises that people with similar needs and inabilities to achieve certain outcomes may have different eligibility determinations because the impact on their well-being is different.

It is important that there is consistency in approach in how the eligibility criteria are used. We have commissioned Skills for Care to develop training material and the Social Care Institute for Excellence to develop practice materials to support implementation of the eligibility criteria across authorities. Professional judgment will remain key to decision-making—this should not become a tick-box approach which does not focus on the person. We have never claimed that this will remove disparity. The system is person-focused, so it is inevitable and right that individual decisions will be made.

As regards the concern of the noble Baroness about requiring people to be unable to carry out two or more outcomes, and whether that would restrict access to care, this was an issue that was raised with the consultation version of the regulations, where there was concern that it would be impossible for people with mental health problems to become eligible due to how we described the outcomes that had to be considered. We addressed this in the regulations we are discussing today by converting the two lists of outcomes which were described in the consultation version of the regulations into one list which would capture all groups. We checked this approach with our stakeholder working group, which included members from the Care and Support Alliance and ADASS. The group concluded that it could not identify any groups that would be unintentionally excluded from eligibility due to this approach.

I turn next to the issue of informing the public, so that they have a clear understanding of their rights and the system overall. The noble Baroness will remember that we discussed this extensively during the passage of what is now the Care Act. We are putting in place a full communications campaign to ensure that people receiving services, their carers and families—and the broader population—understand the impact of the Care Act and what it means for them. The campaign will feature a partnership between the local and the national, building on the successful approaches pioneered by previous campaigns such as Change4Life. Local authorities, working with other local partners including the NHS and the voluntary sector, will get messages out directly to their own populations. We have developed a range of campaign materials and guidance to help councils communicate the changes in their local area. That will be supported by wider-reaching national activity—

Meals on Wheels

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 19th January 2015 Lords Chamber

[Earl Howe]

My noble friend makes an important point—that it is not only the value of the meal that is important to elderly people; it is the relief from isolation and loneliness. Many of the solutions to that lie with local authorities. However, what the Government centrally have been able to do is to raise awareness of the impact of isolation and loneliness and encourage local commissioners to tackle that. To that end we have funded a digital toolkit for local commissioners, which has been supporting them in understanding and mapping commissioning for loneliness and social isolation in their communities.

[Lord Foulkes of Cumnock (Lab)]

My Lords, I declare an interest as a trustee of Age Scotland. May I try to answer my noble friend’s question for the Minister? The reason why there has been such a dramatic reduction in the number of meals on wheels is the swingeing cuts imposed by the coalition Government—and, indeed, the Government of Scotland—on local authorities and voluntary organisations, and it is about time they were reversed.

[Earl Howe]

My Lords, local authorities’ funding through central revenue support has indeed reduced, but spending on adult social care has been relatively protected compared with nearly all other local authority services. In cash terms, councils have reported only a small reduction in money spent on adult social care since 2010, despite the tough public funding climate. It is up to the party opposite to explain where the money would come from—if it will increase local authority spending—given that the shadow Chancellor has ruled out increasing local government spending if Labour is elected at the general election.

Public Health Responsibility Deal

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, we are talking to the supermarket chains about those very matters, and I welcome the action that has been taken. The noble Lord may like to know that, as part of the responsibility deal calorie reduction pledge, Coca-Cola has reduced calories in some of its soft-drink brands by at least 30%, Mars has reduced its single chocolate portions to no more than 250 calories and Tesco has reduced by more than 1 billion the number of calories sold in its own-brand soft drinks.

[Lord Foulkes of Cumnock (Lab)]

My Lords, will the Minister help the House by publishing a list of meetings which Ministers, special advisers and senior civil servants have had with fast food companies in the past year?

[Earl Howe]

My Lords, I shall take that request away and write to the noble Lord.

G8 Summit on Dementia

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 17th December 2013 Lords Chamber

[Earl Howe]

My Lords, it is perhaps too soon to expect concrete proposals from other G8 countries, but I can tell the noble Baroness that the summit was not the end of the story. The G8 countries will be meeting throughout 2014 to build on and develop further agreements. We have agreed to host the first legacy event on social-impact investment in March next year. That will be followed by an event in Japan on what new care and prevention models could look like, and by an event hosted by Canada and France on how industry can harness academic research. There will then be a meeting in the United States in February 2015. We hope that the momentum generated by the summit will elicit the kind of commitments that the noble Baroness rightly seeks.

[Lord Foulkes of Cumnock (Lab)]

Is the Minister aware that after the very brief exchange about dementia yesterday, I heard it suggested that dementia should not be grouped in any way with mental illness because of the stigma involved? Surely the solution to that is that we must all work to remove any stigma from all kinds of mental illness.

