Health and Care Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, Amendment 165 requires the Secretary of State to

“promote self care for minor ailments and prepare a national self care strategy”.

I hope that Ministers will just agree to this, without very much debate.

Self-care is defined as

“the actions individuals take for themselves, on behalf of and with others, to develop, protect, maintain and improve their health.”

It is an important but often overlooked part of the primary care pathway.

Given all the pressures that there are on the health service and that there are going to be over the next 30 to 40 years, surely we should do everything we can to encourage self-help for minor ailments. During Covid, the importance of self-care in reducing the burden on GPs and A&E became very self-evident. Since the outbreak started, people with minor ailments were not able to visit their GP in the traditional manner and learned, or at least practised, self-help behaviours instead. A survey carried out by PAGB, the consumer healthcare association, during the first national lockdown indicated that the pandemic has had an impact on people’s attitudes to self-care. Some 69% of people who would not have considered practising self-care prior to the pandemic said that they were more likely to do so after their experience of lockdown.

Interestingly, if the Government were prepared to run with this strategy, there are all sorts of behaviours that they could start to encourage. They could ensure that individuals understand or are willing to practise self-care; ensure a cultural shift among healthcare professionals toward well-being, enabling people to self-care; ensure that the system is supported to encourage self-care where appropriate, with pharmacies, of course, playing a big role in that; encourage the use of digital technology; enhance the national curriculum on self-care for schoolchildren; and introduce self-care modules in healthcare professionals’ training curriculum.

I come back to the point that the Minister and noble Lords know that the health service is currently under huge pressure, not just because of the backlog. Already before the pandemic, the health service was really struggling to meet its targets. The demographics, the growing older population and all these factors suggest that the NHS will struggle hugely to cope with the pressure on it over the next 20, 30 and 40 years. Surely some part of the strategy to deal with this is to encourage all of us not just to look after our own health more but, where we can, to self-help. I would have thought that message would have been accepted with alacrity on the Government Front Bench. I hope the Minister will be able to say that this is very much taken to heart and that the Government really will start to drive the new strategy. I beg to move.

[Lord Clement-Jones (LD)]

My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.

During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.

In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.

6.15 pm

The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.

I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.

Health and Care Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Clement-Jones (LD)]

My Lords, I thank the noble Earl, Lord Howe, for his very considered response. We have had a very rich debate, and I thank all the speakers. It has been a privilege to take part in what I think the noble Lord, Lord Bethell, called this “conversation”, because we have heard huge experience and authority, right across the board, about the way we might digitally transform the NHS.

In a sense, I think it is about means, not ends: we are trying to reach the same end but we disagree on how to get to that objective. At the core of that disagreement, and no doubt where we will have considerable debate later on in the Bill, is where the digital transformation aspect fits with data confidentiality and data sharing—all of which is necessary as part of digital transformation. I listened with enormous interest to what the noble Baroness, Lady Cumberlege, had to say on that. We have to get this equation right, and we have to build public trust. I say “build” public trust because I do not think it is completely there, post the GP data grab, as it has been called, of last year. We will come on to that on future occasions.

I feel somewhat that the noble Earl, despite his mellifluous approach to these matters, was rather throwing the book of arguments at the need for any form of amendment to the Bill. He always does so with great style, but I was not totally convinced on this occasion. He mentioned the principle that we should not be too prescriptive—in that case, why are we legislating? We are trying to legislate for what the priorities for the health service are in the current circumstances.

[Lord Hunt of Kings Heath (Lab)]

Does my noble friend not think there is an interesting contrast in saying that we must not be too prescriptive but, for NHS England, we are going to tell it what to do?

[Lord Clement-Jones (LD)]

Absolutely. I think the noble Lord, Lord Mawson, talked about a disconnect in another context, but that is probably the word I would use in these circumstances. The Government say that they are going to prioritise good local leadership but do not want to be too prescriptive about who is on the board of the ICB; that they want a clear strategy for digital transformation but do not want to make it a duty; and that a general level of competence and expertise is required but, again, “Oh, no, we don’t want any digital duty; that would be a little bit too prescriptive”.

We need a level of digital maturity, and a regular set of digital maturity assessments. I liked the sound of that, but faced with all the other duties that ICBs will have, which ones are they going to prioritise—the ones that are built into statute, or the ones that are part of a What Good Looks Like programme? The noble Earl quoted exactly the same document that I had access to. It is a splendid document but, without some form of underpinning by legislation, it is very difficult to see ICBs giving priority to that.

