(4 years, 7 months ago)
Lords ChamberMy Lords, this was recently tested in court and the High Court found that the police were operating within the law, so we do not feel that there is any need for further legislation at this point. However, I understand that the decision is being appealed, so that is probably about as far as I can go today.
My Lords, I confess to being rather baffled by the Government’s agreement to this. Only in September, the Metropolitan Police Commissioner said in the context of live facial recognition technology that the UK risks becoming a
“ghastly, Orwellian, omniscient police state”
with
“potential for bias in the data or the algorithm.”
The Information Commissioner expressed deep concern in her last report and in her reaction to the Met’s deployment. She said:
“We reiterate our call for Government to introduce a statutory and binding code of practice for LFR as a matter of priority.”
The Home Office’s own Biometrics and Forensics Ethics Group has questioned the accuracy of live facial recognition technology and noted its potential for biased outputs and biased decision-making on the part of system operators. The Science and Technology Committee recommended a moratorium in its report of just over a year ago. When the Minister responded to me in an Oral Question about the watchlist, that was not reassuring either: the watchlist is extensive. Is the answer not a moratorium as a first step, to put a stop to this unregulated invasion of our privacy? I commend to the Minister in that context my Private Member’s Bill, due to have a First Reading next week.
My Lords, I wish the noble Lord’s Private Member’s Bill all the very best when it comes to your Lordships’ House—without pre-empting, obviously, its outcome.
As for inaccuracy, LFR has been shown to be 80% accurate. It has thrown up one false result in 4,500 and there was no evidence of racial bias against BME people. I should point out that a human operative always makes the final decision; this is not decision by machine.
(4 years, 10 months ago)
Lords ChamberThe noble Earl will appreciate that I cannot discuss individual cases, but I hope that he will also be aware that on 8 August the Government announced a new fast-track system for top scientists and researchers, and the numbers are uncapped. Overall, our visa grant rate is 87%, and 98% of tier 2 applications are granted.
My Lords, many creative organisations have been forced to use standard visitor visas or the PPE route, despite their preference for the security of the sponsored tier 5 system. Will the Government accept the recommendations of the Creative Industries Federation and ensure that any new immigration proposals reduce the administration and costs for tier 5 certificates and enable artists to undertake multiple engagements with different organisations while they are here on a temporary stay?
I appreciate the point the noble Lord makes. He has made it before, particularly on the route from Ireland. There is a concession under the tier 5 route for creative workers and entertainers for non-EEA and non-visa nationals. That concession, as he knows, allows them to enter the UK without obtaining entry clearance. But he will also know that new guidance is now out for those multiple applications. Indeed, not only has the route through Ireland been temporarily clarified since February this year, but we plan to make secondary legislation changes to the Immigration (Control of Entry through the Republic of Ireland) Order 1972 so that non-EEA and non-visa nationals who hold a valid COS not only will receive deemed leave but will not have restrictions on paid entertainment.
(4 years, 10 months ago)
Lords ChamberTo ask Her Majesty’s Government what plans they have to regulate the use of facial recognition technology.
My Lords, on behalf of my noble friend Lord Clement-Jones, and with his permission, I beg leave to ask the Question standing in his name on the Order Paper. I remind the House of my interest as chair of Big Brother Watch.
(5 years, 1 month ago)
Lords ChamberTo ask Her Majesty’s Government what assessment they have made of the (1) imposition, and (2) operation, of public spaces protection orders.
My Lords, we introduced public spaces protection orders, or PSPOs, through the Anti-social Behaviour, Crime and Policing Act 2014 to enable local councils to tackle anti-social behaviour in public spaces. The Home Office does not centrally collate data on the number issued. Our statutory guidance makes clear that PSPOs should be used appropriately and proportionately. The effect of the powers is kept under review through a national anti-social behaviour strategic board.
My Lords, the Minister was very constructive the last time we discussed these issues and helped to change the statutory guidance on PSPOs. However, they are increasing at a faster rate than ever and continue to target homeless people, with bans on begging and rough sleeping. Will the Government now admit that the statutory guidance has not achieved its intended aim? Is it not now necessary to enforce the guidance properly, give better means of appeal against the imposition of a PSPO, or change the original powers?
I thank the noble Lord for his kind words. He is absolutely right: following his concerns and those of the noble Lord, Lord Kennedy of Southwark, 18 months ago we published the updated statutory guidance to make it clear that PSPOs should not be used to target people based solely on their being homeless. As I said, they should be used proportionately and appropriately.