[Earl Howe]

The noble Lord is absolutely right, but he will recall that the question yesterday dealt with the WISH summit, which was focused specifically on mental health and not on dementia. I did not mean to imply that there should be any less emphasis on tackling stigma in both areas.

Cigarette Packaging

Debate between Earl Howe and Lord Foulkes of Cumnock

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

I can give the noble Baroness that assurance. She will know from her time in government how seriously the Department of Health takes its obligations in this area, not least around transparency but also minimising the extent to which officials meet representatives of the tobacco industry. I am sure that my colleagues in other departments need no reminding of their obligations as well. We do of course interact with the tobacco industry, as the framework agreement allows, but we encourage those representations to be in writing and minimise face-to-face contact.

[Lord Foulkes of Cumnock]

My Lords, has the Minister seen reports that Downing Street said yesterday that Lynton Crosby advises on strategy, not on policy. What is the difference in relation to tobacco legislation?

[Earl Howe]

I am sure that we could get into an interesting conceptual discussion about the difference between strategy and policy. The key point is that Mr Crosby has been very clear in his public statement. He has said:

“At no time have I had any conversation or discussion with or lobbied the prime minister, or indeed the health secretary or the health minister, on plain packaging or tobacco issues”.

That is very clear.

Smoking: Cigarette Packaging

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, smoking rates in the UK are lower than those in many comparable western societies, but our reductions in prevalence still lag behind those in countries such as Canada and the United States, and in some Australian states. Overall prevalence is gradually coming down, but we still need to worry about smoking take-up by the young. There is no doubt that smoking is a significant cause of health inequalities in the UK.

On illicit trade, the story is quite positive. In 2000 around 21% of the UK’s cigarette market was illicit, whereas the latest estimate from HMRC for 2010-11 is that around 9% of the cigarette market is illicit. That is too much; nevertheless, we are heading in the right direction.

[Lord Foulkes of Cumnock]

Does the Minister recall that when he was a shadow Minister opposing our legislation, he regularly met Gardant Communications on behalf of Philip Morris International? May I ask him very gently: who does he think had the greatest influence on this U-turn—his friends at Gardant or Lynton Crosby?

[Earl Howe]

My Lords, I have never adopted a personal position on plain packaging; the noble Lord is wrong about that. As an opposition spokesman, yes, I did make it my business to talk to all sectors—to the tobacco companies, to ASH and to other lobby groups—to make sure that the picture I presented from the Benches on which he now sits was a balanced one. I took no personal position, nor, indeed, a position on behalf of the Conservative Party; I need to make that very clear. The decision that the Government have taken has been in no way influenced by Mr Crosby.

Health: Midwives

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, as my noble friend knows, work has been going on for a number of years, including going back to the previous Government, to see whether there are viable ways of ensuring that this small group of independent midwives can obtain suitable indemnity or insurance cover. One of the difficulties we have had is the absence of information on the potential barriers to independent midwives moving to alternative governance and delivery practices in order to obtain that cover—hence the consultation I have spoken about. As I said, we are now analysing the responses. However, I do not agree that there is no way through. We know that some independent practitioners have opted for a corporate or social enterprise model as a way of gaining insurance cover. We are trying to understand what the barriers are to that among those who are resisting the idea.

[Lord Foulkes of Cumnock]

My Lords, why cannot these people just get employment as midwives within the NHS?

[Earl Howe]

My Lords, some of them already do. As I understand it, we are talking about 154 individuals as compared with 41,000 midwives on the register. If they work for the NHS, there is generally no issue; they will be covered by NHS indemnity in one way or another. The issue is if they wish to practise privately as individuals. That is the point of my noble friend’s Question.

NHS: Private Companies

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. Various contracts have been criticised for being too long: PFI is perhaps a good example. Other types of contract have been criticised for being too short because they do not enable providers to invest on a sufficient timescale in order to be able confidently to bid for work. I have little doubt, once again, that this is an area that Monitor will look at and make recommendations upon.

[Lord Foulkes of Cumnock]

My Lords, will the Government consider requiring companies providing services in the NHS to pay their employees at the very least the national minimum wage and preferably a living wage?

[Earl Howe]

My Lords, the national minimum wage applies across all sectors and therefore all employers need to pay heed to that, including those in the healthcare sector.

