Infected Blood Inquiry: Compensation Scheme

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 22nd May 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, I do not think it is for me as a Minister to opine on potential criminal liability. All I can say at this early stage is that the Government will make all relevant information available to those conducting any future criminal investigation.

[Lord Collins of Highbury (Lab)]

My Lords, I echo my noble friend’s comments about the awful circumstances and the apology. Yesterday, after the repeat of the Statement, I reassured the Minister that what was required to implement all the recommendations of the report was cross-party working, and that we will continue to do that whatever the circumstances. He gave a commitment about the other 11 recommendations of the report; the Commons were due to debate it on returning from the Recess. I hope that we can keep that firmly on the agenda so that we properly address all the issues that the report raises.

[Earl Howe (Con)]

I am very grateful to the noble Lord. I am personally keen that we should have that opportunity. I am aware that discussions are ongoing with the usual channels to enable us to have a debate not too far from when we come back from the Recess. Clearly, it is important that these findings be given the most thorough consideration by government. They are very grave indeed. As I said yesterday, the wrongs that have been done are devastating and, in many cases, life altering. A comprehensive response will be given in due course, but that should not prevent us debating the report in the meanwhile.

Business of the House

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 9th May 2023 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I want briefly to add my comments to those of the noble Earl regarding the staff on Saturday. Not only did they carry out their duties well and properly but they were friendly and courteous and took extra steps to make the whole day enjoyable. I join with the noble Earl in his remarks.

Turning to my noble friend’s contribution, unfortunately my noble friend Lord Kennedy, our Chief Whip, cannot be here, so I am the friendly face. I accept the comments of my noble friend Lord Foulkes but we have agreed on tomorrow. In terms of a precedent, I hope the noble Earl will take my noble friend’s comments on board for future occasions.

[Earl Howe (Con)]

My Lords, I certainly take the comments of the noble Lord, Lord Foulkes, on board. There is always a judgment to be made, when the list of speakers is as long as it is tomorrow, as to whether one should seek to divide a Second Reading up into more than one day and thereby have a breakage by way of an adjournment, which in itself is never very satisfactory, or to do as we have done, which is to attempt to make a single debate fit into a single day. It was the general feeling in the usual channels that this is the right outcome in this instance, particularly as it will allow a reasonable speaking time for noble Lords and a reasonable rising time as well.

Higher Education (Freedom of Speech) Bill

Debate between Lord Collins of Highbury and Earl Howe

Report stage
Wednesday 7th December 2022 Lords Chamber

[Lord Collins of Highbury (Lab)]

I will be very brief. There is a danger of this debate widening out too far. In Committee, I advocated to the Minister the UNESCO definition of academic freedom. Of course, there is always that confusion between academic freedom and freedom of speech. I was assured by the Minister in Committee, so I was satisfied with what the Government were saying. I hear what the noble Lord says about quality, but standards of teaching and research are a very important element of our universities; we should not forget that. We should not promote one argument and then undermine the very thing that our universities are very popular for globally. We do not support this amendment. We agreed with what the Minister said before and I look forward to his response today.

[Earl Howe (Con)]

My Lords, as we have heard, the amendments in this group relate to the important issue of academic freedom. I turn first to Amendment 4, tabled by the noble Baroness, Lady Fox of Buckley, which seeks to amend the definition of academic freedom set out in new Section A1 to make it explicit that academics can voice opinions about the institutions where they work, without fear of adverse consequences.

In responding to a similar amendment tabled in Committee by my noble friend Lord Strathcarron, to which the noble Baroness also put her name, I clarified, as the noble Lord, Lord Collins, kindly mentioned, that the definition of academic freedom as currently drafted already covers the questioning and testing of received wisdom, and the putting forward of new ideas and controversial or unpopular opinions. This speech is not limited to particular subjects, so it would include speech concerning the institute at which an academic works. The Bill will therefore already protect the freedom of academics to put forward opinions about the curriculum content adopted by their provider or third-party organisations with which the provider is affiliated.

As the noble Baroness highlighted, there is a reference in the explanatory statement to the UNESCO recommendation. It may be helpful for me to put on record that the Bill as drafted protects academics in a number of the ways listed in that recommendation. Specifically, it protects the rights to freedom of teaching and discussion; freedom in carrying out research, and disseminating and publishing the results thereof; freedom to express freely their opinion about the institution or system in which they work, as I have already said; and freedom from institutional censorship. However, the Bill does not cover conduct which is not speech, such as the act of affiliating with or joining an organisation.