Of course, the other argument the noble Earl made was that if we had a separate duty, we would have to have a whole separate planning process. That is not how these things work. When you have a set of duties, you try to do it in a holistic fashion. You do not say that we need one plan for this duty and another for that duty. If you are going to use your resources sensibly and the capabilities within your organisation in the right way, you need to do it in a planned programme, right across the board.

On the whole issue that having a separate statutory duty risks misalignment, I thought that was where somebody had really been creative and woken up with the inspiration that this was the final killer blow in the arguments being made.

I listened with great interest when the noble Earl came to the question of funding. I have not done any calculations in my head, but I bet that £2.85 billion cap ex spending over three years does not equate to 5% of the NHS budget. As my noble friend intimated to me, when you look at the cost of some of the digital developments that have taken place over the last year or two, you will see that they are highly expensive, in both revenue and capital spending. The noble Earl talked about not ring-fencing We all know the problem of distinguishing between capital and revenue in public spending. That is not to say that that is necessarily right.

Finally, on the idea that we must not tie hands—what is legislation designed to do but to set out parameters?

I thought that the aspect of patient engagement was quite interesting, and I will need to re-read what the noble Earl had to say, because it may be that the current set of duties within the Bill provides for that. That may be a glimmer of hope. Indeed, the whole question about the duty to foster a culture of innovation is a kind of fig leaf. What board is going to treat that as an absolute duty that it needs to plan in and set particular duties to its team for? In a sense, it will be an optional extra if we are not careful.

To tell your Lordships the truth, I am not entirely convinced that we are going to be able to—in the words of the noble Baroness, Lady Cumberlege—“galvanise” the NHS. I thought that was a splendid word; it has a certain electricity about it. I do not think anything in the current Bill is going to deliver that galvanising impact, and we will be left with the disconnect that the noble Lord, Lord Mawson, talked about if we are not careful. But in the meantime, I beg leave to withdraw my amendment.

Medicines and Medical Devices Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Report stage & Report: 2nd sitting (Hansard) & Report: 2nd sitting (Hansard): House of Lords
Thursday 14th January 2021 Lords Chamber

[Lord Clement-Jones (LD) [V]]

My Lords, it is a pleasure to follow the noble Lord, Lord Patel. I support and will speak to Amendments 18, 36 and 57, which have been so well introduced and explained by him, and which I have signed, and will speak to my own Amendment 20.

We have had discussions on this Bill and the Trade Bill about health data and trade issues. The two Bills are intimately connected, and this amendment is very complementary to Amendment 11, passed on Report of the Trade Bill on 7 December. There was no debate or discussion about the new Clauses 7 and 12 and the new subsection in Clause 37 when they were introduced in Grand Committee. On both counts it is therefore vital that we get to grips with them today. I welcome the Minister’s new amendments, which he has spoken to and which take us a step further in terms of patient consent, definition of information and relevant persons. But I have signed, and these Benches support, the additional amendments to those clauses and subsection put forward by the noble Baroness, Lady Thornton, to ensure that we further tighten these provisions. Specifically, we want to tie this to international co-operation on pharmacovigilance or in monitoring the performance and safety of medical devices, and a public interest test put around the disclosure of health data, for all the reasons put forward by the noble Lord, Lord Patel.

As I said when the House debated these issues on Report of the Trade Bill and later passed the amendment, NHS data is a precious commodity, especially given the many transactions between technology, telecoms and pharma companies concerned with NHS data. I cited a recent report in which EY estimated that the value of NHS data could be around £10 billion a year in the benefit delivered, and the fact that the Department of Health and Social Care is preparing to publish its national health and care data strategy shortly, in which it is expected to prioritise the

“safe, effective and ethical use of data-driven technologies, such as artificial intelligence, to deliver fairer health outcomes.”

I mentioned too that, while acknowledging that the UK is a leading player in the fields of life sciences and biosciences, health professionals have strongly argued that free trade deals risk compromising the safe storage and processing of NHS data in much the way that the noble Lord, Lord Patel, has mentioned.

