Levelling-up and Regeneration Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Committee stage
Monday 27th February 2023 Lords Chamber

[Earl Howe (Con)]

I sense that this is a matter that we will come back to at a later stage of the Bill. I do not think I can add anything to what I have already said on this subject.

[Lord Kennedy of Southwark (Lab Co-op)]

I will just come back to one point. I was a bit puzzled by the Minister’s response to Amendment 69 in the name of the noble Lord, Lord Shipley. The Government are taking the power in the Bill to disapply the duty to allocate seats on the basis of political proportionality in the combined authority; they are disapplying that power. The noble Lord, Lord Shipley, was seeking to remove that provision so that, if a party had a third or a quarter of the seats, it would expect something similar on the Executive. When the Minister answered the noble Lord, Lord Shipley, he gave an answer that seemed to agree with what he was suggesting while justifying the position of the Government. It seemed perverse.

I know that there are to be proposals for a Nottinghamshire/Derbyshire combined authority. At the moment Derbyshire County Council and Nottinghamshire County Council are controlled by the Conservatives, and Derby City Council is led by the Conservatives. The only Labour council is Nottingham City Council. On the basis set out in the Bill, the three Conservative councils could get together, gang up on the Labour council and throw it out of the committee structure. That surely cannot be right. Why would a minority council join something if it could be ganged up on and removed from the executive? It would not; we want to bring people together. I know that the noble Lord, Lord Shipley, is trying to ensure that this problem could not happen. I do not follow the Minister’s arguments, which were in support of the noble Lord, Lord Shipley, but were used to say that we cannot have the amendment.

[Lord Shipley (LD)]

My Lords, perhaps I could help the Minister at this point by simply suggesting that we add this to the agenda of our meeting, which gets longer and longer as we speak. It is a very important issue, to which we should add the issue of whether the calculation of political proportionality applies to the membership of the CCA—those who are there—or the bodies that each of those members represents, on behalf of which they have been nominated to attend the CCA. You might get a different answer depending on which it is. To avoid a lengthy evening and discussion at cross purposes, perhaps the Minister will agree that we can talk about it around the table; it might be easier.

Levelling-up and Regeneration Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Committee stage
Wednesday 22nd February 2023 Lords Chamber

[Earl Howe (Con)]

My Lords, we fully understand the desire for urgency in this area. The Minister, my noble friend Lady Scott, has made this clear at this Dispatch Box previously. As I hope my noble friend Lord Young knows, her department is working very hard indeed on this policy area.

[Lord Kennedy of Southwark (Lab Co-op)]

Can the noble Earl confirm whether there is a draft Bill? That would be useful. Can he also maybe give us a bit more on the definition of “urgent”?

[Earl Howe (Con)]

I do not think I can add to what I have already said. I shall endeavour to ascertain the state of play on the drafting of the Bill. I will gladly tell the noble Lord if there is any further information on that, but I do not have it to hand.

Given the extent of government action on these priorities set out elsewhere in policy, and the approach I have outlined to setting a clear, systematic and long- lasting framework for levelling-up missions, I hope that for now this provides the noble Lord, Lord Kennedy, with sufficient assurance to enable him to withdraw Amendment 42.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, I thank everyone who has spoken in this debate. I also —I should have done this when I spoke originally—thank the noble Lord, Lord Young of Cookham, the noble Baroness, Lady Fox of Buckley, and the right reverend Prelate the Bishop of St Albans for signing my Amendment 42. I am very appreciative.

In his excellent speech, the noble Lord, Lord Young of Cookham, highlighted the problems of the opaqueness of the Government’s actions. It is all still a bit grey, and that is an issue. He also raised a very important point. We do not know whether the Bill is there yet, but apparently there is something there. If it appears in the King’s Speech, the other risk is that it will be the last Session of this Parliament and we all know that things drop off at the end and do not happen. The noble Lord made that point well, and the Government should take note of it. We would not want to get a Bill but then see it disappear because, “Sorry, we’re now going to the general election and we’ll have to come back to it afterwards”. That would not be a good place to be at all.

The noble Baroness, Lady Fox of Buckley, made the point that many leaseholders were first-time buyers and often live in areas where the Government want to level up. In this levelling-up Bill we would hope to do something for those people and help them level up. In the worst cases, people are treated appallingly by rogue managing agents and rogue freeholders. There was a very good article in the Financial Times recently. There is a huge insurance scandal coming down the track with what has been going on with managing agents and leaseholders. It is absolutely outrageous; they are just ripping people off.

I thank the noble Lord, Lord Greenhalgh, for his support and welcome him to the cause. It is good to have him on board. If we ever meet in future, we will make sure we invite him. I was delighted to learn that he is now a vice-president of the Local Government Association. I should probably declare that I am as well. I look forward to us working hand in hand on this in the coming weeks and months.

I thank the noble Lord, Lord Thurlow, for his support on this. These are probing amendments, but it is important that we air these issues here and ensure that we get the Government to be absolutely clear where they are. I thank the noble Baroness, Lady Pinnock, for her support as well—it is much appreciated—and my noble friend Lady Hayman.

I thank the noble Earl for his response, but I was hoping for a bit more. I have been in this House for nearly 13 years and have always been very impressed by him, so I was hoping for a little more. Maybe we will come back to this again.

I am still not quite clear where we are on reform or abolition. What we are going to do here is still a little vague. Maybe that is why we are not yet getting the draft Bill that may or may not be produced. At the moment, some leasehold campaigners think the Government are going to abolish leasehold and are saying, “What a wonderful thing to do; it’s really great news that the Government are going to do this”. Another group thinks the Government are going to reform it. They are not doing both, clearly, and they are not being clear about what they are going to do. They are going to disappoint quite a lot of people before the next election, and I think they should reflect carefully on that. They need to be much clearer what their intention is. As the noble Lord, Lord Young of Cookham, said, if they have the draft Bill, they should just publish it and help everybody.

I will leave it there. I beg leave to withdraw my amendment.

Business and Planning Bill

Debate between Earl Howe and Lord Kennedy of Southwark

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Monday 20th July 2020 Lords Chamber

[Earl Howe (Con)]

My Lords, this Bill has passed through your Lordships’ House at greater than usual speed, and all noble Lords understand the reasons for treating it with such urgency. I am grateful to all noble Lords for their constructive engagement with the Bill and for raising many important topics. I hope that your Lordships will agree that the Government have considered and responded to the concerns of noble Lords and have made suitable changes to provisions where appropriate. We have had good debates and the Bill is now in a much better form than it was when it entered your Lordships’ House.

I thank the other members of the ministerial team: my noble friends Lady Penn, Lord Greenhalgh, Lady Williams and Lady Vere. I congratulate especially my noble friend Lord Greenhalgh, who made his first Second Reading speech when introducing the Bill to the House. As my noble friend said in that speech, the Bill supports businesses in four key areas of the economy. It has been a pleasure to work with this team on such a wide-ranging set of measures.

I also extend my appreciation to the Front-Bench spokesmen and spokeswomen on the Benches opposite —for the Liberal Democrats, the noble Baronesses, Lady Pinnock, Lady Doocey, Lady Northover and Lady Kramer, and the noble Lords, Lord Shipley, Lord Addington and Lord Paddick; and for the Official Opposition, the noble Lords, Lord Tunnicliffe, Lord Stevenson and Lord Kennedy, and the noble Baroness, Lady Wilcox—whose constructive and consensual approach has ensured that the Bill is fit for its intended purpose.

Once again, I extend my thanks to all noble Lords throughout the House for scrutinising the Bill with such care, and for their constructive engagement. The Bill is needed urgently, before the summer, so that its provisions can reach their full potential. I hope, therefore, that the other place will promptly accept the amendments we have passed so that the Bill can come into force without delay. I beg to move.

[Lord Kennedy of Southwark(Lab-Co-op)]

My Lords, I thank the noble Earl for his kind comments and join him in thinking that the House has worked very well in dealing with this important Bill. We send it back to the Commons in a much better state. Members from all around the House raised important issues; the Government considered them carefully and listened. We have passed many good amendments over the last few days. I am very grateful to the noble Earl and all his ministerial team for their work.

Business and Planning Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Tuesday 14th July 2020 Lords Chamber

[Lord Kennedy of Southwark]

My Lords, Amendment 77, in the name of my noble friends Lord Hain, Lord Monks and Lord Hendy, and the noble Baroness, Lady Ritchie of Downpatrick, introduces the issue of employer-employee relations and highlights the role of trade unions and other organisations that represent employees in determining the success of these changes.

The Government will want to engage constructively with the relevant trade unions, and it would help the House if the noble Earl could set out how he has consulted them during the drafting of the Bill and sought their views on the issues contained in it, which have a direct consequence for the people they represent.

The Bill seeks to support economic growth, but if workers, their views and the views of their representatives are not taken account of and their safety is ignored, that is irresponsible—and I am sure the Government would not want to do that. The worst thing of course would be if we did not take their views properly into account and that failure contributed to a second wave of the pandemic, which would be—health-wise and economically—an utter disaster for the United Kingdom.

I agree very much with the comments of the noble Baroness, Lady Ritchie of Downpatrick, about how we should look to Germany and the work it does there with its works councils. I was over in Berlin a couple of years ago and saw the great work Rolls-Royce was doing at its factory just outside Berlin.

My noble friend Lord Hain mentioned the Communication Workers Union, and I fully endorse his comments. I also pay tribute to USDAW, the shop workers’ union. I was a member of USDAW for many years. Its members, the shop workers, are the people who have kept our shelves filled, and not without abuse and assaults from people. There have been some disgusting stories of offensive behaviour that shop workers have had to endure from people coming into shops. We should pay tribute to them. During the passage of the Bill concerns have been raised with me by the Bakers, Food and Allied Workers Union, which of course has many members employed in pubs, about their safety as we move forward.

I also endorse the comments of my noble friend Lord Hain that managers and trade unions working together can make a huge difference for businesses, local authorities and the rest of the public sector, particularly the NHS. We should not forget that when we clap NHS workers, pay tribute to shop workers, rightly praise local government staff and call firefighters heroes, they are members of unions such as Unison, Unite, the GMB, USDAW and the FBU. They are the same people—there are not two groups of people, one of heroes and great workers and the other of trade union people. There is something that has always frustrated me, and I raised it many times when the noble Lord, Lord Bourne, was Local Government Minister. When we discussed the tragedy of Grenfell Tower, the frankly totally unfair attacks on the FBU by the Prime Minister always irritated me. I repeatedly raised that, because it was totally unfair. Those heroes are members of that trade union. I will leave my comments there, and I look forward to the reply of the noble Earl to the amendment.