The noble Baroness also referred to the 2015 case of Kharlamov v Russia, and I can confirm the essential features of the case that she set out. Mr Kharlamov was a physics professor who said during a conference that he was unhappy with the nominations process for candidates to the academic senate. The university sued him for defamation. The European Court of Human Rights in due course found in his favour on the basis that the Russian courts failed to fairly balance the relevant interests and establish a pressing social need for protecting the university’s reputation over the claimant’s freedom of expression. I hope that, in the light of what I have said, noble Lords are reassured that this amendment is not in fact needed.

Amendment 5 tabled by the noble Lord, Lord Wallace of Saltaire, seeks to probe the workability, as he put it, of new Section A1(7)(b) in Clause 1. Taken at face value, it would amend the definition of academic freedom so that it would no longer specify that an academic should not be put at risk of a reduced likelihood of their securing promotion or different jobs at the provider. I realise that it is a probe. It is correct that this provision is not included in the existing legislative definition of academic freedom in the Higher Education and Research Act 2017 and the Education Reform Act 1988. However, we want to be clear in the Bill that academic staff should be protected in as expansive a way as possible—so not only from losing their job or privileges, but from being less likely to secure promotion or a different job at the provider. If we do not specify that these are also covered, there may be only partial protection. A person might not be fired but might be held back in their career, by not being promoted or given another role at the provider because of something they have said.

As I mentioned, the noble Lord wants to know how this provision will work in practice. An academic will of course need some evidence to support a complaint that they have been wrongly held back because of their views. They may have been told by a colleague the reason why they have not been promoted. There may be notes from an interview that suggest why this is the case. There may be an email which makes this clear. In the face of such evidence, the question will then be whether the provider has failed to comply with its duties under the Bill. I note the noble Lord’s point about the OfS guidance and I will ensure that the OfS also does so. This is the way that evidence in employment law is often presented. It is not new, nor is the concept of protection from not being promoted, since that can be a matter leading to constructive dismissal, which has been a feature of employment law for some time.

I hope that this explanation reassures the noble Lord that this is an important aspect of academic freedom in the context of freedom of speech, and that he agrees that the provision will protect academic staff to the fullest extent.

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[Lord Collins of Highbury (Lab)]

My Lords, I have a confession to make: when I spoke at Second Reading, I expressed the opinion that this Bill was not necessary. However, during the process of Committee and the dialogue and discussions that I have had with many noble Lords—by the way, I have no interest as a university leader to declare—I was persuaded that there is an issue to address.

My experience as a trade union official over many years is that, when you want to change behaviour and culture, you do not do it through the courts. You do it through the very mechanism that the Bill proposes: improved and strengthened regulation, and a strengthened code of practice. That is what the Bill attempts to do and I have been convinced that it is necessary from hearing the arguments and all the cases and evidence given. This is not a binary choice: I now accept that the Bill is necessary. However, in my opinion, keeping Clause 4 would undermine the very thing the Bill is seeking to achieve. If you support the Bill, get rid of Clause 4, because it would undermine the very thing we are seeking.

Our approach, throughout Committee and Report, has been not to make this a partisan or party-political issue. We have heard the debate and listened, and I have accepted the need for the Bill. That is why I signed the amendment of the noble Lord, Lord Willetts. I expect and hope to divide the House, because this clause needs to go.

[Earl Howe (Con)]

My Lords, I begin by expressing my thanks to noble and noble and learned Lords from all Benches of the House for their thoughtful and helpful contributions to this debate, all of which I listened to with great attention. I think it would be helpful to the House if I begin my response by considering the tort in the round, before turning to the amendments tabled to this clause, bearing in mind the nature of the debate in Grand Committee and the subsequent, helpful discussions that my noble friend Lady Barran and I had with a number of noble and noble and learned Lords outside the Chamber.