(5 years, 6 months ago)
Lords ChamberIf the noble Lord reviews what I said in Hansard, he will see that I talked about two particular issues highlighted by the Migration Advisory Committee.
In addition to listening for the reaction of the Labour Front Bench in this House, from the Government I am listening for the Minister to publicly acknowledge the benefits that EEA migrants have brought to the lives of all of us in the UK. More than that, I hope to hear the Minister confirm that Her Majesty’s Government understand that trade is intrinsically about people, whether working alone or in companies and organisations, and—as previous speakers have brought out—that this is even more important in an economy centred on services, such as ours. Therefore, the more they can move and trade, the better it is for the United Kingdom’s economy. I wish to hear that the Government understand that to restrain the trade of EEA nationals in the UK will not only forfeit the benefits they bring but materially restrain hundreds of thousands—if not more—UK people trading in the EU 27. I would like the Minister to rule out the use of this as a bargaining chip in negotiations. That is why I would like to write this into the Bill. I beg to move.
My Lords, my noble friend Lord Fox has introduced his amendment extremely eloquently and convincingly. In supporting it, I highlight the fact that without the right deal on movement of talent and skills, our creative industries will face major challenges. Some 5.7% of the UK workforce is made up of EU 27 nationals. However, 6.1% of the creative industries workforce is made up of EU 27 nationals. More than that, 10% of the design, publishing and advertising workforce are EU 27 nationals. Some 25% of our visual effects in film—VFX—workforce is from the EU, and that rises to 30% in gaming. We are highly dependent, in those areas of the creative industries, on EU 27 nationals.
Take the music industry, for example. Some £2.5 billion was generated by music in export revenue. Germany, France and Sweden are among our top export markets, and are major destinations for our musicians. In the recent ISM survey of musicians, 39% said that they travel to the EU more than five times a year; 12% travel to the EU more than 20 times a year. More than one in eight performers had fewer than seven days’ notice between being offered work and having to take it, and more than a third of musicians said they received at least half their income from working in the EU 27. There are warnings from these musicians from their experience with the rest of the world. More than a third of musicians had experienced difficulties with visas when travelling outside the EU. In fact, of those experiencing difficulties, 79% identified visas as the source of those difficulties. Musicians in particular rely on being able to work and tour in Europe freely, easily and often with little notice.
It is equally important that the other people vital to touring, such as roadies and technical staff, are able to travel on the same basis. It is also vital that instruments and equipment can be moved around easily, and this must be a reciprocal arrangement. On touring, the Government have said that the UK will look to reach an agreement allowing musicians and museums to tour major events with their equipment and goods. What is considered a major event is not clarified and there are few details on what an agreement would look like.
The Government propose that the new immigration system will preserve the current rules for employing non-visa nationals for short-term work to join a UK production. This allows them to work for up to three months without a visa, requiring only a certificate of sponsorship from their employer, which is cheaper and easier to obtain. For periods longer than three months, the Government are reaffirming that the current tier 5 creative and sporting route, which caters for creative workers such as musicians, actors or artists who are working and touring in the UK, will continue. This is welcome but, again, without the right reciprocal provisions, Brexit is likely to make touring much more difficult for musicians and crews to move across Europe. Increased red tape will make it harder to promote music overseas.
Then, if the withdrawal agreement is agreed, from January 2021 non-visa nationals looking to take up permanent employment in the UK, such as VFX workers, will need to obtain a tier 2 visa. This requires sponsorship from an employer, which must pay a skills charge to make the recruitment. Workers must meet a minimum salary requirement to be eligible for a tier 2 visa. Like my noble friend, I welcome that the Government now plan to consult on the appropriate level for this requirement in the coming year, but the Migration Advisory Committee—MAC—has recommended that it stays at £30,000. There will need to be considerable changes to these proposals if the Government are to ensure that sectors such as the creative industries continue to thrive post Brexit. As the Creative Industries Federation has said,
“high skills do not always command a high salary”.
There is still a huge lack of clarity. The UK Screen Alliance has criticised the plans for a post-Brexit visa system. It says the Bill’s proposed visa system will “severely limit” the VFX and animation industries’ access to international talent. It also says that expensive new EU visas will add significantly to operating costs and impact on the sector’s competitiveness in the global market. Alan Bishop, the chief executive of the Creative Industries Federation, said about the White Paper:
“Unfortunately there is very little in this white paper which will give creative businesses and freelancers in the UK any confidence for the future … government has failed to recognise the challenges freelancers face within the current immigration system—a significant challenge for the Creative Industries Federation where 35% of creative workers are self-employed. Freedom of movement has given British businesses access to the best and brightest freelancers from the EU, presenting those businesses with opportunities to grow and contribute to the continuing health of the UK economy. For international non-EEA freelancers however, the current immigration system provides no long-term route. This is why the Federation has called for the introduction of a freelance visa”.