[Earl Howe]

My Lords, the noble Lord, Lord Hain, made some powerful and extremely significant points on co-operation between employers and employees, and putting that important principle into the context of the current crisis. I thank him for the way he did so. I also thank the noble Lord, Lord Hendy, and the noble Baroness, Lady Ritchie, who joined him in putting forward this amendment, and I thank the noble Baroness, Lady Pinnock, and the noble Lord, Lord Kennedy, for their contributions.

As has been explained, this amendment would require the Secretary of State to produce a strategy for employer-employee co-operation in regard to businesses implementing the provisions of the Bill, which should be done within six months of the Act coming into force. In producing the strategy, the Secretary of State would be required to consult trade unions, other employee representatives, relevant businesses and other appropriate parties. I hope that the noble Lord, Lord Hain, will take it from me that we recognise the importance of effective employer-employee relationships, particularly in the current context. We encourage a constructive approach from both sides.

The noble Lord, Lord Hendy, asked me to say why we would object to an amendment of this kind. We do not think that a ministerially led strategy for employee-employer co-operation is necessary in the context of the Bill. The simple reason for that is that decisions on how to implement the provisions of the Bill rest best with individual businesses, their employees and their representatives, who know far more about their specific circumstances than any government Minister. We do not need to involve the Government in those processes.

I agree that workers’ voices should be easily heard, so it is worth my adding that the Information and Consultation of Employees Regulations 2004 provide another important avenue for the worker’s voice in the workplace. We have recently lowered the request threshold from 10% to 2%, which we believe will encourage employers to be more open with staff about what is happening in their workplace. This has made it easier for employees to secure information and consultation arrangements with their employer on key matters relating to the employer’s strategic direction. That is another reason why we believe that this amendment is not necessary.

The Government recognise that trade unions can play a constructive role in maintaining positive industrial relations. Indeed, to answer the point made by the noble Lord, Lord Kennedy, we have worked with unions, employers and other parties throughout this pandemic to ensure that workplaces remain safe; we will continue to do so as the UK looks towards economic recovery. This is an important subject, not least because so many people owe their lives and their well-being to a great many trade union members. However, for the reasons I have given, and much as I am with the noble Lord, Lord Hain, in spirit, I am not able to accept this amendment. I hope that the Committee will agree and that, for now at least, the noble Lord will feel able to withdraw his amendment.

Extension of Franchise (House of Lords) Bill [HL]

Debate between Earl Howe and Lord Kennedy of Southwark

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Earl Howe]

The noble and learned Lord has raised a very interesting constitutional point. It is so interesting that I think it is appropriate for me to write to him about it, and copy that to noble Lords who have spoken. As noble Lords who have stood where I am standing will be aware, there is a point at which the brief in front of a Minister runs dry. That is the case in this instance, but I reserve the right to produce some arguments.

Another issue raised was about the well-worn principle that there should be no taxation without representation. My noble friend Lord Young’s comments on that issue in the debate on 19 July last year were cited. I can understand why the point about a Japanese citizen could be attacked, but a British citizen of voting age who is not a Member of the House of Lords but who pays no income tax retains the right to vote. The point my noble friend was making on that occasion, which I echo today, is that there is not a direct connection in law between people who have paid tax and people who have the vote.

The reason why Members of the House of Lords cannot vote on Finance Bills goes back a long way. The financial primacy of the Commons dates back many centuries and was formalised by two Commons resolutions in the late 17th century. The first, from 1671, states

“that in all aids given to the King by the Commons, the rate or tax ought not to be altered by the Lords.”

That is quoted in Erskine May. The second resolution is more detailed, from 1678—I would love to read it out, because the language is wonderful. Noble Lords suggested that this is an anomaly or even an affront, but none of it prevents this House debating money Bills or tabling debates on a financial matter.

As many noble Lords have pointed out, Peers who are Members of this House can also vote, where appropriate, in elections to the Scottish Parliament, the National Assembly for Wales and the Northern Ireland Assembly; in local government elections; in police and crime commissioner elections; and in both national and local referendums. The difference in those instances, I say in particular to my noble friend Lord Bourne of Aberystwyth, is that those are forums or offices in which Peers do not have an automatic right to represent themselves.

Noble Lords therefore have a say in local, devolved and national decision-making. Enfranchising noble Lords to vote in general elections would give Peers two ways of being represented in Parliament—it would give them double leverage as citizens. My noble friend Lord Sherbourne suggested that there is no possible downside to such a change. The Government believe, on the contrary, that conferring such an exceptional privilege cannot be right.

I was asked by the noble Lord, Lord Adonis, and others to say something about the commitment in the Conservative manifesto to review the relationship between the Government, Parliament and the courts in a constitution, democracy and rights commission. I wish I could provide him with further and better particulars on this commitment at this juncture, but, as I have said on two occasions recently, it is still too soon for me to do so. The scope of the commission will be announced in due course. However, I can tell him that the aim of the commission will be to develop proposals to restore trust in our institutions and in how our democracy operates. I hope I need not say, although I will, that we will continue to promote the UK’s interests and its values, including freedom of speech, human rights and the rule of law. It is clear, I hope, to most noble Lords that careful consideration is needed on the composition and focus of the commission.

In light of all that I have said, I must end with a disappointing message to my noble friend. Even if the Government supported the principle behind this Bill, and I hope that I have set out clearly our reservations about it, they do not think that spending further parliamentary time on it is justified when other, more pressing electoral reforms—reforms which the Government are working hard to bring into being—have been so widely called for.

[Lord Kennedy of Southwark]

I have just been looking at the Companion. The Minister said that we do not need any representation because we represent ourselves in Parliament—I accept that we are Members of Parliament in a sense—but the Companion and the Code of Conduct talk about acting on personal honour and in the public interest rather than out of private interest. There may be some conflict there. I do not want the Minister to comment on that now, but perhaps he can have a look at it and respond to us in a letter.

[Earl Howe]

My Lords, I would be glad to look at those passages in the Companion. I simply observe that they do not relate to our right to sit in this Parliament; they are much more about how we should behave when we come here.

European Parliamentary Elections Etc. (Repeal, Revocation, Amendment and Saving Provisions) (United Kingdom and Gibraltar) (EU Exit) (Amendment) Regulations 2019

Debate between Earl Howe and Lord Kennedy of Southwark

Wednesday 23rd October 2019 Lords Chamber

[Lord Tyler]

There is a specific issue about transparency of online campaign messaging, which was a major issue in May and was a big issue in the referendum and the subsequent general election. The Cabinet Office consulted about it many months ago. Evidence was taken from the Information Commissioner’s Office; the Electoral Commission also looked into it. I would be grateful if the Minister could take back to the Cabinet Office the concern from all over your Lordships’ House that there seems to be very little action taking place on this. It remains a very sensitive issue, not least because of the important report from the DCMS Select Committee.

[Lord Kennedy of Southwark]

I take the point that the Minister made about the work of the Law Commission. It is doing its work and will come back with some comprehensive reports. However, when I have sat in a room with Chloe Smith and the noble Lord, Lord Young, we have all agreed that there are things we can do now. They have never said, “We can’t do anything because we need this Bill going forward”. There are things that can be done. I would ask the Minister to talk to his officials. He would certainly be encouraged by all of us around this House to sort this out quickly, notwithstanding the much more detailed work of the Law Commission; that cannot be used as an excuse for saying, “We do not know enough about that, so we have to leave the electoral system as inadequate as it is now”.

[Earl Howe]

I take the points made by both noble Lords. There are some tremendously important areas that we need to address. The online issue is one of them. All I can say at the moment is that the strength of feeling that has been articulated this evening will not be lost on my officials: I shall make sure of that. We are committed to implementing an imprints regime for digital election material. This will ensure greater transparency. It will make it clearer to the electorate who has produced and who has promoted online political materials. I assure the noble Lord, Lord Tyler, that we will be bringing forward proposals in this area in the coming months.

The noble Lord asked me whether the progress of the withdrawal Bill might invalidate this statutory instrument. I can reassure him that it will have no effect at all. We simply need to ensure that the European parliamentary elections legislation is not repealed on exit day, in all circumstances—or in any circumstances—so we still require this statutory instrument to be agreed. If it is, the correct result will be achieved, namely that the repeal of the European parliamentary elections legislation will happen not on exit day but rather, as I said either, on 31 December 2020. The SI is needed simply to provide certainty to electoral administrators and to maintain the integrity of our domestic electoral processes.

The noble Lord, Lord Tyler, asked whether I was a permanent or temporary spokesman for the Cabinet Office. I wish I could quantify the length of the piece of string that we are dealing with here. I am but a pale imitation of my noble friend Lord Young, whose presence on the Front Benches is sorely missed. Currently, I respond for the Cabinet Office. It is my privilege to do so and I will continue to do so until requested not to.

Offensive Weapons Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Committee: 3rd sitting (Hansard): House of Lords
Wednesday 6th February 2019 Grand Committee

[Lord Kennedy of Southwark]

My Lords, I have Amendments 79 and 80 in this group. They are word-for-word what was in the Bill when it was first published in the House of Commons. I am attempting to put back into the Bill the clauses put forward by the Government originally—not my usual role here as opposition spokesperson; I am usually trying to take out government clauses or change them, but here we are today trying to put them back in.

My noble friend Lord Robertson of Port Ellen set out clearly at Second Reading and again today why these weapons should be banned. They are more dangerous in terms of their penetrative power and range. My noble friend quoted the Home Secretary’s comments; I shall not quote them again. The Home Secretary was very clear why these weapons had to be banned; he had had intelligence about why it was important to do that. Then we had a complete about turn and the clause was taken out between Second Reading and Third Reading. I am sure we will find out at some point what happened and why that was done. My honourable friend Louise Haigh, the shadow Policing Minister, was very clear that the Opposition backed the Government’s original position and that the provision would pass through the House of Commons without any problems.