The tort has undoubtedly been one of the most controversial measures in the Bill. A number of noble Lords have spoken today to express their opposition to its inclusion in the Bill. However, other noble Lords strongly support the inclusion of the clause. My noble friends Lord Moylan, Lord Frost, Lord Strathcarron, Lord Jackson of Peterborough and Lord Farmer, and the noble Lord, Lord Moore of Etchingham, have written to me setting out compelling arguments for retaining the tort, some of which we have heard today. Many of the arguments have been echoed by the Free Speech Union in a letter to the Secretary of State for Education signed by 49 leading academics, among them, incidentally, Professor Kathleen Stock. Perhaps I might say in that context that I reject the view expressed by my noble friend Lord Moylan that the government amendments, to which I spoke earlier, somehow water down or weaken the tort provision. They address the concerns expressed about the perceived risk of the OfS’s role as a regulator being undermined and of unmeritorious claims burdening universities with unnecessary costs. I am sorry that no noble Lord acknowledged that the government amendments would deal with those perceived risks, in my view, pretty comprehensively.

We are dealing here with a mixture of arguments. Part of the argument advanced for removing the tort is that it is unnecessary and that there are somehow other measures available to achieve the same thing. I think the best place for me to start would be to address that issue. The noble and learned Lord, Lord Hope of Craighead, suggested in Grand Committee that there would be a common-law tort available, even if the statutory tort was not in the Bill, and that view has been supported by other noble Lords. The Government have looked carefully at that proposition, but we are not convinced that that position is sufficiently legally certain, and for that reason it is not something on which we would wish to rely. I believe that opinion is divided even among noble and learned Lords on the issue.

The purpose of including the tort in the Bill at introduction was to make it 100% clear that a tort will be available, rather than leaving it to the courts to infer whether or not Parliament intended there to be a tort, which in certain cases, they may do. To leave the situation uncertain when we have the opportunity to be absolutely clear would be remiss of us.

The noble Lord, Lord Grabiner, made the point that the tort is not necessary because judicial review is available, whether of a decision by the higher education provider or a decision under the complaints scheme of the Office for Students or the Office of the Independent Adjudicator for Higher Education. However, judicial review is not available against decisions of a student union, and damages are generally not awarded in judicial review claims. I am afraid I do not accept his argument that damages would never be quantifiable in such cases. Of course, let us bear in mind—

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[Lord Collins of Highbury (Lab)]

My Lords, my noble friend Lord Sikka knows the Labour Front Bench’s position on his amendment, because I wrote to him about it. He knows that we are very sympathetic to the issues and, like the noble Lord, Lord Wallace, believe that they need to be addressed. Certainly, over the years, all Governments have been focused on sufficient funding of research, through different mechanisms, such as the Medical Research Council and the Economic and Social Research Council—all these bodies through which we have attempted to ensure that research is open and transparent.

One of the problems that my noble friend is seeking to address is the sort of research when somebody decides to ask a question, hoping they know what the answer will be, and those tend to be funders, whether from business or industry. They are seeking a particular outcome and, if they invest in that research and the outcome is not the one they want, of course they will not publish. The noble Baroness, Lady Fox, focused on charities. I keep harping on about my own experience in the trade union movement, but I must admit that we certainly funded research in the hope that it would support our case for greater workers’ rights and higher pay. It did not always come out the way we wanted and we were sometimes not particularly keen to publish it. We did not prevent the academic from expressing the view and certainly did not stop them from publishing it themselves, but we were not necessarily going to promote it.

The Bill is about freedom of speech—we have had a long debate about it. When it comes to academic freedom and research, there are much more complex questions that should not really be dealt with in the Bill. I am fully sympathetic to some of the arguments that my noble friend Lord Sikka made, but this is not the right Bill, and certainly these amendments are not the right ones.

[Earl Howe (Con)]

My Lords, Amendment 23 tabled by the noble Lord, Lord Sikka, seeks to ensure that the provision of grant funding for research does not interfere with the academic’s freedom to edit and publish their research. The only exceptions would be if there was a confidentiality agreement between those giving and receiving the grant made in advance or if a court finds that full publication would threaten national security, public safety or health.

The noble Lord is of course right to be concerned about the provision of grant funding for academic research and, as he acknowledged, we discussed this issue in Grand Committee, although perhaps not conclusively. The approach in the Bill is to place duties on registered higher education providers, their constituent colleges and student unions. I have to say that it goes too far to place duties on others, such as those who give grant funding, and I am also not at all comfortable with the idea of interfering in the private contractual arrangements between parties, which would be the effect of this amendment.

If an academic wishes to seek grant funding, it is for them to agree with the other party what contractual arrangements should apply. That is in fact reflected in proposed new subsection (3)(b) of the noble Lord’s amendment and reflects the Haldane principle: that decisions on individual research proposals are best taken by researchers themselves through peer review—a principle enshrined in the Higher Education and Research Act 2017.