Those are the words of two significant organisations in this field.
The Government have had plenty of time to consider all these issues and have had plenty of sound advice, not least from quarters such as the July report of the House of Lords European Union Committee, Brexit: Movement of People in the Cultural Sector. That is why this amendment is so important, and I very much hope that the Minister will reflect in his response that the Government fully understand the needs of the creative sector.
My Lords, a powerful case has been made by the party to my left. My sadness is that the framing of the amendment before us deals largely with how any future trade agreement with the EU should have a relaxed approach to the mobility framework and, picking up the point of our earlier debate, tries to insert in some measure the fourth pillar of the GATS process, which allows for individuals to travel in support of goods and services.
The case we heard, and the emotion it raises, are about the much broader ideas of freedom of movement and the ability to transfer skills, particularly in the creative industries. Although it was not specifically mentioned, presumably it seeks to try to loosen the way in which the Government currently treat overseas students. There is a wider, richer, deeper and more important argument about the need for mobility, its importance for any modern nation state and the contribution it can make to our economy and our culture. That needs to be answered, but it is not picked up particularly by this amendment.
We too discovered this problem when tabling amendments. The title of the Bill means that we can not have as broad a discussion as we would wish. However, there is an immigration Bill coming, and others in your Lordships’ House will want to pick up many of the points made here and raise them in the context of a much wider and more appropriate set of immigration conditions and arrangements, which will satisfy much of the discussions we have heard this afternoon.
On the narrow question of where we move, it would be wrong to try to seek a broader solution to the problems identified through a generic approach. There is no doubt that what appeared to be—and it was appearance rather than reality—unbridled immigration was a factor in the referendum that led to the formation of the Brexit arrangements. We would be stupid to ignore that. There are probably answers and solutions that would be satisfactory to all concerned, but not in this amendment. Nevertheless, I will listen carefully to what the Minister says in response to this point. This issue will not go away and we look forward to returning to it at a future stage.
(5 years, 11 months ago)
Lords ChamberTo ask Her Majesty’s Government what assessment they have made of the impact of changes to arrangements for Certificates of Sponsorship, in particular those affecting artists visiting the United Kingdom for music festivals.
My Lords, we welcome artists from across the world visiting the UK to perform in music festivals, recognising the needs of the creative arts and to promote the creative industries. Specific arrangements were introduced in 2008 under tier 5. While there have been no changes to these, we recognise concerns raised by the sector about the operation of tier 5 in specific areas and we are working with it to understand and address them accordingly.
My Lords, the UKVI now seems to be telling its officers that all non-EU entertainers need an entry visa if they come through Ireland, whereas previously, certificates of sponsorship could be presented and activated when they came to Britain. This change was not announced publicly and no proper consultation with the music industry took place. It was taken unawares and the new requirement has had a major impact on major summer music festivals such as Glastonbury, Edinburgh, Glyndebourne, Reading and Leeds. Is this the hostile environment we can now expect for all artists—whether they are EU citizens or not—if Brexit takes place? Is the Home Office now dictating our cultural and creative exchanges?
I hope the noble Lord could concede that it is not hostile; it is quite the opposite. There has been a change in how the tier 5 route is implemented when individuals enter the UK, particularly from Ireland. Because there are no routine immigration controls on these routes, the correct form of entry clearance cannot be given and the certificates of sponsorship therefore cannot be activated. It has nothing to do with exit from the EU. Work is well under way to identify a workaround for the tier 5 concession route when entering the UK from Ireland to avoid the requirement to obtain a visa before arrival. I hope that gives the noble Lord some comfort.
(11 years, 1 month ago)
Lords ChamberMy Lords, it is a pleasure to follow the noble Baroness with her great rallying cry for our tourism industry. I also thank my noble friend. In recent years, I have spoken many times on tourism—about how we can take advantage of its huge potential for economic growth—and on live music, especially in the context of deregulating many aspects of promotion and performance, but always as separate issues. However, I am delighted that, thanks to my noble friend, they have been brought together in one debate, and I agree with nearly everything that has been said so far.