It is interesting that the Government have gone much further than what people on the Government Benches wanted. The Member for The Cotswolds, Sir Geoffrey Clifton-Brown, suggested level 3 security, but that is not here. They were not looking for the weapon to be banned but wanted enhanced security, very much along the lines of the amendment moved by the noble Lord, Lord Lucas, but there is nothing here. That security level means that the gun, the bolt and the ammunition are kept in three separate safes. At the moment the Government are proposing not to do that. They are going to leave the security as it is. That is regrettable.

I am not an expert on guns. I do not particularly like guns, but I have fired some weapons, including a sniper rifle and a few shotguns. I fired them on ranges, and when I was in the Armed Forces Parliamentary Scheme I did some stuff. I have shot only at targets and clay pigeons. I am very pleased that we live in a country where we have tough laws on weapons. I am very proud that we have them, and they are good.

My noble friend Lord Robertson was right to point out in respect of evidence that, before Hungerford and Dunblane, handguns were not generally seen as an issue. It was only after the two tragedies that Government had to act to ban them. We can never say what is going to happen in the future.

The Government were right in their original proposals, and it is shame we are here today. The noble Lord, Lord Lucas, has tabled an amendment to improve the position today. I am very pleased to see it because it is better than the Government’s suggestion. It at least gives level 3 security. That will make it more difficult for weapons to be obtained illegally, and although it is not an absolute guarantee it is certainly progress. I shall not press my amendment, but I am looking forward to hearing the Minister’s comments in response to the debate, because these are serious issues. As my noble friend Lord Robertson said, although the Government removed the two clauses, at no point has the Home Secretary withdrawn the remarks he made. My worry is that after we have had this review, the Government will decide that we need to ban these weapons and then will say that we have no legislation to ban them and we will have to wait until something comes along. That is the often the case with many things which we suggest in opposition. The Government aim to do things and say they will do them at some point when they find a Bill they can put them in. My worry is that we may end up there. I raised that point at Second Reading with the noble Baroness, Lady Williams. If the Government are going to do a consultation and then decide to ban these weapons, they should take a power to enable them to do that through secondary legislation. I look forward to the Minister’s response.

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, my noble friend Lord Lucas began by quite rightly pointing out that this is a Bill about setting boundaries. As we have heard, this group of amendments deals with what is the appropriate form of regulation for high muzzle energy rifles. We have heard a variety of views from all sides of the Committee. Some noble Lords are seeking to restore the prohibition of these rifles removed from the Bill in the Commons. Other noble Lords are seeking to go further than the amendments made in the Commons by also removing the prohibition on so-called MARS rifles, while yet other noble Lords seek to find a middle way by introducing mandatory security requirements. I will endeavour to disentangle these competing approaches by setting out the Government’s considered view on the various amendments.

I begin with what is, in effect, the middle-way option, if only because my noble friend Lord Lucas’s Amendment 74 is the first one in this group, but I will address my noble friend Earl Attlee’s Amendments 80A to 80C as they cover similar ground, albeit from a different perspective. Amendment 74 provides us with an opportunity to test whether a requirement to apply the highest standards of security for the storage of specific firearm types when not in use might be an alternative to prohibition. The Government are not seeking to prohibit ownership of high muzzle energy rifles through this Bill, so it is relevant for us to discuss the merits of applying enhanced security to the storage of such firearms while they continue to be available to civilians under our firearms licensing arrangements. I know that the noble Lord, Lord Kennedy, takes the contrary view, and I will come on to his amendments shortly.

The Bill will prohibit civilian access to more rapid-firing rifles, which makes any discussion of secure storage in respect of these weapons otiose, although we will come to Amendments 78A and 79A, which would have the effect of removing that prohibition from the Bill, and Amendments 78B and 79B, which seek to make changes to the prohibition.

The Government are concerned about the potential public safety risks that more powerful and more rapid-firing rifles pose, should they fall into the hands of criminals or terrorists. It is therefore right that where any such firearms remain available for civilian use and ownership on a firearms certificate issued by the police they should be subject to the highest standards of security to prevent theft and misuse. I therefore understand the reference in my noble friend Lord Lucas’s amendment to the requirements of level 3 security. This relates to different levels of security arrangements that are set out in the Home Office’s Firearms Security Handbook, with level 3 being the highest level of security measures set out in the handbook.

The first point I want to make in respect of this amendment is that it would be something of an anomaly to specify particular security conditions in this way in the Bill. It is currently an operational matter for police forces to satisfy themselves that the security in place for any firearm held by a civilian is proportionate to the risk that the specific firearm poses, taking all relevant factors into account. The issue of the relevant firearms certificate can be made contingent on the required levels of security being in place. While it is right that we should ask the police to have due regard to the requirements of the handbook, it would, as I have said, be an anomaly to set out in primary legislation the level of security required for one specific rifle type.

While I fully understand the point behind the amendment, it is important to be aware that the Firearms Security Handbook is a joint Home Office and policing document, intended to guide forces. The document has no specific legal weight and can be amended administratively. In such circumstances, I contend to my noble friend, it would not be appropriate to specify level 3 security in this Bill.

Amendments 80A to 80C in the name of my noble friend Earl Atlee address the same issue, but in a different way. These amendments in turn seek to amend the Firearms Act 1968 in order to provide the Secretary of State with an order-making power to specify the conditions relating to the secure storage and transportation of high muzzle energy rifles, which must be attached to the relevant firearms certificates issued by the police. The point behind the amendments is important. Dangerous firearms held in the community must be kept and stored as securely as possible.

The Government have given a commitment that we will consult on the issue of whether high muzzle energy rifles should be subject to a general prohibition, along with a number of other issues relating to firearms safety, after the Bill has completed its passage through Parliament. But the Government recognise the strength of feeling on this issue, on all sides. I know that some, including the noble Lord, Lord Kennedy, have concerns about waiting for a further public consultation to run its course, particularly if this leads to a call for further legislation. We therefore take the point that there is a case for action in this area at this time. The Government will therefore give further consideration to the amendments tabled by my noble friends Lord Lucas and Earl Atlee ahead of Report. I cannot at this juncture give a commitment beyond that, but I assure both my noble friends that the case they put forward has landed and will be looked at seriously.

Amendments 78, 78B, 79A and 79B provide us with an opportunity to consider potential alternatives to the prohibition of the rifle types specified in Clause 32. Clauses 32 and 33 will strengthen the controls in respect of rapid-firing rifles, as defined by these clauses. As I explained earlier, these are currently available for civilian use or ownership under general licensing arrangements administered by the police under Section 1 of the Firearms Act 1968 or Article 45 of the Firearms (Northern Ireland) Order 2004. This means that at present they can be owned only by somebody who has a firearms certificate for which they have been vetted by the police. Following advice from experts in the law enforcement agencies, we consider that these rifles should be brought under stricter controls. That will be achieved by adding them to the list of prohibited firearms provided for by Section 5 of the Firearms Act 1968 and Article 45 of the Northern Ireland order. Weapons that are so prohibited are subject to more rigorous controls than other firearms and may be possessed only with the authority of the Secretary of State.

My noble friend Lord Shrewsbury and the noble Earl, Lord Erroll, argued that the proposed ban of rapid-fire rifles could discriminate against disabled shooters. That point was raised during discussion of the Bill in the other place. I have to say straight out that I am not impressed by that argument. If the prohibition has an impact on disabled shooters, those who provide shooting facilities should see what alternative assistance might be provided to disabled shooters by shooting clubs, whether by adapting other types of rifle or adapting the places where disabled people shoot. So I am afraid that I do not find my noble friend’s and the noble Earl’s argument particularly powerful on that issue.

It is not our intention to restrict unnecessarily or arbitrarily the lawful use of firearms by licence holders for legitimate sporting purposes, for example. The vast majority of people in lawful possession of firearms use them responsibly and it is right that any controls need to be proportionate. But at the same time, the Government are concerned about the recent rises in gun crime and the changing threats and heightened risk to public safety. All firearms are by their very nature potentially dangerous and, indeed, lethal, but the rifles specified in Clauses 32 and 33 are considered to be more dangerous than other firearms permitted for civilian ownership under the firearms legislation. These rifles can discharge rounds at a much faster rate than conventional bolt-action rifles, which are permitted under licence and are normally operated manually with an up-and-back, forward-and-down motion.

The definition as set out in the Bill refers to the use of the energy from the propellant gas to extract the empty cartridge cases. This brings them much closer to self-loading rifles, which are already prohibited for civilian ownership under our firearms laws. The Government are therefore concerned about their potential for serious misuse and loss of life if they were to fall into the hands of criminals or terrorists.

--- Later in debate ---

[Earl Howe]

That is extremely helpful. I agree with my noble friend. That is exactly why the Government felt that a longer public debate about this issue was appropriate.

In the light of representations made by representative firearms bodies and others during the passage of the Bill, the Government sought advice from the National Crime Agency on whether heightened security standards governing the safe storage of these rifles would be sufficient to reduce the concerns expressed to us. In the light of the advice received, we took the view that we should look again at options for enhancing the security requirements associated with these particular rifles, rather than push for their prohibition under the firearms legislation at the present time. That is why the provisions to prohibit high muzzle energy rifles were removed from the Bill on Report in the Commons.

It is the Government’s view that we should not proceed with prohibition without considering further the views of the police, relevant shooting organisations and members of the public. As was announced in the Commons, it is the Government’s intention to launch a full public consultation on this and on the firearms safety issues that have arisen during the Bill’s progress. That will provide an opportunity fully to consider the views of all those involved or with an interest and to make a better assessment of whether enhanced security, as proposed by my noble friends, would be sufficient to address the risks set out by the police and the NCA.

Finally, Amendment 80D in the name of my noble friend Lord Attlee seeks to make a change to the definition of “rifle” in Section 57 of the Firearms Act 1968. The purpose of that definition is to make it clear that the ordinary definition of “rifle” includes carbines, a particular type of long gun firearm with a shorter barrel than a normal rifle, which is classified as a rifle for the purposes of firearms controls. As he helpfully set out, my noble friend’s purpose in tabling the amendment is to make it clear that when we talk about rifles, including for the purposes of Clauses 32 and 33, we are talking about hand-held rifles, specifically those that are fired from the shoulder. My noble friend is clear that he wants there to be no confusion with artillery or guns fitted to tanks. The Government are not persuaded that this change to the Firearms Act is necessary. “Rifle” will continue to carry its normal meaning. I understand that this might have been a concern had we been talking about rifled weapons, but we are not.