However, in my view it would go too far to require legal proceedings to determine whether full publication of research would threaten national security, public safety or health. First, those are extremely limited reasons, which I appreciate is the noble Lord’s aim, but there may well be other legitimate reasons why the grantor would not want full publication. Secondly, this would potentially open the door to costly and time-consuming litigation. I fear that this may have a chilling effect on grant funding if it deters grantors, which is obviously not desirable; it may also affect the academic, as a potential party to the litigation, who is likely not to have the means to fund their part in it. It does not seem to me that the involvement of the courts in such a matter is appropriate.

Noble Lords have suggested that there is a lacuna as regards transparency in the domestic funding of higher education. I hope that I can allay that concern very simply. The Higher Education Statistics Agency collects data about research grants and contracts, which is publicly available. The OfS collects data that it needs to support its functions, including ensuring that providers are financially sustainable, and publishes this through annual reporting.

Given those points, I hope that noble Lords will agree that this amendment is not necessary.

Higher Education (Freedom of Speech) Bill

Debate between Lord Collins of Highbury and Earl Howe

Committee stage
Monday 14th November 2022 Lords Chamber

[Earl Howe (Con)]

I am grateful to the noble Lord. I shall reflect on that point and write to him, if he will allow me to clarify the Government’s position in that way.

I have already set out how we envisage the tort will operate, so I will not repeat that. Suffice to say that, in the view of the Government, the statutory tort will provide an important legal backstop by giving individuals a specific right to bring a claim before the courts. This could include a number of people in different situations. For example, and purely by way of example, it could include students expelled from their course because of their views; organisers of an event that is cancelled, having incurred costs in the process; and a visiting speaker disinvited at the last minute, with the accompanying media furore and perhaps damage to feelings and reputation. There are other instances I could give. Noble Lords who wish to remove this clause need to be comfortable about removing a backstop provision that could offer a remedial route to certain individuals, such as those I have mentioned.

I hope I have been able to set out why we believe that this clause fulfils a duty that we surely owe to those who believe that their legal rights in this area have been infringed.

[Lord Collins of Highbury (Lab)]

A number of noble Lords referred to the chilling effect and the Minister did not really cover that point. He keeps talking about this being a backstop, but if its effect is to prevent the invitations and stop the debate, what does he think about that chilling effect? It has completely the opposite effect to what he has been speaking about.

[Earl Howe (Con)]

The point the noble Lord, Lord Collins, makes goes hand in hand with the point that I would like to reflect upon. The issue raised by a number of noble Lords was the sequence of events: whether the Bill should make clearer that the complaints process should have first been exhausted before a recourse to the courts is made. So if I may I will consider the noble Lords “chilling effect” point in that context, as well as in the context of the overall clause, and write to noble Lords accordingly.

Higher Education (Freedom of Speech) Bill

Debate between Lord Collins of Highbury and Earl Howe

Committee stage
Wednesday 2nd November 2022 Grand Committee

[Lord Collins of Highbury (Lab)]

This has been a really informative debate. Fundamentally, the noble Baroness, Lady Falkner, has set it in the proper context. I am not sure which hat she was wearing but whichever it was, this has been put in context; it is about balancing duties.

I must admit that, the more we discuss the clauses in this Bill in detail, the more I think about unintended consequences. If we have existing duties and responsibilities, why have they not worked? Why is it that Governments immediately resort to legislation rather than thinking about what is actually going on and asking what powers that they have could be better utilised? On the first day in Committee, a number of noble Lords made precisely that point. They highlighted where they think that things have gone wrong, but did not see this legislation as being particularly the right mechanism for putting it right. This debate has been extremely useful.

I must admit that I found the contribution from the noble Lord, Lord Mann, enlightening. My tendency is to look at my own personal experience at university—many, many years ago. There was quite a lot of hostility and demonstrations, and certainly some of the extremists that the noble Baroness, Lady Fox, talked about—maybe even the noble Baroness herself, as I suspect that we were both at the same university—frequently tried to stop me speaking on behalf of the Labour Party. By the way, I like the idea that I have the luxury of speaking in a personal capacity; maybe we should tell Conservative Central Office that that is the case—though I am tempted not to do that.

At the end of the day, what we have here is agreement on fundamental principles but disagreement about how you best achieve them. Invariably, there are competing interests at stake when speakers are invited to our campuses but, as the noble Lord, Lord Mann, said, freedom of speech is not a trump card. I make that point to the noble Lord, Lord Moylan. He may be able to qualify his words but, fundamentally, as the noble Baroness, Lady Falkner, said, those words do put it into a hierarchy, which I think is particularly dangerous.