Through the amendment to the Trade Bill from the noble Baroness, Lady Thornton, and likewise this amendment, the objective is to ensure that it is the NHS, not US big tech companies and drug giants, that reaps the benefit of all this data. This is especially important given what the Ada Lovelace Institute called in its report, The Data Will See You Now, the “datafication” of health, which, it says, has profound consequences for who can access data about health, how we practically and legally define health data, and our relationship with our own well-being and the healthcare system. Health information can now be inferred from non-health data, and data about health can be used for purposes beyond healthcare. Harnessing the value of healthcare data must therefore be allied with ensuring that adequate protections are put in place in trade agreements, if that value is not to be given or traded away.

At the time, I raised questions about the provisions of the UK-Japan trade agreement, and there is no doubt that these questions will linger unless an amendment of this kind, to both this Bill and the Trade Bill, goes forward.

There have been many shortcomings in the sharing of data between various parts of the health service, care sector and Civil Service. The development of the Covid-19 app and the way that the Government have procured contracts for data management with the private sector have not improved public trust in their approach to data use. That is why clear safeguards are needed to ensure that, in trade deals and international agreements, our publicly held data is safe from exploitation where it is not for public benefit.

On Tuesday, the Minister heavily emphasised the public interest test that he wanted to see applied to the sharing and use of Clause 3 information. The data covered by Clauses 7, 12 and 37 is even more important. He used the same language today and in correspondence, so I hope he can accept these amendments. As the noble Lord, Lord Patel, has said, we also want to see the aspect of patient consent clarified.

I turn briefly to Amendment 20. I welcome the Minister’s Amendment 19, but Amendment 20 is designed to get the Minister to further clarify what is meant by “consent” in Clause 7. Informed consent is very much a familiar concept in healthcare, especially in treatment and trials, and, indeed, that is effectively the definition on the NHS website. It depends on capacity, explanation, understanding and it being voluntary. That is why my amendment would insert the word “informed”, to make it abundantly clear that, at the very least, that is what is intended here. I look forward to the Minister’s reply.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, it is a great pleasure to follow the noble Lord, Lord Clement-Jones, and I welcome the opportunity to debate this important group of amendments. I welcome the government amendments, but feel that my noble friend Lady Thornton’s amendment is very important, as indeed are some of the others in this group.

I have always been strongly in favour of using patient information. It is a rich source of data for scientists to pursue in the search for medical advances. We all benefit, and I am sure that the great majority of the public see this and are agreeable to information being shared. But we must have appropriate safeguards, and that is why the government amendments to restrict the persons to whom information may be disclosed, and the addition of a definition of patient information and the need for individual patient consent, are all very welcome.

My understanding, however, is that information pertaining to patients can be shared where it has been rendered non-identifiable. As the University of Birmingham has commented, this may be in line with current data protection principles but there is still a danger of a care.data-type problem, in that the provisions might allow the Government to share with “relevant persons”—as they are now called—outside the UK information they hold on patient data through NHS bodies without consent when anonymised. The noble Lord, Lord Patel, referred to some of the issues with care.data. The stricter definition of patient information may address some of the concerns that the definition of patient data—being restricted to identifiable data—left anonymised data open for use or barter as part of international agreements. Part of this broader concern is that aggregate data can reveal patterns that may allow for re-identification, especially for small patient clusters in respect of rare diseases and conditions.

Medicines and Medical Devices Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 12th January 2021 Lords Chamber

[Lord Clement-Jones (LD) [V]]

My Lords, on 4 November in Grand Committee, the noble Baroness, Lady Thornton, and my noble friend Lady Jolly introduced amendments designed to limit the ambit of the information-gathering powers under Clause 3, which deals with falsified medicines. I raised the subject at Second Reading but was unable to be present for the debate in Grand Committee.

The Minister, the noble Lord, Lord Bethell, said in resisting the amendments:

“We also want to explore creative uses of information as long as they are for public interest purposes. Therefore, we do not want to constrain or limit options ahead of engagement with stakeholders.”


It was not at all clear what the Minister meant by “exploring creative uses of information”, and in fact it was quite concerning given that these have not been set out anywhere in any consultation document. However, he went on to say:

“I should make it very clear that the overarching principles of the Bill as set out in Clause 1 also apply to our powers here. The scope of the purposes mentioned is not unfettered. The appropriate authority must be satisfied that regulations dealing with anything under Clause 3—not just around how the information will be used—will promote the health and safety of the public. In making that assessment, the appropriate authority is required to have regard to the three considerations discussed previously in Committee.”—[Official Report, 4/11/20; col. GC 326.]