In the light of the explanations I have provided and my commitment to consider further Amendments 74 and 80A to 80C, I hope that my noble friend Lord Lucas will feel able to withdraw his amendment.

[Lord Kennedy of Southwark]

In my contribution, I made a point about the Government taking out amendments then putting them back in. Like the noble Baroness, Lady Williams, at Second Reading, the Minister referred to consultation. Today, the Minister told us that the Government remain very concerned about these weapons and their power. I worry that we will have the same problem as with the rogue landlords database. We wanted to make the database public through the Housing and Planning Act. We won the votes in the Lords, but they were overturned in the Commons. A year later, the Government changed their mind. Now, of course, the noble Lord, Lord Bourne, is saying, “The Government want to make the database available. We need primary legislation but we cannot find anything to tag it on to”. I worry that the Government will decide in the end that they want to ban these weapons but will say that they cannot find the legislation. Will the Government consider a precautionary power so that if they decide to, they could do that very quickly through secondary legislation?

[Earl Attlee]

My Lords, the noble Lord, Lord Kennedy, could achieve his objective by supporting my amendment, or at least the concept behind it, slightly more strongly.

--- Later in debate ---

[Lord Kennedy of Southwark]

My Lords, I will speak very briefly. The amendment is clearly a good addition. We certainly want consistency on medical checks, police checks and how people look at this issue. Without that, we will have problems. That cannot be right. We want to ensure that people’s suitability to have a weapon is assessed, and to know that this is done to the highest possible standards. We are all clear on that. Where we have inconsistency, we have problems. I support the amendment and I hope that the Minister will respond positively to the issues raised.

[Earl Howe]

My Lords, I am grateful to my noble friend Lord Shrewsbury for raising this issue. His amendment would place a duty on the Secretary of State to,

“within the period of six months beginning with the day on which this Act is passed, publish a report on how the Government’s Guide on Firearms Licensing Law (April 2016) is being implemented”.

The Home Office has published guidance on firearms licensing law for many years. The latest edition was published in 2016 and is currently undergoing revision to take account of recent legislative changes. It is an important document as it assists police forces in applying firearms law.

The Government want to ensure consistency of approach and high standards for police firearms licensing, and for this reason, we introduced the power to issue statutory firearms guidance in the Policing and Crime Act 2017. The new statutory guidance will apply to issues such as background checks, medical suitability and other criteria aimed at protecting public safety. We will be holding a public consultation shortly on the introduction of the new statutory guidance.

The amendment moved by my noble friend indicates a particular interest in the medical aspects of the firearms guidance, and in the engagement by GPs with the information-sharing arrangements which were agreed and introduced in 2016. These arrangements were brought in to help ensure that police would have sight of relevant medical information about certificate holders and applicants, to safeguard both licensed gun holders and other members of the public.

Counter-Terrorism and Border Security Bill

Debate between Earl Howe and Lord Kennedy of Southwark

3rd reading (Hansard): House of Lords
Tuesday 15th January 2019 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness, Lady Hamwee, and the noble Lord, Lord Judd. I beg your pardon. The noble Lord, Lord Kennedy, should speak first.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, I rise briefly to say that I support the amendments before us. I am pleased that the Government have listened to the proposal put by my noble friend Lord Rosser, who is unable to be with us today. I think that the noble Baroness, Lady Finlay, has raised an important issue as regards the medical terminology used, but the noble Earl has answered the point in terms of what can be expected. Generally, I support the amendments because they certainly clarify what we put forward in the first place and I thank the Government for listening in this case.

[Earl Howe]

My Lords, I am doubly grateful to all noble Lords who have spoken. I am sympathetic to the point made by the noble Baroness, Lady Hamwee, but only up to a certain point. Given that this is Third Reading, our starting point has to be that any further amendments to the Bill should be limited to those that are absolutely necessary to improve the drafting of the Bill in the light of the amendment agreed by the House at Report. I am not persuaded that adding to the list of exemptions from the offence properly falls within the category of amendments that we should now be contemplating at this late stage of the Bill, either today or when the Bill returns to the Commons to consider the Lords amendments.

However, I can assure the noble Baroness that the Government will keep the list of exempted purposes under review. The Bill now helpfully includes a power by regulations—a Henry VIII power to all intents and purposes—to add to the list of exempted purposes should it be appropriate to do so in the light of experience of operating the new offence. I am sure that officials in the Home Office will closely scrutinise the use of this power and will work with their colleagues in the Department for International Development and the Foreign and Commonwealth Office to determine if peacebuilding could usefully be added to the list of exempted reasons in the future.

But I need to make clear to all noble Lords that this is a nicety. In the absence of such an exemption the Government are clear that entering and remaining in a designated area for the purpose of engaging in peacebuilding would constitute a reasonable excuse. We have that all-encompassing provision, as the noble Baroness is aware, in the Bill. There is a problem associated with any approach that has within it a list of some kind, which is why we started out with a very short list indeed. Through our debates we persuaded ourselves that it would be helpful to augment the very short list that the Government started off with, but we have to ask ourselves where we stop.

I hope what I have said has offered some assurance to the noble Baroness and she understands that, while it would not be appropriate to add peacebuilding to the list of exemptions at the moment, that will not preclude us doing so in the future, should there be an operational imperative.

Counter-Terrorism and Border Security Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 17th December 2018 Lords Chamber

[Lord Kennedy of Southwark]

My Lords, Amendment 34 brings the attention of the House to an important issue that the noble Lord raised in Committee. I suspect from the response given then by the noble Earl, Lord Howe, to that short debate that, unless there has been a major shift in government thinking, this amendment will make no further progress. That is not to say that the noble Lord has not raised an important issue and deserves a considered response from the Government, which I am sure he will get.

At the heart of the amendment is an attempt to protect fellow citizens and, using a review, to look beyond the introduction of national identity cards, which was my party’s policy when in government. We also looked at the advances in science. We learn on a regular basis how advances in science have brought criminals to justice, particularly those who committed the most heinous crimes many decades ago. They thought they had got away with it, but advances in science brought them to justice.

The issues raised by the noble Lord are for a wider debate on a future date on issues of science and technology and how they are used to keep us safe, while being fully aware that criminals also seek to use advances in science and technology to commit crimes, to murder people and to threaten our country and its values. I am clear that the noble Lord is asking for a review and nothing more than that. We must keep things under review. What should the state do to keep us safe? What is being done now and is it proportionate? I look forward to the Government’s response and thank the noble Lord for raising these issues.

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, I am grateful to my noble friend Lord Marlesford for once again setting out his arguments in favour of introducing national identity numbers backed up by a national identity register containing biometric data of everyone in the country, or at least the adult resident population. I recognise the constructive intentions behind this amendment. My noble friend will recall that in Committee I stated that the introduction of a national identity number and register would be prohibitively expensive and would represent a substantial erosion of civil liberties. I know that I will disappoint him by saying that this remains the Government’s position. In consequence, I remain unconvinced of the need to carry out a review to determine this.

Any measure of the kind my noble friend is proposing would have to be evidence-based. We have seen no evidence that a national identity number or biometric database would offer greater protection against terrorism or greater control at the border. As I said in Committee, although a number of European countries have national identity numbers, these have not been able to prevent terrorist atrocities from being carried out—a point well made by the noble Baroness, Lady Manningham-Buller. Indeed, even were we to imagine any of those countries having a biometric database alongside national identity numbers, it is hard to see how this would have made any difference to the ability of the police to forestall those attacks.

Resources need to be directed to where they can be relied upon to add tangible value. I am of a view that the investment we are making in security, counterterrorism, better use of intelligence and cybersecurity is a more effective use of resources to keep the country safe against the ongoing threat from terrorism and hostile state activity. I know my noble friend takes a more sanguine view than many noble Lords about the retention of biometric data, but let us think about the debates we have had during the passage of this Bill. During debate on Schedule 2, the Government have been quite properly probed by noble Lords as to whether we have got the balance right on the retention rules for fingerprints and DNA taken from persons arrested for, but not charged with, a terrorism offence. I am clear that the balance is right but the Government accept that, where someone has not been convicted of an offence, there need to be appropriate restrictions on the retention of biometric data. I believe that this view is shared by the overwhelming majority of Members of your Lordships’ House.

Against the backdrop of those debates on Schedule 2, my noble friend’s proposition appears all the starker. He is advocating a national database containing the biometrics of the whole population with, presumably, the data being deleted only on the death of an individual. In considering such a proposition, it is instructive to remind ourselves what the Constitution Committee said about the then Identity Cards Bill in March 2005—that,

“the constitutional significance of the Bill is that it adjusts the fundamental relationship between the individual and the State … the Bill seeks to create an extensive scheme for enabling more information about the lives and characteristics of the entire adult population to be recorded in a single database than has ever been considered necessary or attempted previously in the United Kingdom, or indeed in other western countries. Such a scheme may have the benefits that are claimed for it, but the existence of this extensive new database in the hands of the State makes abuse of privacy possible”.

We do not believe the case against a national identity register has changed in the intervening years.

Having said that, I hope that I have been able to reassure my noble friend that the Government take the need to counter terrorism and maintain border security very seriously; indeed, we would not be debating the Bill today if this were not the case. Having again had the opportunity to debate the issue, and with the reassurance I have offered about the Government’s commitment to protect the public, I respectfully ask my noble friend if he would be content to withdraw his amendment.

Counter-Terrorism and Border Security Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Committee: 3rd sitting (Hansard): House of Lords
Monday 12th November 2018 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend Lord Marlesford for again setting out his arguments in favour of establishing a national identity register. I give way to the noble Lord, Lord Kennedy.

[Lord Kennedy of Southwark]

That is very kind. It is my fault. I thought that the noble Lord, Lord Paddick, was going to jump up—but obviously he did not in the end. The noble Lord, Lord Marlesford, raises an important point with his amendment and it is important that we have this discussion. We have moved on from identity cards—that was a policy that my party certainly at one time supported—but our data is held by all sorts of organisations. In many cases non-government organisations have more data and know more about us than government organisations. As the noble Lord said, his amendment calls only for the possibility and desirability of a review. In that sense, I hope that he will get a reasonable response from the noble Earl.