Whether we like it or not, universities have a broad range of responsibilities, and not only to academic staff and students; they are also big employers and so have a duty to other staff as well—particularly when it comes to statutory legislation such as that on health and safety, which is something they must take into account when exercising these responsibilities.

As the noble Lord, Lord Mann, said, students have a right not to be harassed or subjected to hate speech. Most importantly, as he said, they have a right to protest and to say that the opinions being expressed by somebody who has been invited to their university are abhorrent. When I was at university, extremist religious faith groups were saying that my sexuality represented an evil thing that needed to be banned and stopped. Fortunately, we have moved on and do not allow that in quite the same way. If a religious fundamentalist came here, I would expect to have the right to say that I found their opinion abhorrent. The noble Lord, Lord Mann, was absolutely right, and the case that he used to illustrate this is an important one.

When I looked at the Bill’s Committee stage in the Commons, I saw that points were made, with reference to the evidence sessions, about how the Equality Act could be used:

“Professor Stephen Whittle from Manchester Metropolitan University acknowledged as much in the Bill Committee, recognising that the Equality Act would afford protection only if the speech were directly addressed to the complainant. That is important because front groups such as Hizb ut-Tahrir, which is not a proscribed organisation but which often espouses antisemitic views, could come on to campus under the guise of freedom of speech.”—[Official Report, Commons, 13/6/22; col. 80.]


There is real concern here about how we must have that balancing act and ensure that people are protected. The example from the noble Lord, Lord Mann, about a family member of someone who suffered the consequences of terrorism, is a really important one.

At the end of the day, we have to try to take into account the sentiments contained in Amendments 29, 32 and 44 and ensure, as the noble Lord, Lord Smith, said, that we recognise those balancing responsibilities. As the noble Baroness, Lady Falkner, said, it is important that this proposed law does not inhibit the balancing of those responsibilities. I certainly have a lot of sympathy for the amendments in the name of the noble Lord, Lord Mann.

[Earl Howe (Con)]

My Lords, as we have heard, this group brings together a series of amendments that seek to clarify in the Bill how its duties will interact with other duties and responsibilities.

Amendments 29 and 44 in the name of the noble Lord, Lord Mann, seek to ensure that providers and student unions balance their duty to take steps to secure free speech with their duty of care to students, staff and members. Amendment 32 would add this consideration to the duty to promote in Section A3.

I am grateful to the noble Lord for raising this important point and listened with care to the examples he gave. He is quite right that providers have a duty of care to their students under common law, as well as obligations to their staff under employment law. Student unions also have responsibilities to their staff under employment law. It is of the utmost importance that they can fulfil these obligations, providing an environment in which students, academic staff and members can thrive and taking reasonable steps to promote their health, safety and welfare.

As I mentioned, the noble Lord cited a number of examples to illustrate his arguments around the duty of care, one of which was a speaking invitation issued to a convicted terrorist. Inviting a convicted terrorist would likely require consideration under the Prevent duty in addition to the wider points he made on duty of care. I will cover the Prevent duty in more detail when I cover Amendment 69, if he will allow.

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[Lord Collins of Highbury (Lab)]

Yes. Then we get into a much bigger question, which for me is the most important political question. I know my noble friend has also entered into debates on that issue, including on TRIPS and stuff like that.

I will be interested to hear the Minister’s response to this point. Personally, I do not think that these amendments are in the right Bill or the right place.

[Earl Howe (Con)]

My Lords, this group of amendments relates to impartial research funding. Amendment 34 in the name of my noble friend Lord Moylan would introduce a new duty to require higher education providers to take reasonable steps not to refuse to grant funds for research because of a recipient’s lawful principles or political opinions.

Amendments 45 and 46, also tabled by my noble friend, seek to make clear, first, in respect of donations and sponsorship to registered higher education providers and, secondly, in respect of funding through UK Research and Innovation, that the donor, grantor or provider may never restrict the freedom of speech of those working under the funding. Amendment 53 in the name of the noble Lord, Lord Sikka, is about the awards of grants for academic research.

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[Earl Howe (Con)]

I would hope that a rugby club would not be responsible for inviting somebody to talk about gender politics.