Of course, as the result of the very welcome government Amendment 4, the safeguarding of public health is the key objective, and by Amendment 6, Clause 1(3) has been tightened up too. However, having carefully considered these amendments and the Minister’s previous response, I must still question his interpretation of Clause 3 and how it interacts with Clause 1. Clause 3(1)(b) currently says that the regulations may make provision about

“the use, retention and disclosure, for any purpose to do with human medicines, of information collected for the purpose of preventing the supply of falsified human medicines.”

At best there is a conflict between the two clauses, and at worst Clause 3 is open-ended and gives the Government far too much discretion in the scope of regulations under Clause 3.

In the discussions we have had with the Minister between Committee and Report—for which I am grateful—it became clearer that we need to ensure that this information regarding falsified medicines is used for limited purposes. The Minister cited a whole range of possible uses for the data, which came as a considerable surprise. As I said earlier, there has been no industry consultation, despite considerable ambition on the department’s behalf. That is why in this amendment we have tied the purpose to “ensuring patient safety”. What possible objection could there be to this limitation? Why would the Government want any wider scope, especially if the Minister believes that Clause 1 already provides a limitation?

I have now seen the brief announcement issued by the department on the consultation on the regulations to be carried out on a new national scheme. It says:

“We are committed to public consultation around the need and details of any national scheme, as well as a specific consultation on the use of data collected as part of any scheme.”


That lacks detail, to say the least.

Many noble Lords have been briefed by the Company Chemists’ Association about the commercial sensitivity of this data. As my noble friend Lady Jolly said in Grand Committee:

“The Department of Health and Social Care already has access to a very wide range of data on the sales of medicines, and their use in the UK, under the Health Service Products (Provision and Disclosure of Information) Regulations 2018. These require manufacturers, wholesalers and pharmacies to provide summaries of products sold and prices paid. Ministers can request more detailed information if required.”—[Official Report, 4/11/20; col. GC 324.]


Given this access and the known sensitivities about falsified medicines directive data, it is unclear why the department has included this sweeping provision in Clause 3(1)(b). I described this as “legislative creep” at Second Reading. It goes well beyond the EU falsified medicines directive of 2011 and the associated delegated regulation of 2016. Of course, this was not acknowledged in the Commons by the Minister, Jo Churchill. As a result of the efforts of several noble Lords, the changes proposed to the FMD provisions are now out in the open—but that does not make it any more acceptable.

This might seem rather a specialised part of the Bill, but clarity about the scope of Clause 3 is vital if we are to have confidence that a suitable scheme for falsified medicines data will be put in place that does not go well beyond the current scheme in terms of the sensitive data that is collected and used. I hope the Minister can do better than last time in giving greater assurance about the ambit of Clause 3 so that I do not need to divide the House. I beg to move.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, it is a great pleasure to support the noble Lord, Lord Clement -Jones, and my noble friend Lady Thornton. I urge the Minister to respond, as the noble Lord asked, on how Clause 3 will actually be used. It did not help that the Explanatory Notes made no mention of what the noble Lord described tonight and at Second Reading as “legislative creep”.

We have had submissions from a number of organisations that make the point that the wording goes beyond the current EU legislation, which was carefully implemented after extensive consultation with the relevant bodies. That is from the Company Chemists’ Association. The ABPI said that the falsified medicines directive was introduced as a barrier to counterfeit and falsified medicines entering the supply chain, thus reducing the potential risk of harm to patients, that the ABPI and its members have worked to fund and implement the falsified medicines directive, and that any future considerations under this clause must include full consultation with industry.

So there is general concern in the industry about how the clause will be used. We know that the department already has access to a wide range of data on medicines sales and use in the UK under the Health Service Products (Provision and Disclosure of Information) Regulations. Given this and the known sensitivities around falsified medicines data, I am still unclear why the department wants to extend the purposes for which data is collected under a future UK system. I know that we were very privileged—

Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 9th September 2020 Lords Chamber

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I am delighted to move this amendment on behalf of my noble friend Lord Patel.

In parallel to this Bill, the Government are taking through the Medicines and Medical Devices Bill to ensure that we have an effective regulatory system post Brexit. As the noble Lord, Lord Bethell, explained at Second Reading, we must do all that we can to support the UK’s thriving life sciences industry. He described a world where big data, artificial intelligence and genetics have become enormously powerful engines of innovation, and where engineering and computer science have combined with medicine to generate exciting new medical developments.