[Earl Howe]

Once again, I thank my noble friend for the amendment. As he will recall, in 2010 the Conservative-Liberal Democrat coalition decided to end the identity card scheme and the associated national identity register because it was expensive and represented a substantial erosion of civil liberties—and I have to tell him that this Government have no plans to revisit that decision. There are good reasons for that. We have not seen any evidence that a national identity number or database would offer greater protection against terrorism or greater control at the border. There is no evidence that it would have prevented the 2017 terrorist attacks in the UK, and it has not prevented the attacks in France and Belgium, where national identity registers are in place. If my noble friend’s concern relates to people entering this country from abroad, I simply say that the UK is not in the Schengen area: we retain full control of our border and can carry out the necessary checks on those entering the UK.

UK citizens’ biometric data that is already held is stored in different government databases for specific purposes, with strict rules on how they can be used and retained. We cannot foresee any benefits that would justify the expense of introducing a national identity number for everyone in the country linked to a centrally held database which, if it were biometric, would presumably hold the biometric data of all of us indefinitely—an idea which, as I mentioned earlier, Parliament has expressly rejected. Protecting the public and keeping citizens safe is a priority for the Government. We are making big investments to those ends. We believe that the investment that we are making in better security, better use of intelligence and cybersecurity is a more effective use of our resources.

NHS: Dermatology Services

Debate between Earl Howe and Lord Kennedy of Southwark

Wednesday 17th December 2014 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they are taking to improve dermatology services in the National Health Service.

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

My Lords, we want all patients with dermatological conditions to have access to high-quality, patient-centred services wherever they live. NHS England has set national standards to ensure that the needs of patients with the rarest skin conditions are met, the National Institute for Health and Care Excellence has published clinical guidance and quality standards to drive improvement for common conditions, and we are currently investing more than £9 million in dermatology research.

[Lord Kennedy of Southwark (Lab)]

My Lords, does the noble Earl believe that we have the balance right between the training that doctors and other healthcare professionals receive and the people they have to deal with, who have conditions ranging from minor skin complaints to serious skin cancers? If we do not have the balance right, what appropriate changes have to be made to make sure that patients are provided with the best possible care?

[Earl Howe]

My Lords, the Government have mandated Health Education England to provide national leadership on education, training and workforce development. Dermatology is currently a key part of the generalist undergraduate medical curriculum and a component of GP training. The General Medical Council requires that the undergraduate medical curriculum should provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including dermatology.

NHS: Funding

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 17th November 2014 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they intend to take to deal with the projected funding gap for the National Health Service in England.

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

My Lords, NHS spending has increased in real terms by £5 billion over this Parliament, underlining the priority the Government place on the NHS. NHS England’s Five Year Forward View set out a range of future scenarios. While NHS funding beyond 2015-16 will be a matter for the next spending review, the Government believe that changes in the way that services are delivered are essential, both to moderate rapid increases in demand and to improve efficiency.

[Lord Kennedy of Southwark (Lab)]

My Lords, I first declare an interest as president of the Society of Chiropodists and Podiatrists, a small trade union professional association that has members working in the health service.

Is the noble Earl aware of the concerns of the BMA and others that the recent changes to NHS structures, particularly funding structures, actually risk worsening health inequalities? What will the noble Earl do to ensure that that does not come to fruition?

[Earl Howe]

My Lords, tackling health inequalities is one of the major tasks facing NHS England. It is built not only into its mandate but into legislation, and we expect NHS England to address it at every level—both in the acute area and in the community. It is of course up to local commissioners to prioritise their funding, but we expect to see over the next few years a shift from care in the acute sector to care in the community, both to prevent acute admissions and to ensure that people stay healthy for longer in their own homes.

NHS: Ambulance Response Times

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 21st July 2014 Lords Chamber

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

My Lords, the NHS is responding to the majority of emergency calls in less than eight minutes, despite the number of these calls having increased by almost 14% from 2011-12 to 2013-14. The NHS has been supported to ensure that urgent and emergency care services are sustainable all year round and are ready for the pressures that winter can bring. Some £18 million will be allocated directly to ambulance service commissioners with a further £10 million to ensure sustained high performance.

[Lord Kennedy of Southwark (Lab)]

My Lords, FOI disclosures indicate that, since 2010, seven out of 10 of England’s ambulance trusts have increased their spending on commercial and voluntary ambulances. In London, spending has grown from £829,000 in 2010 to £9.2 million in 2013. Does the noble Earl share the concern of the president of the College of Emergency Medicine, Dr Clifford Mann, who has said that this is an issue which is causing deep concern and is,

“incredibly wasteful and potentially dangerous”?

[Earl Howe]

My Lords, patients have the right to a high-quality urgent and emergency care service whenever they call upon it, and we expect ambulance trusts to provide that. We are aware that independent or voluntary ambulance services may be used to support NHS ambulance services because they can help manage peaks in demand. Individual NHS ambulance services have got to ensure that 999 calls are attended by staff who are properly trained and adequately equipped. Indeed, since 2011 the providers of independent ambulance services have had to register with the Care Quality Commission, which monitors, inspects and regulates all services.

Criminal Justice and Courts Bill

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 14th July 2014 Lords Chamber

[Lord Kennedy of Southwark]

My Lords, at Second Reading I made reference to this and other clauses in this section of the Bill. I said I believed that the Government were attempting to,

“close the loophole that Professor Don Berwick identified in his review of the events that took place at the Mid Staffordshire NHS Foundation Trust”,—[Official Report, 30/6/14; col. 1620.]

although of course these amendments have much wider implications for a wider group of employees looking after vulnerable people, as the noble Baroness, Lady Finlay, outlined. These clauses were added late to the Bill during its passage through the Commons and I do not believe that they were looked at in any great depth there. As I said at Second Reading, it seemed odd to me that volunteers were not also included in these clauses, so I hope the noble Earl can address that in his reply.

We have wonderful people working in the caring professions here in the UK and we have wonderful volunteers helping people, but we must be clear that an abuser who exploits people could easily be in either group. Look at the horror story of the actions committed by Jimmy Savile. He was a volunteer at numerous establishments that were caring for vulnerable people. He was never an employee at any of the hospitals he visited but it appears he had power, influence and keys, and the system in place failed his victims for decades.

There is always the risk of unintended consequences and we need to be very careful that these clauses do not create a culture where healthcare professionals would have their normal, everyday clinical decisions open to criminal investigation, as the noble Baroness, Lady Finlay, and my noble friend Lord Beecham outlined. I do not for one minute believe that that is the intention of the Government but we have to be very careful that that is not what is created or what people believe has been created. So the amendment moved by the noble Baroness, Lady Finlay, is very welcome as she attempts to bring clarity to the issues and talks about,

“a serious and substantial departure from the duty owed by the care worker to the individual in all circumstances”,

that,

“causes the avoidable death of, or serious harm to, that individual”.

For the same reasons, my noble friend Lord Beecham and I tabled Amendment 33, which makes it clear that clinical medical judgment exercised by a registered medical practitioner is excluded.

These are very serious matters. I hope that the Minister can address the points that I have made about volunteers and the whole question of the sanctions being applied only to the most serious cases, as well as those about harming transparency and improving excellence in care made so well by the noble Baroness, Lady Finlay, and my noble friend Lord Beecham.

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

My Lords, I am grateful to the noble Baroness, Lady Finlay, and both noble Lords for tabling these amendments, which give me the opportunity to explain the Government’s thinking behind these important new offences of ill treatment or wilful neglect.

The Government are clear that the ill treatment or wilful neglect of users of health or adult social care services by an individual paid to provide those services is never acceptable. It is for this reason that we accepted the recommendation of Professor Berwick and the National Advisory Group on the Safety of Patients in England to introduce a new, clear and specific criminal sanction for those guilty of ill treatment or wilful neglect. However, Professor Berwick’s original recommendation proposed that the offence should apply only in the most egregious cases, where the ill treatment or wilful neglect caused “serious harm or death”—in effect, a harm threshold. Amendment 30 would create a similar threshold by requiring both a “serious and substantial” departure from a care worker’s duty towards the victim and that the conduct must cause serious harm or avoidable death.

When we were developing these new offences, we gave careful consideration to these very issues. For us, it raised a number of difficulties. For example, if you set a harm threshold, you are effectively saying that any ill treatment or wilful neglect that fails to cause sufficient harm to meet that threshold can be tolerated. Similarly, a situation could arise where two people are subjected to the same behaviours by the same care worker with the same intent, but one is much more seriously harmed than the other. I cannot see how it can be fair that the lesser harmed victim cannot have the protection of the new offence simply because they have been fortunate enough not to suffer really serious harm.

We exposed these very concerns in our consultation on the formulation of the offence earlier this year. The overwhelming majority of those who responded supported our proposal that the offence should focus on the conduct of the care worker, not on the outcomes for the victim. The way in which the noble Baroness’s amendment is framed puts the focus of the offence back on to outcomes. Someone could be subjected to wholly unacceptable ill treatment or wilful neglect but the perpetrator could have a defence if they could show that their conduct did not meet the “serious and substantial departure” threshold of the noble Baroness’s amendment, that the harm suffered was not sufficiently serious or that the victim’s death was unavoidable.

I also have some concerns about that phrase “serious and substantial”. Guaranteeing an objective and consistent interpretation seems to be fraught with difficulty. I fear that care workers could find themselves with less certainty about when the offence might bite, rather than more.

This brings me to the other point I want to make in respect of Amendment 30. It relates to the imaginary case study that the noble Baroness put before us. We recognise that it is important that there should be clarity around the types of behaviours which will be captured under this offence, and I understand the concern expressed by some that, without this, there is a risk that care workers could be less willing to be open and honest when things go wrong.

There are a number of issues to consider here. First, and most importantly, it must be remembered that the underlying premise on which the offence is predicated is that any neglect must be wilful; that is, deliberate, or else completely reckless as to whether the conduct will cause harm. In the case of ill-treatment, the courts have interpreted this as being ill-treatment that was intentional or reckless. I can assure the Committee that this is in practice a high bar to get over. Demonstrating that that is the case to the standard of proof required in criminal law will not be easy. Nor do we want it to be. We know that the vast majority of care workers would never dream of setting out to ill-treat or neglect those in their care. In the example given by the noble Baroness, a balancing of priorities is taking place. The offence would not cover that situation, but accidents and genuine mistakes do happen, and we have formulated the offence to make it clear that such situations will not be captured by it, no matter how serious the outcome may be for the patient or service user. Care workers need have no fear that being open and honest when such an accident or mistake occurs will place them at risk of prosecution under the offence.