[Lord Collins of Highbury (Lab)]

The Minister is completely wrong about that. It is highly likely that they would, because there is a highly controversial issue around gender, sex and sport. I think he does not fully understand the range of issues that can be addressed by a huge range of societies in the university community.

[Earl Howe (Con)]

I bow to the noble Lord’s superior knowledge on this. If noble Lords will allow, I will conclude.

I mentioned the possibility of a monetary penalty, which was raised by the noble Baroness, Lady Garden. The power to impose a monetary penalty is based on the existing enforcement regime for higher education providers and is intended, obviously, to encourage compliance.

New Section 69B will also require the OfS to maintain and publish a list of student unions at approved fee cap providers. This will make it clear which student unions the OfS has been informed by its providers are subject to the duties in new Sections A5 and A6. It will also require those student unions to provide the OfS with information it may require for the performance of its functions. These are new regulatory functions, intended to ensure compliance by student unions with their new duties. Together with Clause 3, this clause will ensure that freedom of speech is protected by not just higher education providers but student unions.

Higher Education (Freedom of Speech) Bill

Debate between Lord Collins of Highbury and Earl Howe

Committee stage
Monday 31st October 2022 Grand Committee

[Earl Howe (Con)]

I take the noble Lord’s point entirely. I think that I said that the definition I referred to was non-exhaustive. It is quite deliberately non-exhaustive, because it is a definition that we felt was appropriate for the purposes of the Bill. I suppose I could sum up the issue by saying that we believe there is a consistency between the Bill and the ECHR, even if there is not total congruency.

I emphasise that the duty in the Bill to take reasonably practicable steps means that providers, colleges and student unions can take account of all their legal duties on a case-by-case basis. If another legal duty requires or gives rise to certain action, it would not be reasonably practicable to override that.

Amendment 11 would provide that a non-disclosure agreement with a provider does not mean that members, staff, students or visiting speakers could not speak freely. There is an exception for intellectual property. I very much support the spirit of this amendment—in particular, victims of sexual misconduct and harassment should never be pressurised into keeping silent. The previous Minister for Higher Education, Michelle Donelan, strongly supported work in this area. She launched a voluntary pledge in January this year, in conjunction with Can’t Buy My Silence and universities, to encourage providers to commit not to using NDAs to silence victims of complaints of sexual harassment, abuse or misconduct, and other forms of harassment and bullying. To date, 74 higher education institutions and three Oxford colleges have signed up to this. The Government are working with Can’t Buy My Silence to call out those who have not yet done so.

[Lord Collins of Highbury (Lab)]

Does the noble Earl not think that that is a good example of where good practice can be adopted not by legislation but by employers agreeing that something is not appropriate? Can he not proudly point to that as somewhere the Government have intervened and change has happened without the need for legislation?

[Earl Howe (Con)]

We certainly hope that this will gain traction. I agree that in most circumstances it is better to encourage voluntary action, as long as it works. This is very much a work in progress.

We have also asked the Office for Students to create a new registration condition to ensure that it properly tackles sexual misconduct. This would have real teeth and would mean that providers could be sanctioned with penalties, suspension from the register or even deregistration. This follows the publication by the OfS of a statement of expectations for providers in this area.

I make the point that we are the first Government who are prepared to tackle this issue. I shall continue discussing with colleagues on both sides of the House how best we can tackle sexual harassment and misconduct in our universities. I therefore have no difficulty in committing to taking this matter away and looking at it further.

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[Lord Collins of Highbury (Lab)]

My Lords, I welcome these amendments, because they probe the practical implications of these clauses. The noble Lord, Lord Grabiner, raised the point about the code of practice, and I was going to ask the Minister exactly how the code of practice in new Section A2 would cover the circumstances in relation to these amendments.

At the end of the day, as the noble Lord, Lord Mann, says, organising meetings has all kinds of implications for universities and colleges. Health and safety is a critical issue for the organisation of meetings, and the timing of meetings has employment issues, relating to staff and things like that. There is a whole range of practical issues that could result in having to say to the organisers of a meeting that they cannot have their meeting on that day or in that place.

The Minister may say that the code of practice referred to in new Section A2 talks about the procedures to be followed in connection with the organisation of meetings to be held on the provider’s premises. I want to know about the status of the code of practice and how the office of free speech will look at it. Are we going to end up with universities producing a code which fits all their requirements—health and safety requirements, employment law conditions, staffing issues, security issues and so on—then being tied up with people challenging it through the complaints process, saying, “They said that thing about health and safety as an excuse to ban us having a meeting on the premises.” I have heard it before. I have heard people say, “What has health and safety got to do with it?” or “Why should a maintenance staff member tell us to get out at 8 o’clock when I want to continue this speech and have this meeting?” There are practical implications.