Health: Obesity

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 12th November 2012 Lords Chamber

[Earl Howe]

I congratulate my noble friend, as ever, on his powerful advocacy in this area. He is absolutely right that NICE recognises in its guideline that dietary management, including calorie intake, is of predominant importance in battling obesity. It does, however, recognise that exercise is important. It emphasises that although an individual’s ability to be physically active may be hampered by their level of fitness, recommendations can be built up gradually. It is a balance. NICE will continue to act as a source of advice for the medical profession. It is an independent organisation, as my noble friend understands, and Ministers consciously do not interfere with its operational integrity or independence. However, we expect it to take advice and evidence from a range of clinical sources.

[Lord Foulkes of Cumnock]

My Lords—

--- Later in debate ---

[Lord Foulkes of Cumnock]

My Lords, I, too, have an interest to declare; I think it is fairly obvious if you look at me. That is why I want to ask a serious question of the Minister. Will he say to medical practitioners and others that it does not help to be critical and condemnatory of those of us who are obese? It is important to give information and encouragement. Otherwise, there can be complications and people can end up with depression and other illnesses, so it is very important to give encouragement. I am glad to say that that is why I have been able to lose more than a stone in the past month.

[Earl Howe]

Not for the first time, the noble Lord is an example to us all. I agree with the point he makes about the way in which doctors engage with their patients on this often sensitive subject. That is why the previous Government very commendably put in place a suite of resources to guide GPs in this area. Those have since been supplemented by electronic training modules on the identification and management of obesity and supporting behaviour change in patients. NICE has produced a clinical guideline to supplement its advice on obesity and exercise to guide clinicians on exactly how they approach this topic.

NHS: Health Tourism

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 28th May 2012 Lords Chamber

[Earl Howe]

The rules are complex, depending on whether the person is from the European Union, where certain rules apply, or from other parts of the world. There is no mandatory requirement for people to carry health insurance unless there is a transparent medical need when they enter the country. For example, a heavily pregnant woman might be asked to produce proof that she could pay for treatment if giving birth was likely. There are clear rules for NHS trusts where a patient who is chargeable presents. The trust must seek either to secure payment before treatment or to bill the person immediately afterwards.

[Lord Foulkes of Cumnock]

My Lords, in answer to the question asked by the noble Lord, Lord Roberts of Llandudno, the Minister rightly described the situation as it currently is. Is the Department of Health doing any study into the disaster that would happen in terms of healthcare between Scotland and England if Scotland were to separate from the rest of the United Kingdom? If it is not doing a study, why not?

[Earl Howe]

My Lords, were that situation to occur, the issues arising from it would be little different from the issues today in that health is already devolved. However, I cannot speculate on whether there would be a different policy on immigration in Scotland compared to south of the border as we are really not in that territory yet.

Health: Clinical Commissioning Groups

Debate between Earl Howe and Lord Foulkes of Cumnock

Thursday 26th April 2012 Lords Chamber

[Earl Howe]

The noble Baroness makes an extremely important point, which is why we have laid great stress on training and ensuring that the NHS Commissioning Board will develop appropriate guidance on procurement, avoiding conflicts of interests and avoiding unfair competition entering the arena.

[Lord Foulkes of Cumnock]

My Lords, what is the estimated extra cost of all this extra bureaucracy?

[Earl Howe]

My Lords, I do not accept that it is extra bureaucracy. Conflicts of interest arise in all walks of life and have to be managed. I do not think that issuing guidance represents extra bureaucracy.

National Institute for Health and Clinical Excellence

Debate between Earl Howe and Lord Foulkes of Cumnock

Wednesday 14th December 2011 Lords Chamber

[Earl Howe]

My Lords, part of the objective of the growth strategy is to break down some of the barriers that undoubtedly exist to pharmaceutical companies conducting clinical trials in this country. There have been unwelcome delays in the system and we are putting in place several measures to get rid of them, which in turn should encourage pharmaceutical companies to view the UK as the platform of choice for clinical research.

[Lord Foulkes of Cumnock]

My Lords, has the Minister thought—

Health: Funding

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 1st November 2011 Lords Chamber

[Lord Foulkes of Cumnock]

Did I catch the Minister’s first answer right—did he say that it would be the new head of commissioning who would have this responsibility? Am I right in saying that this is the professor who was described by MPs as not having the experience necessary and not understanding the job of head of commissioning, and who was only approved by the committee in the House of Commons on the casting vote of the chairman? Is this the guy who is going to be responsible?

[Earl Howe]

My Lords, the chief executive-designate of the NHS Commissioning Board is Sir David Nicholson, who is currently chief executive of the NHS. He is not the gentleman to whom the noble Lord referred. He currently runs the NHS. Professor Malcolm Grant, to whom I think the noble Lord was referring, will be chairman of the NHS Commissioning Board Authority, in a non-executive capacity.