That iconic Rolling Stones live concert in Hyde Park in 1969 remains in the memory of many people of my generation, even if we were not there. Major live music concerts have been an essential part of our enjoyment for many years. My noble friend rightly lauded the Olympic and Paralympic opening and closing ceremonies at the 2012 Games, which particularly showcased British music and demonstrated its international appeal. He also mentioned Glastonbury. Just in the past few days, we have been reminded of its recurring appeal to a huge audience. Then we have the BBC Proms, mentioned by the noble Baroness, Lady Liddell. The last night, in particular, has a global audience. The Notting Hill Carnival is one of the largest street parties in Europe and attracts about 1 million people each year.
There are also our destination venues, whether for opera, classical music or rock music, mentioned by the noble Lord, Lord Black. The O2 has been the most popular live music venue in the world for five years running. Now, the Olympic Park is itself becoming a major venue for live music events. Then, of course, there are music destinations such as Liverpool. Is there anywhere quite like Liverpool, that place of musical pilgrimage and my noble friend’s native city?
The CEBR/Arts Council report made it clear that there was a very strong link between arts and cultural engagement and tourism. I welcome the news that UK Music will shortly be publishing a major update on the contribution that live music makes to tourism in the UK. As my noble friend mentioned, UK Music’s last report in 2011, Destination: Music—the Contribution of Music Festivals & Major Concerts to Tourism in the UK, first documented the significant contribution that live music makes to tourism. Because of this ground-breaking work, we now know that live music attracts millions of tourist visits each year and that these music tourists account for around 40% of live music audiences. Most of these visitors are domestic tourists and, although overseas music tourists make up a very small proportion of live music tourists, there is still massive potential. While overseas visitors account for 5% of music tourists in terms of numbers, they account for an amazing 18% of spending.
I am a trustee of the Barbican, home of the LSO. We know only too well the importance of tourists to our music events. As was shown by a recent survey conducted by BOP Consulting for the City of London Corporation, a significant percentage—some 7%—of bookings for ticketed performances at the Barbican are from abroad. They come from at least 106 different countries.
We all believe that the UK is the centre of the world for live music but we need hard facts to establish this and the role that live music plays in generating tourism. The new UK Music report will be very welcome, especially if it can demonstrate what proportion of live music audiences is comprised of tourists as opposed to the local population, and the economic impact of their visit to the live music event. I hope that this new information will really prompt the Government, DCMS, BIS, DCLG, Defra, the Home Office and the Treasury—all relevant government departments—to get together with VisitBritain, VisitEngland, UKTI, the British Council, the Arts Council and both the music industry and the tourism and hospitality industry to identify the real levers and barriers to growing music tourism at national level.
We need a properly joined-up strategy, particularly in terms of reducing regulation. In that context, I very much welcome the Government’s intention to improve on the Live Music Act by raising the audience level where no entertainment licence is needed to 500. The new higher audience exemption should have significant benefits for the tourism sector, where many businesses look to provide customers with live music as part of the overall visitor experience. I have a few suggestions for further government action regarding music performance and the issue of flyer distribution, which is dealt with by my Private Member’s Bill.
I welcome the fact that music is part of the GREAT campaign, but we absolutely need to make sure that our British brand is sold abroad. However, we still need to ensure co-ordination so that UK artists touring abroad can make the best use of networks provided by our British embassies, UKTI and the British Council. In that context, we should ensure that music and cultural industries are represented in trade missions. I am a great believer in the power and potential of British cultural diplomacy. We need to sort out the major issue with national insurance contributions for entertainers, on which HMRC is currently consulting. As the noble Baroness, Lady Liddell, mentioned, we also need to sort out the perennial issue of visas for visitors to this country.
We need to take care to ensure that the late-night economy is able to flourish, and to tackle anti-social hotspots so that people feel safe when they go out. I am delighted that the late-night levy is reduced for pubs which join a community scheme, such as Purple Flag. For larger venues, we need to sort out the scandal of secondary ticketing and ensure that fans are not paying over the odds or being scammed by online ticket touts by going along the lines of the Olympics legislation, so that the bands and their promoters receive the full ticket price. At the end of the day we need to acknowledge in our IP policies the central importance of copyright to the recording industry, which makes the primary investment in artists’ development. That of course means, I hope, implementing the Digital Economy Act earlier than 2015.
Having visited the BRIT School a couple of times recently, we also need to make sure that the live music sector has enough people with the right skills—the subject of Darren Henley’s brilliant review. I very much welcome the resulting national plan for education and the establishment of the new music education hubs in particular. In addition to promotion and action at national level, it is clear from the recent live music roundtables conducted by UK Music that we need strong local strategies. There are some serious lessons to be learnt from local and regional successes, involving public and private sector partnerships.