How does a university know that the code of practice it adopts according to new Section A2 will meet the requirements? Will draft codes be circulated? What sort of advice and guidance will universities get—or are the Government simply going to say that this is all about what is reasonably practicable? I have heard those words many times in different contexts, particularly in terms of employment law and conditions. I hope that the Minister can reassure us on these probing amendments. Universities are independent bodies and should be able to manage their own organisation without the interference of outside bodies. I think this is a step too far.

[Earl Howe (Con)]

My Lords, the group of amendments to Clauses 1 and 3 tabled in the name of my noble friend Lord Willetts and spoken to by the noble Lord, Lord Stevens, seek to give higher education providers and student unions the flexibility to move events to alternative premises but not cancel them. The noble Lord, Lord Mann, has also tabled Amendment 6 to the provisions concerning premises.

Under the Bill as drafted, providers, colleges and student unions will already be free to move events to alternative rooms, should that be appropriate. The main duty of taking reasonably practicable steps to secure freedom of speech is linked to the provisions that are the subject of these amendments—those in proposed new Section A1(3). This means that the duty is to take reasonably practicable steps to secure that the use of premises, and the terms on which such use is offered, are not based on the ideas, beliefs or views of individuals or groups. The duty to take reasonably practicable steps therefore means that there is already flexibility.

In any event, a provider, college or students’ union is not required under the Bill to allow the use of their premises at all times and in an unlimited way. It is open to them to offer particular rooms for use by event organisers at specified times. As regards Amendment 6, Section A1(3)(a) refers to “any premises” but could refer to “premises” without changing the effect. It should also be noted that the relevant body can place conditions on the use of rooms.

In this context, it might be helpful to touch specifically on the point raised at Second Reading by the right reverend Prelate the Bishop of Coventry regarding concerns about the use of faith spaces. I was very happy to meet him some days ago to discuss this. The example given by the noble Lord, Lord Mann, of having an anti-Israel talk right next to Jewish premises, touches on a similar point. Sections A1(3) and (4) on the use of premises essentially replicate the wording of the Education (No. 2) Act 1986, referring to beliefs among other things in that context. As I said earlier, the provisions link back to the main reasonably practicable duty in subsection (1), so it is not an absolute requirement. I think that was an initial cause for concern on this point, so I am happy to clarify that. In fact, the “reasonably practicable” steps wording enables providers to continue to designate spaces for use by faith groups without any obligation for the provider to open those spaces up to other groups, whether or not they have conflicting ideologies.

Under the reasonably practicable steps duty, it would be legitimate for a provider not to offer a particular faith space to any group that wants to hold an event, but to offer another suitable space, thereby upholding the freedom of speech duties and preserving the integrity of the space set aside for the faith group. The legislation enables providers to respect the religious views of those with designated rooms, taking into account the duties under the Equality Act, while still complying with the freedom of speech duties. To pick up a point made by the noble Lord, Lord Grabiner, we anticipate that the Office for Students will publish guidance for providers on how to comply with the duties. We can certainly discuss this with the Office for Students to ensure that it covers this issue, which I hope will provide noble Lords with further reassurance.

I just say to the noble Lord, Lord Collins, that providers are already required under the Education (No. 2) Act 1986 to have a code of practice regarding freedom of speech. The Bill strengthens that requirement. Providers will now need to include a statement of values in their codes of practice that clearly sets out the importance of freedom of speech. Providers should be setting the tone and expectations campus-wide so that everyone is confident to express their lawful views and challenge received wisdom, even if their views are unpopular. Codes of practice will also need to set out the criteria that providers will use to make decisions about the use of their premises for events involving potentially controversial views, as well add the criteria for when exceptional circumstances may apply regarding the payment of security costs. The Bill strengthens the duty on providers already set out in the Education Act 1994 so that all students, not just those who are members of student unions, are made aware of the duties and the code. Once again, the Office for Students will give guidance on this.

Elections Bill

Debate between Lord Collins of Highbury and Earl Howe

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

[Lord Collins of Highbury (Lab)]

My Lords, I too wish the noble Lord, Lord True, a speedy recovery and a quick return to duty, hopefully in time for Report. I am sure that the noble Earl would be pleased by that.