Other safeguards will be in place, besides the fundamental protection given by the formulation of the offence itself. As with a whole range of criminal offences, the Code for Crown Prosecutors means that a public interest test will have to be met before a prosecution is brought. Moreover, even in the unusual event of an alleged victim or their family deciding to pursue a private prosecution, the care worker has protection. They can exercise their right to refer the case to the Director of Public Prosecutions for scrutiny, who will have discretion to take over the case and close it down.

With regard to Amendments 31 and 32, I am aware that in his remarks at Second Reading the noble Lord, Lord Kennedy, raised the issue of whether the ill-treatment or wilful neglect care worker offence should include volunteers. We considered that very carefully during the development of these offences. Indeed, we again addressed the issue directly in the consultation in March. We know, of course, that it is not only formally employed care workers who can ill-treat or wilfully neglect those in their care. Sadly, it can happen in many situations, as the noble Lord rightly pointed out, but his amendments would bring a vast number of people within scope of the offence because “volunteer” has a wide interpretation. Family carers; people who provide assistance to friends or neighbours by, for example, taking them shopping or to medical appointments; people who help out in nursing homes at meal times; volunteer patient transport drivers—all such people, and more, would be caught by the amendments.

Our view is that there is a significant difference between those employed to provide these services and those who do so voluntarily. Paid arrangements give rise to a formal obligation to provide services to a reasonable standard. That represents a significant and important difference from informal arrangements, where there is no element of prescribed obligation. I am sure that it is not the intention to make subject to the criminal law all those people who, from the goodness of their hearts, are willing to give of their time and effort to help others.

I would add that we do already have in place arrangements to provide safeguards in such situations. For example, the Care Act 2014 includes provisions explicitly relating to the powers and duties of local authorities to assess and meet the needs of informal carers, such as friends and family carers. Moreover, where an individual is volunteering in, for example, a day centre or nursing home, there are nowadays statutory duties on the operators of those facilities to carry out appropriate checks on the suitability of the individual to do that work and ensure that they receive training in health and safety, safeguarding and other procedures necessary to provide protection for the users of that service. It is no longer the case that someone could just walk in off the street, offer their services and come immediately into contact with vulnerable patients or service users.

It is the Government’s view that these arrangements provide adequate safeguards in these specific circumstances in a far more proportionate way than applying this offence would do. The latter would also risk putting people off volunteering for fear of prosecution, however unlikely that prosecution might be in practice.

I turn finally to Amendment 33. Although I can readily understand the motive behind it, I have to say that I cannot agree that it is necessary, even on the “for the avoidance of doubt” basis which the amendment adopts. We have been clear from the outset that matters involving the exercise of informed clinical judgment by any healthcare professional, not just registered medical practitioners, should be outside the scope of these ill-treatment or wilful neglect offences. We addressed this explicitly during the consultation exercise and the offences have been formulated to ensure that this is the case. I reiterate my earlier remarks about the key element being that of wilfulness. There has to be intent to ill treat or neglect, or recklessness as to whether the perpetrator’s actions or omissions will cause ill treatment or neglect, for the offence to bite. For a surgeon making decisions about the relative priorities of two patients or the best course of treatment for a particular condition, the implications and effects of their decisions will be uppermost in their minds. They will be all too aware that their decision may cause further delay or discomfort in the short term, even though the longer-term outcome may be better, but in taking these sorts of decisions healthcare professionals are not deciding deliberately to ill treat or neglect. They are taking decisions in what they believe to be the best interests of the patient, taking into account other priorities. I cannot see how a doctor who can demonstrate that they have followed appropriate clinical practice and professional standards in exercising their clinical judgment would fall prey to this offence.

--- Later in debate ---

[Lord Kennedy of Southwark]

My Lords, I will be brief. This amendment was tabled by me and my noble friend Lord Beecham. It seeks to close what we thought was a loophole in the clauses that the Government introduced here. It seeks to introduce a criminal liability on a director of a corporate body or an incorporated association for failing to sack employees who have committed an offence of ill treating or wilfully neglecting an individual in their care. That seemed to us to be a serious omission on the part of the Government. As I said in my contribution on the previous group, these clauses did not get a huge amount of scrutiny in the other place; they were added very late. We think that this is a serious omission and that the Government should look at it very carefully. The amendment is a probing one, designed to get a response from Government at this stage. We may want to come back to it on Report, but I would be grateful if the Minister could give us his views on this. I beg to move.

[Earl Howe]

My Lords, I am grateful to the noble Lord for giving me the opportunity to deal with this important issue of individual liability, where a care provider offence has been committed. Professor Don Berwick was very clear, in his recommendation on the creation of the offence, that it should apply to organisations providing care as well as to individual care workers. We completely agree with that principle; however, we have deliberately formulated the offence in respect of care provider organisations somewhat differently from the care worker offence, for two reasons. First, we wanted to try to ensure that the care provider offence could be applied to an organisation as an entity in its own right, without the need to first identify and convict an individual of sufficient seniority within the organisation’s management hierarchy so that they could be seen as the controlling mind of the organisation. That is why Clause 18 is modelled on the corporate manslaughter offence. Secondly, we wanted to ensure that the focus of the care provider offence was unequivocally on the provider organisation as a whole. We deliberately chose not to create a situation where attention could be deflected on to an individual such as a director when the offence had been committed by the organisation’s board acting as an entity, not as individuals. The intention is that the care worker offence will apply in respect of individuals, with the care provider offence capturing organisational failings that have allowed ill treatment or wilful neglect to occur.

It seems to me that this amendment would risk creating exactly that possibility of deflection away from the organisation by specifying that in certain circumstances an individual director of a care provider organisation is to be treated as a care provider in their own right, irrespective of the activities of the remainder of the board. Moreover, given the way the care provider offence is structured, I have to say that I think there would be some difficulties in making out the elements of it in relation to an individual director. For example, I fear that the historical difficulties in extrapolating the existence of a relevant duty of care from the organisation as a whole to an individual director could also arise here, and if that duty cannot be demonstrated then the offence cannot apply in any circumstances.

Nevertheless, I reassure the noble Lord that it is the Government’s policy to strengthen corporate accountability in health and social care and to hold individuals to account where they are responsible for failings in care. It is for this reason that we are introducing a fit and proper person test for directors of care providers. Directors will also be liable for the care worker offence when committed by them. Also, Clause 22(2) to (5) clarifies that a conviction for the care provider offence would not preclude an organisation being convicted for a breach of the proposed new fundamental standards for health and social care or a health and safety offence on the same facts, if this were in the interests of justice. It would therefore also be possible to convict an individual on a secondary basis for such an offence under provisions such as Sections 91 and 92 of the Health and Social Care Act 2008 or Section 37 of the Health and Safety at Work etc. Act 1974. This ensures that existing liabilities are not reduced as an unintended consequence of the new offence.

I am afraid that it seems to me that the noble Lord’s amendment would be in direct contradiction of the Government’s position on how the care provider offence should be applied. I am therefore unable to accept it. I hope that the explanation I have given will enable the noble Lord to withdraw the amendment.

[Lord Kennedy of Southwark]

I thank the Minister for his explanation. I shall reflect on it. My only intention is to protect people and staff and that, where people or companies have done wrong, we deal with them properly. The points that he outlined may provide sufficient protection and guarantees. I beg leave to withdraw the amendment.

National Health Service: Hospital Beds

Debate between Earl Howe and Lord Kennedy of Southwark

Wednesday 11th June 2014 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what is their response to the Organisation for Economic Co-operation and Development’s report on the number of hospital beds per person in the United Kingdom in comparison to Europe.

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

My Lords, numbers of hospital beds per person do not provide meaningful comparisons of good-quality care. Our NHS is making efficient use of its beds by judging patient demand and managing bed numbers accordingly. In the NHS, as in Europe, the number of beds has reduced because progress in medical technology is enabling more patients to be treated and discharged on the same day, and average length of hospital stay has reduced over the past decade.

[Lord Kennedy of Southwark (Lab)]

My Lords, France has twice the number of beds we have here in the UK while Germany, I think, has nearly three times as many. We are now seeing dangerous levels of overcrowding, with greater risk of infection due to beds not being cleaned properly in time. Does the Minister not see that this is very reminiscent of the previous time his party was in office and that the NHS is just not safe in their hands?

[Earl Howe]

No, in a word. First of all, it is very important to compare like with like. A number of other health systems have completely different models from our own. For example, they still have large, long-stay hospitals for people with mental health problems and older people. The NHS has a strong primary care tradition and is committed to providing care in the community. Some of the statistics that have been collated by the OECD include systems in Europe where nursing home beds are included in the figures or indeed the private sector. We are seeing healthcare infections at their lowest ever levels. There have been dramatic falls in both MRSA and C. diff infections since 2010.

Drug Companies: Medical Trials

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 24th February 2014 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they intend to take in respect of drug companies that withhold the results of medical trials.

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

My Lords, companies are legally required through the marketing authorisation application process to provide the relevant regulatory authority with all information for evaluation of a medicine. This includes clinical trial results which are both favourable and unfavourable. The Medicines and Healthcare products Regulatory Agency has powers to take action where particulars supporting an application are incorrect or where the company has failed to inform authorities of new information that would influence the evaluation of the benefits and risks of the product.

[Lord Kennedy of Southwark (Lab)]

My Lords, the number 1 risk on the Government’s national risk assessment for civil emergencies, ahead of both coastal flooding and a major terrorist incident, is that of pandemic influenza. Is the noble Lord concerned that Tamiflu, which is supplied for use in a flu epidemic, may not be as effective as was once thought? Is he concerned that many large-scale trials of Tamiflu have not been publicly reported?