My noble friend mentioned Liverpool, which is a prime example of how music has been used to attract visitors to a city. In London, I know that the mayor, building on the 2010 Cultural Metropolis strategy and the World Cities Culture Report is keen to promote London’s music heritage much further, which is greatly to be welcomed. He has conducted a London Music Education Survey and is keen to work on music tourism campaigns telling the great story of London as a global capital of music. PRS for Music Foundation has, over the past decade, supported a significant number of local and regional festivals both with direct funding and collaboration with other bodies, such as the Arts Council. There are some good examples, including the St Magnus International Festival, Manchester Jazz Festival, and so on.
Such public-private partnerships reap important economic and cultural value to local communities across the UK, as we have heard from all around the House already today. I will, I am sure, be validated by the forthcoming UK Music report. With real understanding of the potential, both locally and nationally, we can unleash the power of music tourism for all our benefit.
(12 years, 2 months ago)
Lords ChamberMy Lords, I am not going to be provoked. I thank my noble friend Lady Kramer for so expertly setting the scene for this debate. A question on so many people’s minds is, “Where is the growth going to come from?”. I want to focus on the sectors with great potential for growth for which the DCMS has prime responsibility—the creative industries and tourism—both of which, I am glad to say, received some attention in the Treasury’s plan for growth last year and in the update this March. On the way, I also want to touch on higher education.
First, however, I shall say a word about the Olympics. There is no doubt that this has been an extraordinary achievement for the ODA, LOCOG and all the others involved in the preparations for the London Olympics. We were, however, promised a business legacy for the Olympics and I wonder whether the Minister can explain why it appears that, through the IOC rules, some 75,000 businesses will be banned by their contracts for 12 years from declaring that they have acted as a supplier to the Olympics.
Although official breakdowns of statistics are not helpful in this area, the digital and creative industries combined seem to contribute at least 7% of UK GDP, and those employed in the creative and digital fields now number perhaps 2 million. We are pre-eminent in so many areas but there is very strong competition internationally in a number of areas in the sector. I therefore welcome the new tax relief for video games, animation and some TV production that was introduced in the last Budget. Perhaps we will see an improved tax relief for co-productions in next year’s Budget. It is also noticeable how much investment is being made in film and television production—and at this point I should say “of the legitimate variety”. I very much welcome the formation of Creative England to support film and television productions and the activities of Film London to attract film and TV production to London. The UK Film Council estimates inward investment in the film industry at nearly £1 billion per annum, but there is a great deal to be done to secure optimum growth in this sector.
Skills issues in the creative industries need to be properly tackled in each part of the sector to ensure a talent pipeline. Shortages of skilled workers are a particular problem for the creative industries. I welcome the co-ordinated approach adopted by the report of the Creative Industries Council Skillset Skills Group to the Creative Industries Council earlier this year. The report made many extremely useful recommendations, many of which essentially involve action by the industry itself. However, as the Creative Industries Council and government Ministers have strongly endorsed the report, what are the Government, in particular, doing to improve and mitigate further regulatory measures, particularly the regulatory framework for freelance training as part of the Red Tape Challenge? What are they doing to make sure that sector skills council roles are clarified and communicated?
I welcome the strategic partnership between Creative Skillset, the skills council for the creative industries, and Creative and Cultural Skills, which covers a different group of creative industries, but surely there is a strong case for merging the work of the two and ensuring that skills issues across the sector are tackled in a fully joined-up way. The Creative Industries Council report urges greater “synergy and exchange” between STEM subjects and the creative industries. What action are the Government taking to respond to the recommended changes in the curriculum? Does this tie in with their response to the Livingstone-Hope Next Gen review of skills in video games and visual effects?
We also need to recognise that our creativity, ideas and intellectual capital will increasingly drive our future prosperity. The place of intellectual property has never been more important to society or our economy. The report in 2010 by TERA Consultants estimated that 250,000 jobs are at risk if we fail to do anything further about copyright infringement by 2015. The film policy review carried out by the noble Lord, Lord Smith of Finsbury, contained important recommendations about copyright issues, including sanctions for the recording of films shown in cinemas and the important question of implementation of the Digital Economy Act. What is the Government’s response to that? If they are serious about the health of the creative sector, it seems extraordinary that we can only expect introduction of the initial obligations code under the Act in 2014.