It is vital that changes being made in the immigration system protect the excellent UK medical research environment, which drives vital progress for our patients. That is contingent, as Cancer Research UK has reported, on the maintenance of the UK’s leading research environment and our continuing ability to attract, recruit and retain global scientific talent at all levels. It is this mixture of domestic and international talent that supports our thriving research environment. For example, 31% of the UK’s Nobel prize winners in science were born outside the UK, while 50% of Cancer Research UK’s supported PhD students are not from the UK, rising to 76% of postdoctoral researchers at its institutes.

I welcome the Government’s ambition to make the immigration system work for science and research, but the science and research community has real worries about the cost of the system, particularly in comparison to other countries. The current UK immigration system is already one of the most expensive in the world. The total average up-front cost for a tier 2 skilled worker visa, typically used by scientific workers, is 540% higher than the average cost in other leading scientific nations. Most of Cancer Research UK’s researchers say the ease with which their dependants can access public services and take up work is a key factor in choosing a research destination, yet a researcher coming to the UK with a family of four faces nearly £10,000 of fees if they want to apply for indefinite leave to remain. Much of that cost is associated with the health surcharge.

At the moment, research organisations will often step in and pay these charges, but they themselves are struggling financially, particularly given the uncertainty about research grants post Brexit. Cancer Research UK estimates that a typical institute that it funds could face additional costs of between £300,000 and £800,000 once EEA workers move on to the new system. That is a lot of money which should be spent on research activities.

The new global talent visa will play a crucial role in attracting the scientific talent the UK needs. It is a welcome step, but it also retains fees at a damagingly high level. A five-year visa would incur up-front costs of £2,608 for a researcher looking to move here. It is more expensive than India, France, Australia, Germany and Japan. The global talent visa is designed for experienced research staff, but many who are early in their careers or in vital technical roles will not be eligible. We need the new immigration system to work for all the members of a research team. That means attracting researchers early in their careers and ensuring that vital technical staff, who are after all the backbone of many research teams but who are often not that highly paid, are made to feel welcome to live and work in the UK.

The reduction of the salary threshold to £25,600 is a positive step, but researchers who are not eligible for the global talent visa will still be required to apply via the tier 2 route, which is both costly and bureaucratic. Technical staff, particularly outside London, may still fail to pass the salary threshold and will thus be excluded from the chance to contribute to our research environment. For technicians in particular this route is daunting and, as I have said, it is far from certain that they will earn above the £25,600 salary threshold the system proposes.

Amendment 34 is a constructive approach to encourage the Government to undertake an impact assessment of the effects of these regulations on the recruitment of international research and innovation staff in the United Kingdom. These people are vital to the future prosperity of this country. We believe that the Government should delay exercising the power to modify visa charges until the evaluation has been received, so that they can be fully informed about the impact of fees on recruiting these very talented people. I hope that, as a result, the Government will then bring forward a reduction in the total visa costs for researchers and their dependants, a review of the costs faced by medical researchers through the NHS surcharge and consideration of exemption. An option to spread fees over the lifetime of a visa to reduce up-front payments should be considered, along with an improved, digitised system to streamline visa applications and prepare for an expected increase in demand. I really hope that the Minister and the Government will listen to this sympathetically. I beg to move.

[Lord Clement-Jones (LD) [V]]

My Lords, I will speak to Amendment 69 in my name. Our creative industries are hugely successful, generating over £111 billion for the UK economy. Over the past decade, the sector has grown twice as fast as the UK economy as a whole and is part of a bigger creative economy employing more than 3 million people and generating value across the whole supply chain.

Music is a key component of our creative industries. UK Music’s inaugural Music by Numbers report revealed that in 2018 the UK music industry contributed £5.2 billion to the UK economy and that the total export revenue of the music industry was £2.7 billion. British artists account for one in eight albums sold around the world. Music tourism made a £4.5 billion contribution to the UK economy in 2018.

Given the unique nature of the sector, the high volume of freelancers, micro-businesses and performance and project-based work, it is vital that any new visa system is both shaped by and tailored to the creative industries. This is primarily a services and content-driven sector, so the ability to tour and easily move the people, equipment and materials they travel with is vital.

For many roles, too, there is a shortage of applicants with the required skills, experience or qualifications. The UK is a prime destination for the production of music, offering globally recognised recording studios, composers and performers. Our music producers are used by international musicians. Not only does this ensure a continued influx of talent into the UK; it also creates employment opportunities for UK-based music producers, performers, engineers, music technicians and so on.