[Earl Howe]

My Lords, during the course of last year, the Government gave detailed evidence to the Science and Technology Committee on the issue of data provision in respect of clinical trials. The committee made a number of helpful recommendations on the removal of barriers to transparency. In our formal response, we set out how we would work to achieve the aims of greater transparency. In the light of that response, the Government are looking into the recommendations of the PAC report on the stockpiling of Tamiflu and access to clinical trials data, published in January. We will give our formal response to the report next month.

NHS: Accident and Emergency Units

Debate between Earl Howe and Lord Kennedy of Southwark

Tuesday 26th November 2013 Lords Chamber

[Earl Howe]

I shall say more on Lewisham in a moment. This is a time-limited debate, and I hope that I may be allowed to conclude my speech.

The principles that I have just enunciated are further enshrined in the four reconfiguration tests first set down to the NHS in 2010, which all local reconfiguration plans should demonstrate. These are support from GP commissioners, strengthened public and patient engagements, clarity on the clinical evidence base, and support for patient choice.

Our reforms allow strategic decisions to be taken at the appropriate level. We are enabling clinical commissioners to make the changes that will deliver real improvements in health outcomes. That is the purpose of reconfiguration. Furthermore, local commissioners proposing significant service change should engage with NHS England throughout the process to ensure that any changes are well managed strategically and, crucially, that they will meet the four tests that I have just referred to.

Given the scale of change across the health system, it is important that local NHS organisations are now supported when redesigning their health services. We are working with our national partners, NHS England, the Trust Development Authority and Monitor, on the continuing design of the interfaces, roles and responsibilities of organisations in the new system. For example, stroke care in London, which has been centralised into eight hyper-acute stroke units, now provides 24 hours a day, seven days a week acute stroke care to patients regardless of where they live. Stroke mortality is now 20% lower in London than in the rest of the UK, and survivors, with lower levels of long-term disability, are experiencing a better quality of life. That is why we must allow the local NHS to continually challenge the status quo and look for the best way of serving its patients.

I turn specifically to accident and emergency departments and points raised by a number of noble Lords. The NHS is seeing more than 1 million additional patients in A&E compared to three years ago and, despite this additional workload, it is generally coping well. I can say to the noble Lord, Lord Kennedy, that we are meeting our four-hour A&E standard and have done since the end of April. The latest figures show that around 96% of patients were admitted, transferred or discharged within four hours of arrival. There are now 500 more A&E doctors in the NHS than there were under the previous Government. Trusts expect to hire 4,000 more nurses, due to the Francis effect, as a result of the public inquiry that the party opposite decided not to pursue.

I have heard many noble Lords describe the current situation as a crisis. I do not share that perception. The NHS is performing well under pressure. Dealing with an extra 1 million patients in A&E does, however, mean that we must look at the underlying causes. Providing urgent and emergency care for people is not just about A&E. It is about how the NHS works as a whole and how it works with other areas such as social care, and how it faces up to the challenge of an ageing population of more people with long-term conditions. Therefore, the Government are taking action to respond to the immediate winter pressures and, looking longer term, we will tackle the unsustainable increasing demand on the system.

NHS England, Monitor and the Trust Development Authority, working with ADASS, have been working together on the A&E improvement and winter planning since May. Staff across the service have worked extremely hard to prepare this year and are committed to making sure that their plans are robust and that patients will receive the services they should expect and deserve. This process was started earlier and is more comprehensive than in previous years. We are determined to do everything we can for the NHS to continue providing high-quality care to patients throughout the winter, which is why we are backing the system with additional funds in the short term to help local areas prepare for and manage additional pressure during the winter.

We have allocated £250 million of funding to NHS England to help cope with winter pressures, with another £250 million for 2014-15. There will also be an extra £150 million from within the NHS England existing budget this year to ensure that everywhere receives a fair share of the funding.

It is, however, clear that the current situation is unsustainable in the long term. That is why we asked Sir Bruce Keogh to lead a review of urgent and emergency care with the first phase published on 13 November, which was also roundly welcomed by the system, including, as noble Lords will be aware, by the NHS Confederation and the Royal College of Surgeons. There will be a further update in spring 2014.

The review is aimed at delivering system-wide change, not just in A&E but across all health and care services in England by concentrating specialist expertise where appropriate to ensure that patients with the most serious illnesses and injuries get the best possible care and ensuring that other services, such as primary and community care, are more responsive and delivered locally. This will mean that people will understand how to access the most appropriate treatment in the right place as close to home as possible.

The noble Baroness, Lady McDonagh, the noble Lord, Lord Patel, and others referred to NHS 111. The introduction of the NHS 111 service is part of the wider revisions to the urgent care system to deliver a 24/7 urgent care service that ensures people receive the best care from the best person in the right place at the right time. This is not only government policy; it was a policy fully signed up to by the previous Government and initiated by them. Although NHS 111 has had a difficult start, we have backed the service with a £15 million fund to support it over the winter. NHS 111 now deals with more than half a million calls a month, and 97% of them are answered in under a minute. The first phase of the urgent and emergency care review sets out a significant expansion and enhancement of the NHS 111 service so that patients know to use the 111 number first time, every time, for the right advice or treatment.

NHS Direct, which was referred to by the noble Baroness, Lady McDonagh, and the noble Lord, Lord Patel, will continue to provide 111 services to patients until alternative arrangements can be made by commissioners. The transfer of NHS Direct’s 111 services is progressing well.

Together with NHS England, we are putting together a strategy focusing on the people who are the heaviest users of the NHS, vulnerable older people and those with multiple long-term conditions. Here I am addressing particularly the points raised by the noble Lords, Lord Patel and Lord Kakkar, and my noble friend Lord Selsdon. The vulnerable older people’s plan will focus on improving out-of-hospital care services centred on the role of general practice in leading proactive, person-centred care within a broader team and is due to be published later this year. A key element of the plan is the provision of joined-up care for vulnerable older people, spanning GPs, social services, and A&E departments themselves, which is overseen by an accountable GP. The aim of proactive care management is to help keep people healthy and independent longer.

A number of noble Lords referred to the workforce challenge. Health Education England is working with stakeholders on a number of innovations to help alleviate the workforce problems in emergency medicine. Through the Emergency Medicine Workforce Implementation Group, Health Education England will work to develop alternative training routes for emergency medicine and a range of mid-level non-doctor clinician posts. They will work with NHS England on potential workforce and training requirements.

I would like to address the point made by the noble Lord, Lord Kennedy, about Lewisham. Lewisham’s A&E is not closing. The TSA proposals were a response, as he is well aware, to a very difficult, long-standing challenge facing south London. The new Lewisham and Greenwich NHS Trust must now work with its commissioners and community to deliver a clinically and financially sustainable future. As regards north- west London, which the noble Lord, Lord Dubs, referred to, the Secretary of State has endorsed the recommendations of the Independent Review Panel, and it is now for CCGs in north-west London, working with NHS England, to take this forward. The decisions here were supported by all the commissioners in the area and all the medical directors in the trusts and all but one of the relevant local authorities.

My noble friend Lady Manzoor spoke about public awareness and engagement. I agreed with a lot of what she said. Through our reforms we have strengthened local partnership arrangements through health and well-being boards. These will provide a forum where commissioners of services, local authorities and providers can discuss the future shape of health services. As I have said, local cases for clinical change should be driven from a local level. We know that these reconfigurations work best when a partnership approach underlies them.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. However—and this is the thought which I leave with your Lordships—those decisions are made only when the local NHS, working with local people and local authorities, is convinced that what it proposes is absolutely in the best interests of its patients.

[Lord Kennedy of Southwark]

My Lords, before the Minister sits down—

NHS: London

Debate between Earl Howe and Lord Kennedy of Southwark

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

Largely, the judgment by NHS England will be made by local area teams—but not in isolation. It has to be a collaborative exercise, which is my overall answer to my noble friend’s second question. The successful integration of services must depend on close collaboration between the different constituent parts of the NHS but also with adult social care and local authorities. It is striking that already we are seeing this happening in north-west London, as we are in many other parts of the country. For the system to work as we want it to, all the constituent parts need to be effective and efficient. The integration of services, which is one example of how the NHS can become more productive in the future, as well as more clinically effective for patients, is an essential way of ensuring that we have a sustainable NHS in the future.

[Lord Kennedy of Southwark (Lab)]

Will the noble Earl confirm, first, that there will be no further appeal in respect of Lewisham hospital after the decisions of two courts; and, secondly, that there will be no attempt to change the law in respect of Lewisham hospital? What lessons have been learnt by the noble Earl and his ministerial team that they can apply to what is going on in north-west London? We are all aware that the Minister has never visited Lewisham hospital; the last ministerial visit was in May 2010. Will he tell the House—if not from the Dispatch Box, then by writing and placing a copy in the Library—when Ministers last visited the hospitals in north-west London that have been mentioned?

[Earl Howe]

I can certainly find out the answer to that last question. As regards the appeal, we have only just received the judgment, as the noble Lord will know. But that is only the outline judgment. We have not received the full text. It is important that we read that and inwardly digest it before we finally decide on the way forward. The lessons of Lewisham are very clear. I confirm that we shall not be legislating around Lewisham and the recent provisions in the Care Bill were not retrospective, as the noble Lord is aware. I have not personally visited Lewisham, which is clearly an omission that I should at some point rectify, but it is important for me to put on the record that the concerns expressed by the people of Lewisham are, and have always been, entirely understandable. Ministers greatly respect the wish of local residents to see their hospital thriving, as it always has in the past. Nevertheless, as I said earlier, Lewisham and Greenwich now have a challenge. There is a financial issue that needs to be addressed and I hope that commissioners and providers, acting together, can do that successfully over the months ahead.

NHS: Out of Hours Service

Debate between Earl Howe and Lord Kennedy of Southwark

Tuesday 26th March 2013 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what steps they are taking to ensure high-quality out of hours GP medical care is in place.

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

My Lords, people are entitled to expect high-quality health services at any time of day or night. All out-of-hours services must be delivered according to national quality requirements, and local providers have a legal requirement to make sure that high-quality out-of-hours care is in place. If this is not happening, we expect action to be taken immediately to improve services.

[Lord Kennedy of Southwark]

The publication of the Patients Association survey and the comments from the BMA highlight that many GP practices are struggling to cope with a rising workload as resources are falling. Does the Minister agree that, with many other changes taking place across government on 1 April, we are in a dangerous and worrying period for people who find themselves in need of health and related services?