Although the Hargreaves report commissioned by the Government has some good aspects it relies on very dubious figures for its economic impact assessment. It seems to assert that current copyright laws in this country are inhibiting innovation, that copyright reform will somehow deliver a massive increase in our creative industries’ output and that copyright exceptions will make Britain more attractive for overseas investors, and so creators’ rights in the UK should be weakened. By contrast, in the first report of the digital copyright exchange feasibility study, Richard Hooper has put his finger on the real issue: there are barriers to the exploitation and licensing of intellectual property rights where there is complexity of process in the organisations involved in establishing ownership of rights, and in some cases insufficient availability of repertoire under licence. It certainly appears that the majority of responses to Hargreaves, published last week, are more minded to take the Hooper approach. There are exciting prospects for a Britain with a digital copyright exchange in place becoming an international hub for rights clearance, if we can get HMRC to negotiate suitable double-taxation provisions.
Turning to higher education, as the UUK report Creating Prosperity at the end of last year made clear, our higher and further education sector makes a major contribution to the development of talent and skill for the creative economy. Some 16% of our students are engaged in courses relevant to the creative economy. Rather than trying to restrict access for foreign students through our visa system, we need to create more internships for overseas students in the creative industries and the arts. As so many have said, not least London First and the vice-chancellors of our universities, we need to exclude non-EU students from our permanent net migration figures, as so many other countries, such as the USA and Australia, are increasingly doing. I look forward to hearing what the noble Baroness, Lady Valentine, has to say on this subject. Perception about UK visa policy is hurting our message that we are open for business and welcome international students and visitors.
How good are we at promoting the quality and potential of these industries overseas? Do we have the right architecture? I welcome the activities carried out by UKTI, in particular the appointment of the new IP attachés. I also welcome the signs of increased co-ordination between Visit Britain, the Arts Council, UKTI and the British Council, but how does that fit in with the Creative Industries Marketing Strategy Board or the Creative Industries Council? Is the Intellectual Property Office involved? If not, surely it should be. I certainly welcome the creation in 2011 of London and Partners as a single promotional organisation for London.
There is also the important question of investment in our digital and creative industries, particularly for start-ups and SMEs, and I particularly welcome the commissioning of work by the Creative Industries Council on access to finance. Can the Minister indicate any conclusions from its report, which I believe was presented to the council on 12 June, and when it will be published? Much depends on how attractive we are as a location for investment. The stories that could be told in our regional cities—for example, Liverpool, Manchester and Birmingham—are good ones. I applaud the Tech City initiative and UKTI’s involvement in that.
I shall not talk about broadband, but that is absolutely crucial to the further development of our creative industries. Tourism, however, is the world's fastest growing activity and the UK has enormous advantages and attractions. Although tourism is acknowledged as the third largest industry sector, employing directly and indirectly some 3.6 million people, there is still a lack of adequate government appreciation of its potential. Symptomatic is the recent letter from the British ambassador to China addressed to the Home Secretary about his frustration over the lack of promotion of Britain as a tourist destination to the Chinese and the cost and complexity of visas for tourists.
We should be much more joined-up. Should there not be a Cabinet committee which joined together the strands of government policy? There are many other deregulation issues—I hope that I have made a contribution to that agenda with my Live Music Act—but we need to make sure that our tourism industry is unshackled by many of the regulations that afflict it.
(12 years, 7 months ago)
Lords ChamberMy Lords, I was hoping that the noble Lord, Lord Owen, would be taking part in this debate, as I believe that he was going to be talking about competition law, but this is an opportunity to intervene briefly on the issue. I think the noble Lord, Lord Kakkar, for giving us the opportunity.
The main arguments given by the department for there being a low risk of application of EU competition are that, for commissioners, healthcare is provided on a universal basis on the principle of solidarity and, for providers, that they will not be regarded as undertakings unless the particular economic activity in which they are engaged is part of a market.
However, a number of questions arise. What if providers collaborate, as they do in the post-acute care and enablement programme, which is a collaborative model? What if other providers who are excluded from a consortium object to that? It could be alleged that there is anti-competitive behaviour. What if commissioning bodies create a market, as we have done with elective surgery and ISTCs? There are also question marks over the criteria for mergers, in particular when foundation trusts merge. Why cannot we also temper the application of EU law by referring specifically to Article 106 of the TFEU in terms of the task of integration assigned to commissioners, and mitigate the Competition Commission’s exercise of its duties regarding tariffs, Monitor’s duties, and so on, by praying in aid the need to have regard to the interests of patients?