Smoking

Debate between Earl Howe and Lord Foulkes of Cumnock

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

My Lords, I did not see that report, but what the noble Lord says disturbs me. I think we all want to see an increase in adoption rates and we do not want to see potentially good adopters turned aside for what may appear to be trivial reasons.

[Lord Foulkes of Cumnock]

My Lords, I moved Private Member’s legislation in the other place in the early 1980s and got nowhere on it. Only when legislation was moved was there a real reduction—a complete ban—on smoking in public places and only through legislation can effective action be achieved. Is it not also the case that smokers lighting up cigarettes in cars are dangerous in terms of road safety? That is an extra reason for doing it. Will the Minister therefore stop pussy-footing around and saying that this can be achieved voluntarily, when we all know that it can only really, successfully and effectively, be achieved through legislation?

[Earl Howe]

My Lords, I do not agree with the noble Lord’s analysis. It is true that, on current evidence, the legislation is having a beneficial effect; I would not dissent from that. However, we know that voluntary behaviour change is eminently possible. It would explain why, between 1996 and 2007 when the legislation came in, secondhand smoking exposure in children in England declined by 70 per cent. That was driven by not only the evidence but also awareness campaigns and increased awareness in the lead-up to the legislation. Therefore, voluntary action can have a beneficial and marked effect.

NHS: University Health Centres

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, the characteristics of each GP practice will naturally vary according to the patient population. Although a practice situated on a university campus may have higher numbers of patients who require mental health advice and support, there may well be fewer patients in need of other services. I am not aware that there is a particular issue of underfunding of university practices in relation to the mental health burden. As the noble Baroness will know, the QOF was adjusted in 2008 with a two-year time delay, so university practices have had a chance to adjust and prepare for the change.

[Lord Foulkes of Cumnock]

Are university health centres gearing up to deal with cases of anxiety and depression among students at English universities who wish to go to Scottish universities for a further degree and who find that they will have to pay the full fees, unlike students from other countries in Europe? Is that not a disgraceful, discriminatory proposal by the Scottish Government? Can this Parliament not find a way of outlawing such discrimination?

[Earl Howe]

My Lords, I congratulate the noble Lord for introducing this vexed topic into a health Question. It would be improper for me to comment on the deliberations of the Scottish Parliament.

NHS: Consultation on Reform

Debate between Earl Howe and Lord Foulkes of Cumnock

Tuesday 26th April 2011 Lords Chamber

[Lord Foulkes of Cumnock]

To ask Her Majesty’s Government how they propose to report the outcome of the consultation on NHS reform to Parliament.

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

My Lords, we ran a public consultation on NHS reform last year and received some 6,000 responses. As a result, we brought forward important changes to our modernisation proposals. We are now taking advantage of the natural pause in the legislative process to listen and reflect, supported by advice from the new NHS Future Forum. The Government will then respond to the forum’s report and the wider listening exercise, setting out the improvements that we will make to the Bill based on what we have heard.

[Lord Foulkes of Cumnock]

My Lords, did the Minister see the Statement by the Secretary of State that the reason for the pause was because the Bill was allegedly not understood and he had to explain it better? Will he explain to Mr Lansley that it is precisely because the Bill is well understood that there is such widespread opposition, including an unprecedented vote of no confidence by the Royal College of Nursing? Will he give a guarantee that substantial amendments will be brought before Parliament after the current consultation? Otherwise, it will be seen as a complete sham.

[Earl Howe]

My Lords, I think there is widespread agreement that the principles on which the Bill is based, such as devolving control of the NHS to local levels, placing patients at the heart of decisions about their own care and improving public accountability are the right principles for us to be guided by, but that there are also, as the noble Lord said, questions and concerns, some quite deep, about what we are doing and the mechanics of putting the principles into practice. As the Prime Minister and Deputy Prime Minister made clear, this is a genuine chance to make a difference. Where there are good suggestions to improve the legislation, those changes will be made.

Health: Sickle-Cell Disease

Debate between Earl Howe and Lord Foulkes of Cumnock

Monday 14th March 2011 Lords Chamber

[Earl Howe]

My Lords, I am aware of the tragic case to which my noble friend refers, which is of course the subject of an investigation at the moment. The facts, as I am aware of them, suggest that the failings that occurred in that case were more to do with poor practice than a lack of training, although we will see what emerges from the inquiry. However, I can tell her that there is national guidance on the symptoms and emergency treatment of people with sickle-cell disease, published by the Joint Royal Colleges Ambulance Liaison Committee. All ambulance crew staff receive training in the assessment and management of patients with sickle-cell conditions in line with those guidelines and further national guidance was issued to staff in 2009. It is regularly updated and it is taken very seriously.

[Lord Foulkes of Cumnock]

Do both of the Minister’s replies apply also to Scotland?