South London Healthcare NHS Trust

Debate between Earl Howe and Lord Kennedy of Southwark

Thursday 31st January 2013 Lords Chamber

[Earl Howe]

My Lords, perhaps I may put on the record my own recognition that Lewisham hospital is an excellent hospital. There is no question about that and there has never been any question about it. The hospital provides good care for local people and it is highly valued. Only this afternoon I had one noble Lord from my own Benches telephoning me to tell me of his personal experience of Lewisham hospital and its excellent maternity care.

The noble Lord asked me two specific questions. He quoted the Statement where at one point it was made clear that a non-admitting urgent care unit at Lewisham would not improve patient care. That is the precise reason why Sir Bruce Keogh recommended something different; namely, an admitting A&E unit with 24/7 cover. He looked at the recommendation and was not satisfied with it in terms of risks to patients. I hope that that is helpful to the noble Lord because I think he misconstrued what I was saying.

On the question of risk, any set of assumptions that relies on hypotheses around patient flows in the future and clinical referral decisions has to be, by its very nature, uncertain. It is the view of the trust special administrator and the review of my right honourable friend that the assumptions underpinning these decisions are reasonable, and that was backed up by Sir Bruce Keogh. But the noble Lord has a point because the implementation of these recommendations is going to be key, and that is why the TSA has recommended a programme board to oversee the implementation of these recommendations over the next few years. It is absolutely essential that commissioners and the providers in that area buy in to these proposals. We believe that they will, but it is important that if the financial risk is to be minimised, we get as close as possible to the forecast and predictions that the TSA has set out.

[Lord Kennedy of Southwark]

My Lords, I want to draw the attention of noble Lords to my declaration of interests in respect of Lewisham hospital. I would like to pay tribute to the staff of the hospital who serve the community so well, and the local residents involved in the save Lewisham A&E campaign for the fantastic campaign they have run. It is supported by local GPs, local businesses and Millwall Football Club. We have a great hospital that is supported and valued locally. In the past two years the ConDem Government have spent £12 million on funding the refurbishment of the Lewisham A&E unit. We have a fantastic children’s A&E unit. That refurbishment was finished only in April last year, yet today they have downgraded our maternity and A&E services to pay for the failings of a neighbouring trust. Will the noble Earl agree to publish all of the legal advice the Government have received in respect of the decision they have taken today? Can he also tell the House if he has ever visited Lewisham Hospital? I am glad he agrees that it is actually a great hospital. If he has not visited it, will he confirm that he is willing to do so at the earliest opportunity, in the light of his responsibilities for quality and urgent care? Further, can he tell the House what he would have spent the £5 million on?

[Earl Howe]

My Lords, the facilities at Lewisham A&E are indeed very good, and a lot of money has been spent on them. I would hope that the noble Lord will therefore welcome the fact that we are keeping an A&E department open. That department will be comparable with many other A&E departments around the country. It will be a fully functioning department other than for those difficult and critical cases which, by common clinical agreement, need more specialist care where clinical resources can be concentrated. That is increasingly the view of senior clinicians in the royal colleges around London.

The other point that the noble Lord may need to factor in is that many of the services in an area of the country, whether it is London or anywhere else, depend on networks. What we envisage for Lewisham and Woolwich, taken together, is that they will be part of an active network, with staff rotating between the two. There will be an understanding of what each hospital is capable or incapable of doing, and an understanding on the part of ambulance trusts as to where best to take patients. We have already seen the results of that policy. This is not idle speculation. There is proof positive from the decision to decrease the number of acute stroke units in London from 32 to eight; the mortality rate has more or less halved since that decision was taken. So there is clear clinical underpinning.

I note the noble Lord’s understandable regret that Lewisham has been caught up in the problems of its neighbour. However, as the Statement made clear, the people of Lewisham also depend on the services of South London Healthcare Trust, so to say that there is somehow an island of patients who simply go to Lewisham would not be fair.

The noble Lord asked me about publication of the legal advice. I can confirm that the decision of my right honourable friend has been taken in the light of consideration of the legal issues and advice to him that it is lawful. The normal position is that the Government do not publish legal advice; there is a long-standing precedent. However, I can tell him that the legal advice backs up his decision.

Diabetes

Debate between Earl Howe and Lord Kennedy of Southwark

Thursday 10th January 2013 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they are taking to reduce the number of amputations due to diabetes.

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

My Lords, foot complications of diabetes are usually preventable. Early identification and prompt treatment prevent amputations. NICE guidelines recommend annual foot checks, which are included in the quality and outcomes framework for general practitioners. NHS Diabetes has established regional diabetes footcare networks. People with vulnerable feet require expert protection, while those with problems need urgent specialist care. Local national health services are responsible for commissioning podiatry services and multidisciplinary specialist footcare teams for people with diabetes according to local needs.

[Lord Kennedy of Southwark]

I draw the attention of the House to my declaration of interests in respect of Diabetes UK. One hundred and twenty-five amputations take place each and every week in England alone, and 80% of those are preventable. The record of the Department of Health is not good; the figures are going up, not down. If I asked this question in a year’s time, what progress does the Minister expect that his department would have made to reverse that trend?

[Earl Howe]

The noble Lord is absolutely right that this is a major public health issue and one that impacts very seriously on the health and well-being of individuals, so it is a priority for us. We are committed to reducing the number of avoidable amputations among people with diabetes. In fact, progress is being made: although the number of amputations is going up, the rate is falling. However, we are under no illusion that this will be a growing problem because of the growing number of people with diabetes. All our work on improving completion of the NICE nine care processes for people with diabetes and improving timely access to specialist diabetic footcare multidisciplinary teams will support that aim, and the Diabetes UK Putting Feet First campaign has real potential to improve awareness of foot complications in diabetes.

NHS: Reform

Debate between Earl Howe and Lord Kennedy of Southwark

Monday 6th June 2011 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government how they will ensure that their proposals for the reform of the National Health Service do not lead to a break up of the service.

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

My Lords, the Government are currently pausing to consider possible improvements to the Health and Social Care Bill. However, our proposals will reinforce the NHS as an integrated system, joining up working between the NHS, public health and social care locally. A new NHS commissioning board will set national commissioning guidelines promoting greater consistency. All NHS bodies and providers of NHS services will remain bound by the NHS constitution, and the Secretary of State will remain accountable overall.

[Lord Kennedy of Southwark]

My Lords, I thank the Minister for his reply. Does he understand the issue of low morale within the NHS that is being caused by these proposals, as well as the concern and worry among patients? Let us be clear that the record of the Conservative Party on the NHS, now supported by the Liberal Democrats, is a great worry to citizens and to anyone who values and cherishes this House.

[Earl Howe]

My Lords, I accept that a number of aspects of the Government’s proposals have caused concern in many quarters, and that is why we have chosen to pause in order to listen and reflect on those concerns. As I have said, we will be bringing forward proposals shortly to improve the Bill. I hope that those proposals will meet with widespread acceptance. I think that it is fair to say that it is not the main principles which the Government have laid out that have been the subject of controversy but rather the detail and the implementation, which we are looking at most closely.

Health: Preventable Sight Loss

Debate between Earl Howe and Lord Kennedy of Southwark

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, I quite agree with the noble Lord that sight tests allow an invaluable opportunity to review all aspects of eye health, including investigations for signs of disease. The uptake of NHS sight tests is, I am glad to say, increasing. As regards messaging, the department has worked, and continues to work, with NHS Choices on the development of articles and videos to raise the profile of visual health and promote the importance of regular sight tests. Looking ahead, and as part of their new public health responsibilities, we propose that local authorities will have primary responsibility for the health improvement of their local populations. They could well choose, if they wished, to promote eye health and work to improve the wider aspects of health and lifestyle that contribute to improved eye health. We are currently consulting on the public health outcomes framework, as I am sure the noble Lord is aware. We are also consulting on the scope of the evidence base for public health and the interventions that will work best.

[Lord Kennedy of Southwark]

Does the noble Earl agree that one of the groups of people at risk of developing eyesight loss is people with diabetes? As part of the increased work to deal with diabetic retinopathy, should not everyone at risk have, in addition to their normal eyesight tests, annual eye screening? This service must not be cut but be expanded, as early detection and prevention is right for the patient, their family and ultimately the taxpayer, as thousands of pounds that would otherwise have to be spent on dealing with preventable complications will be saved.

[Earl Howe]

My Lords, the noble Lord makes some extremely important points. This is a good news story and very good progress has been made; more people with diabetes are being offered screening for retinopathy than ever before, and to higher standards. More people are being offered screening now than when the screening programme was announced in January 2003. At that time, 1.3 million people with diagnosed diabetes in England were being screened. The latest figures, for December 2010, show that 2.21 million people were offered screening.

Health: Influenza Vaccination

Debate between Earl Howe and Lord Kennedy of Southwark

Thursday 20th January 2011 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what plans they have to review the advice on the availability of the flu vaccination.

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

My Lords, the Government’s policy on flu vaccination is informed by the expert advice of the Joint Committee on Vaccination and Immunisation. The JCVI last met on 30 December to review the latest evidence. The committee decided that there were no grounds to change the risk groups that are offered vaccination and recommended that efforts be focused on maximising vaccine uptake among all those in the risk groups. As with all vaccination programmes, the JCVI will keep this matter under review.

[Lord Kennedy of Southwark]

I thank the noble Earl for his response. The latest figures show that approximately 780 people are in critical care, and there is still a long winter ahead of us. What steps are the Government taking in case the numbers continue to rise? Secondly, what steps have been taken to address the reported shortages of flu vaccines in some areas, with GPs and pharmacies running out of stocks?

[Earl Howe]

My Lords, the noble Lord’s figures are slightly historic. Figures due to be published today will give a better picture. I spoke yesterday to the Chief Medical Officer, who told me that the rates to be published at 2 pm today will show a decrease from the figure that he mentioned. There has also been a further decrease since the new figure and it appears that the worst is over as regards the incidence of flu. On the second question, there have been reports of vaccine shortages. We have taken steps to address that by releasing stocks of the monovalent H1N1 vaccine from our national stock. That system is working well. There is an online ordering system, which GPs are using. They are also ordering stock directly from the manufacturers and we understand that that system is working well, too. The reports of shortages are, I hope, a matter of history.