(12 years, 9 months ago)
Lords ChamberMy Lords, from the outset the noble Lord, Lord Warner, and my noble friend Lady Williams have hit the button on this debate. Like the noble Lord, Lord Warner, I am a sceptic about nudge theories and think that they need to be investigated. I thought that the House of Lords committee under my noble friend—my former noble friend—the noble Baroness, Lady Neuberger, interrogated the issue extremely well. We are in an obesity crisis. We are expecting 50 per cent of adults to be obese by 2020 and I believe that we are going to have to do something rather more drastic than simply nudge people. Personally, I am quite attracted to the idea of a fat tax. Let us see the evidence of whether a nudge is going to prevent us from facing a major obesity crisis by 2020 that is even greater than the one that we already have, or whether a fat tax is the only way that we are going to get there. The spirit of the amendment moved by the noble Lord, Lord Warner, is absolutely correct in that respect.
Very ingeniously, the noble Lord has introduced the idea of patient control over their own records. I do not know whether this is the right place in the Bill to be debating this issue, but I do know that it is an extremely important suggestion. Patients should have control over their own records, which should not be simply under the control of the local GP. It is increasingly important for pharmacists to have sight of a patient’s records—with the consent of the patient; that is the essential control—and that other healthcare professionals should do so. There should not be a monopoly on the sight of patients’ records for general practitioners. With the consent of patients, other health professionals should be able to see them. We will then have proper integration of healthcare without expecting GPs to be the gatekeepers for all an individual’s healthcare needs.
I do not know whether we are starting the debate that was referred to at Second Reading, but this is an important area which I hope will be discussed further during the course of the Bill.
My Lords, I should like to make a short intervention to ask my noble friend one or two questions. When I was a Minister I was responsible for the Health of the Nation policy, which I much enjoyed. At the time we introduced the five-a-day programme. That was 21 years ago, so we can see how long it has taken to get that message deep into the psyche of the British people. There is something about promoting good health and habits of living to the population—it takes a very long time.
I want to speak to Amendments 62, 65 and 68. I was very much hoping that we would have a debate on Amendment 94A, which is about Public Health England. But courtesy is the hallmark of this House and, as the noble Lord, Lord Patel, is not here, it is absolutely right that we should not debate it today.
On Amendment 62, on scientific and other evidence, from the noble Lord, Lord Warner, it is the “other evidence” that I want to ask my noble friend about. As my noble friend Lady Williams said, other evidence is something that you build up, and I am quite concerned about how we are going to get this evidence into health and well-being boards and how we will ensure that the Government have enough evidence that builds from the bottom up. One problem is with access to data; if we are going to have joint needs assessments through the health and well-being boards and strategies, and if that information on the ground cannot be shared, it will be very difficult to ensure that we have joint needs assessments. The GPs have those data and share them with other people in the National Health Service, but I do not believe that at this time they can share them with local government. That will be a very important issue because, although they are anonymised data, if you are going to run a public health programme on obesity you really need to know exactly in what geographical area that obesity is at its worst so that you can target it. When you are looking at the needs of individuals, you may have information about the numbers of people who have diabetes or coronary heart disease, but it is when you link those diseases to individuals that you get back to the previous debate that we were having on long-term conditions. Linking some of this stuff together is absolutely critical, and maybe my noble friend could think about that in the intervening time and write to me—and to other noble Lords, if they are interested.
I agree with my noble friend Lord Clement-Jones that this may be not quite the right moment to discuss medical records, but I really cannot resist it, although I will be brief. Some 21 years ago, in this House, from the place where my noble friend now sits, I made my maiden speech on medical records, so it is something that I have quite an interest in. When I produced a policy document on changing childbirth, one recommendation was that women who were pregnant should hold their own medical record, sometimes known as hand-held maternity notes. That has had an enormous impact; it has made those women feel that they are very important—they are pregnant and they are going to have a child and a whole readjustment to family life. That is a very important time in a woman and her partner’s life, and it acted as a sort of passport to them. Bearing in mind that 30 per cent of women who are pregnant are obese, which has a huge impact on the next generation, it seems to me that having hand-held records or access to or ownership of your own records is terribly important. Of course, we have the red book that women get about their children so that they can share that information with health professionals.
My last point is on Amendment 68 and the standing advisory committee. I absolutely understand why the faculty of public health and other people like that idea. I am not sure whether that advisory committee, as has already been suggested by the noble Baroness, Lady Finlay, will make an annual report. That is possible. We will have the Chief Medical Officer’s report annually, as she said, which is a very brave and independent document; the Chief Medical Officer says how it really is, and I know that it is very often extremely uncomfortable for the Government.