The market for touring musicians and composers is extremely competitive, and the UK needs to be easily accessible to continue to attract international talent for continued global investment in the UK. As the Minister is aware, and as I and others argued on Second Reading, the creative sector wants to see the Government provide a simple way for European Union musicians and other artists to tour in the UK, and request reciprocity in the trade negotiations. This would mean extending the permitted paid engagement scheme, allowing for multiple visits and permit-free festival arrangements for EU citizens, and for multiple visits and the seeking of a reciprocal touring visa with the EU to enable creators and performers to travel temporarily and to take their equipment with them, tax free.

The UK already offers visa-free entry, including for work purposes, to non-visa nationals. However, the scope of that route for non-visa nationals is too restrictive, and it does not provide any certainty, because ultimately, it is down to the discretion of the UK border official to assess whether the musician is qualified to perform the paid engagement, or that the paid engagement relates to their area of expertise, qualification or occupation. The details provided by the UK Government in the context of the UK points-based immigration system require further clarification of the status of musicians.

European musicians need to be able to tour without restrictions. This includes the transportation of their equipment, and it applies not only to performing musicians but also to song writers, composers, performers and producers, who often travel for work-related purposes. The crew—the trusted people whom musicians rely on when touring—need to be expressly included within simplified touring provisions. This affects UK musicians touring Europe as well as European Union or EEA musicians touring the UK. So we need clarity in any trade agreement that performers and their equipment can tour throughout the European Union without restrictions. Offering a simple solution to musicians or composers intending to perform in the UK would provide a good negotiating position to ensure a favourable system with the EU and other countries, based on reciprocity.

At present, because of freedom of movement for people, UK performers can play a concert in Amsterdam one night, then simply travel to Paris the next night, with no associated costs or red tape. Following the end of the transition period, this freedom will end for UK musicians, unless there are appropriate measures in place to support touring musicians, composers and so on. Countries such as France have traditionally required work permits for performances by artists from non-EU countries. A new reciprocal system is needed post-transition, to ensure that musicians and their crew can operate across Europe in an economic and unbureaucratic way, preserving vital economic and cultural links.

Costly bureaucracy will make touring simply unviable for many artists, putting the development of future globally leading UK talent at risk. This has become even more urgent following the social distancing measures and other restrictions imposed on live events. Most musicians, composers and everyone else involved in the successful organisation of live music events are self-employed or operate as small and medium-sized businesses. Social distancing restrictions will render impossible any economically viable live events at least until the end of 2020, with catastrophic consequences for the live music sector. Based on the figures for live music in UK Music’s Music By Numbers report, the loss to the sector will be at least £900 million.

Health and Social Care Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Tuesday 13th March 2012 Lords Chamber

[Lord Clement-Jones]

My Lords, in moving Amendment 297, I shall speak also to Amendment 301. First, I declare an interest as chairman of the council of the School of Pharmacy, University of London. For the avoidance of doubt from the outset, I will not press these amendments.

In Committee, I moved an amendment to provide a due diligence defence to the currently strict liability criminal offence committed under Section 64 of the Medicines Act 1968. This has the potential to operate very harshly on those making single errors dispensing medicines, whether in retail or hospital pharmacies. The intent of the original amendment was to remove the injustice that pharmacists and some others among healthcare professionals face criminalisation through single dispensing errors.

It was also very importantly designed to increase patient safety by removing barriers to a learning culture within the pharmacy profession and to ensure that pharmacists who wish to declare a dispensing error in the interests of patient safety are not penalised. The formulation of a defence, which gains universal acceptance among the pharmacy profession, has however proved more difficult than originally anticipated. Although the regulator, the General Pharmaceutical Council, has been supportive of the proposed amendment, there is as yet no consensus with the pharmacy professional bodies as to the best way legally of formulating a defence that meets these objectives.

There is, however, a unanimous view among professional pharmacy bodies that it would be better not to amend the Act at this juncture in this way but to wait for the full review of offences under the Medicines Act due to be carried out by the Medicines and Healthcare products Regulatory Agency, the MHRA. There have of course been helpful discussions to this effect with the chief pharmacist and his colleagues at the department, and agreement, as I understand it, that we should go forward on this basis.

In this context, it would extremely helpful for all concerned if the Minister could confirm the timetable for the scoping of the sanctions and penalties in medicines legislation review to be carried out by the MHRA and any other details of the review that he can give at the present time, such as the procedure, the timetable, and the involvement of the regulator—the GPhC—and professional bodies.

Although this is not directly within the gift of the Minister, it would be extremely helpful if he could also indicate that the department will engage with the DPP and the Crown Prosecution Service to encourage them in the mean time to engage with the profession and the regulator in reviewing the prosecution guidelines for offences under the Medicines Act. That would be extremely welcome to all those concerned in the profession. I beg to move.

[Lord Hunt of Kings Heath]

I must say that I am surprised that the noble Lord moved this amendment. He told me yesterday that he was not going to and did not have the courtesy to tell me that today he is. The amendment raises a very interesting question. No doubt we will be very interested to hear the response of the noble Earl, Lord Howe. He might perhaps add the membership of the review team to the details of the review.

Police Reform and Social Responsibility Bill

Debate between Lord Clement-Jones and Lord Hunt of Kings Heath

Thursday 9th June 2011 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, given the late hour and that this is our last group of amendments, I shall not tempt fate by seeking to open a more general debate about alcohol and young people. We will perhaps be able at the start of our sixth day of Committee to debate more general issues under Amendment 240M in the name of the noble Baroness, Lady Coussins.

I do, however, wonder whether we have got right our approach to children and alcohol. While I accept that there are very serious issues around allowing the sale of alcohol to children, there is no doubt in my mind that the crackdown on the sale of alcohol in pubs to older teenagers up to the age of 18 has not really had the desired effect. It seems to have encouraged those young people just to buy or get booze and drink it on the streets, whereas many 16 and 17 year-olds were clearly much better off under supervision in licensed premises. I worry about the advice that organisations such as the Royal College of Physicians have again given to parents about alcohol and young people. It seems so unrealistic as to lack any credibility. I do not expect the Minister to answer these substantive questions; I shall just say to her that I am not sure that either the Government of whom I was a member or hers, or many of the bodies involved, have taken a realistic attitude.

The amendment brings us back to a debate that was held in the other place, where there was a vote in Committee. It suggests that among the penalties available it might be useful to have a training order. Where appropriate, it would enable those persons who sold alcohol to undergo training and help to ensure that the behaviour in question is not repeated. I understand that there is considerable support for this proposal. I would be interested to know whether the Government, in the light of the debate in the other place, have given some further thought to this matter and consider that it might be appropriate. It is not a substitute for other penalties; it is just another option that might be adopted. I beg to move.

[Lord Clement-Jones]

My Lords, I support the amendment of the noble Lord, Lord Hunt, and I shall speak to Amendment 240N, which has a similar concept, and Amendment 240L.

Training orders would be a more proportionate way of addressing instances of underage selling where there has been no intent to do so. They would provide a positive alternative to a fine or a closure order and give an additional discretion to the authorities. Under Amendment 240N, a training order would require a business to close for a period of 24 hours to train staff in their legal obligation not to sell alcohol to those aged under 18 and on the importance of checking proof of age. There would be a cost to business in terms of lost revenue but the staff would still be paid, which would not be the case in the event of a closure order. Training orders would provide a remedy that would address the issue and provide a long-term solution. At the same time the business concerned would still suffer the penalty of a temporary closure, resulting in loss of sales for the period of the order. Both Amendment 240KA and Amendment 240N are to be commended.

Amendment 240L is rather more radical. It would remove the proposed extension to closure notices. A closure of more than 48 hours could have a severe impact on any licensed premises and their staff, not least in the current difficult economic climate. The current system has, I am reliably informed, worked well, and it is unlikely, the licensed trade tells me, that many premises would accept a notice to close for longer than 48 hours but would instead opt to go to court.

The need for and benefits of extending the current norm of 48 hours is therefore questionable—certainly the upper two-week period, 336 hours, would seriously damage businesses, particularly small hospitality businesses, which have been among the hardest hit by the recent recession. A two-week closure would affect the income not only of the business itself but also of its employees who, in most instances, would not be paid. Such extended closures could be justified only where the underage sale was made with intent; otherwise training orders, as we have discussed, as proposed by Amendments 240KA and 240N, would be a more effective and fairer solution.

No one would condone deliberate sales to those who are under age. However, a closure notice extending to 336 hours is an extraordinarily draconian proposal. I hope that the Government will accept that many breaches are not with intent but are inadvertent; and that where staff need proper training the concept of training orders is a more constructive way forward.