My Lords, I rise to support Amendments 72A, 81A, 91A, 200A, 201ZA, 327B, 327C, 329A, 331C and 333B—all amendments on speech and communication. I think that Amendment 218A should also have been included because it deals with integration—in this case, for the commissioning groups. I hope that when the Minister deals with that later amendment, he will be able to recall this debate.
I support these amendments very warmly for all the reasons that the noble Lord, Lord Ramsbotham, and my noble friend Lady Wilkins have set out so cogently. I should also, in this very brief intervention, like to draw attention to the excellent BBC film “The Kid’s Speech”—not “The King’s Speech”, although that was very good too—which graphically portrayed not only the crippling effects of stammering on children’s development, as well as on their happiness, but also an integrated way to deal with it, employing educational as well as physiological expertise. I commend this short documentary to anyone who wants to understand why it is so important to help these children properly early on.
The assessment and treatment of speech, language and communication problems must come within public health. I asked the Minister about this when I made a few remarks at Second Reading. However, with that vast marathon of questions, I quite understand that he did not have time to reply, although I hope that he will be able to do so at the end of this debate. The information must be accessible to those with low literacy and poor understanding. Finally, there must be integration not only with the health and social care services but also with education and children’s services, or we shall fail that very large number of children with speech, language and communication difficulties.
I, too, support the amendments of the noble Lord, Lord Ramsbotham. He clearly has a great deal of support in the Committee for the amendments, on which he spoke so eloquently, as did the noble Baroness, Lady Wilkins.
I come at this as a former chairman, and now the president, of Ambitious about Autism, the autism education charity, and also as a very strong supporter of I CAN, the communications charity for children. I also strongly believe that speech, language and communications needs should be regarded as a public health issue. As both the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Wilkins, highlighted, speech, language and communication needs are the most common disability experienced by children or adults, and it is now being recognised that communication is indeed the single most significant factor in determining a child’s life chances. Because our economy has become increasingly dependent on communication-based employment, the fitness of a person in this century will be defined ever more in terms of his or her ability to communicate effectively. The economic impact on society of people whose communication disability renders them unemployable is significant and is growing year on year. As a society, we need to recognise this issue and find ways to improve the communication skills of children and adults.
As has been pointed out by the noble Lord, Lord Ramsbotham, a number of primary care trusts and local authorities in England have indeed already recognised the importance of boosting early language and communication development. They have aligned the work of speech and language therapists with the Healthy Child Programme and Sure Start children’s centres to create a powerful public health approach based on primary prevention.
However, in contrast, many commissioners—this was also mentioned by the noble Baroness, Lady Wilkins—as reported by Sir Ian Kennedy last year in Getting it Right for Children and Young People, have a limited understanding of children with speech, language and communication needs. Many of these local areas are still not doing enough to address these needs, and it is clear that the economic and social benefits of early intervention and prevention of speech, language and communication needs must be much better promoted. That is why the approach indicated by these amendments is so important and why I support them.
I have added my name to one of the amendments in this group but support many of the others. The key issue is that children often need accurate diagnosis but do not get it. It is the way in which you detect learning difficulties of all sorts—sensory impairment and motor impairment. The need for a range of services integrated to support children is critical because as they grow up, unless their needs are addressed early they become greater; they do not decrease.
I shall illustrate that. A little girl, whom I shall call Emily, is eight. She was born prematurely but by the time she is eight, having had a stormy neo-natal period, she has epilepsy, cerebral palsy and swallowing difficulties. She is wheelchair-dependent, partially sighted and has communication difficulties. For her ordinary care, like other children, she needs her GP, district nurse and health visitor. For her hydrocephalus she needs paediatric neurosurgery. For her complex epilepsy she needs paediatric neurology. She needs physiotherapy because of the cerebral palsy and cramps. She needs speech and language therapy to help her learn to swallow efficiently and occupational therapists who help her to manipulate her communication device through which she communicates with her family who love her dearly and want to do the best for her.
That is one example and we have hundreds of children in our country who need integrated co-ordinated care. Perhaps Emily was lucky because she got the interventions that she needed and they were brought together. But, we also have a lot of children, as referred to in this debate, who are being missed on the way through because they do not have such clear-cut presentations. That is why, unless we use this as an opportunity to really change the way that we look after our children in health and social care in the broader context, we will be failing them.