This has been a very good debate, because it has focused on broader issues of principle which we need to probe the Government on. The noble Lord, Lord Wallace, is absolutely right, as we have said at a number of stages, that this Bill represents missed opportunities. It is not so much what is in it as what is not in it that has been a problem. I am sure that the amendments which we have tabled will be considered. If they are not in this legislation, we will return to these broader issues of principle. The one thing that we would have all hoped for in terms of that right to vote is clarity, which we do not get here for all kinds of reasons, not least legacy reasons. Noble Lords have spoken about the complications that we will now face which we had not faced previously, not least that we will have some EU citizens with the right to vote and some without the right to vote, based on when they arrived—an arbitrary date as far as they are concerned.

Of course, the principle that we have sought to highlight in our amendment is what sort of qualification would make sense, would be clear and would be easily understood. We bandy terms such as “no taxation without representation” around, but lots of people who should be perfectly entitled to vote do not pay tax, particularly council tax. Residency is an important principle and perhaps the missed opportunity that this Bill could have addressed more properly, not least because of that legacy. I am not arguing at all for a change in what happened in the Brexit vote. We have left the EU. However, there is a legacy that we must consider there, particularly on people who have made their home here.

I must declare an interest, not least because in my household, with every general election that comes around, we are denied the right to vote. I wish we could vote but we cannot. My husband has lived here for 27 years; he has been a taxpayer, a national insurance payer and a council tax payer. He is a member of the Labour Party, has campaigned for candidates and has voted in every local election that he has been permitted to. The legacy of that will continue. The complication is that it will not apply to other EU citizens who establish the right of residency, who work here and who pay tax here. After a certain date they will not have that right to vote. It causes unnecessary complication.

Throughout this Bill I have readily agreed with the noble Lord, Lord Hodgson, particularly on citizenship education—and by the way, citizenship education should not be limited to citizens of the United Kingdom. The rights and responsibilities of living in this country should be understood by all who live in this country, and we would create a much safer society if we undertook that responsibility. That is why we should consider a right to vote based on the clear principle of residency. Maybe we will not have the opportunity in this Bill. The noble Lord, Lord Hodgson, said that people who just pop over here should not have the right to vote. However, because of our legacy as an empire and our legacy in terms of the Commonwealth, it is a bit ironic that a student from Australia on an overseas experience visa can land in this country and get the right to vote, but my husband, who has been here for 27 years and paid tax, does not. It does not really make sense.

This is, sadly, a missed opportunity. Amendment 156, in the name of the noble Baroness, Lady Suttie, and my noble friend, deals with precisely that issue: instead of clarity we end up with confusion, with some people having the right to vote and others not, but both having the right of residency and to work and pay tax and national insurance. This country will have to consider that at some stage, if not now. I hope the Minister will understand why we have tabled our amendment. I agree with the noble Lord, Lord Wallace, that this is a missed opportunity. I am sure none of these amendments will be agreed to, but I hope that the principle we are trying to establish will be considered in the future.

[Earl Howe (Con)]

My Lords, I begin by conveying the regret of my noble friend Lord True that he is unable to be in his place today because of illness. As a result of his indisposition, the Committee finds itself with a deputy Minister in the shape of me. That is a privilege for me, but I am only glad that I am so ably supported by my noble friend Lady Scott in this endeavour.

My Lords, this group of amendments deals from various perspectives with the voting franchise in the context of UK national elections. I hope that I can be of help to noble Lords in setting out the Government’s approach to this issue and the logic that lies behind it. I was grateful to my noble friend Lord Hodgson for what he said in connection with Amendment 152, which I shall begin with.

The purpose of Amendment 152 is to require the Government to allow EU citizens to vote in UK parliamentary elections. It may be helpful if I explain our policy position on this. Our policy has always been that after our exit from the EU there should not be a continued automatic right to vote and stand in local elections solely by virtue of being an EU citizen. The provisions in this Bill are based on two main planks: first, to respect the existing rights of those who chose to make their homes in the UK before the end of the implementation period; secondly, to look to retain rights on a bilateral basis where possible.

Amendment 152 would extend the parliamentary franchise to EU citizens where no such rights previously existed. In a similar vein, Amendment 156 seeks to allow EU citizens to continue to vote and stand in local elections in Northern Ireland. Those who are nationals of an EU member state have never been able to vote in UK parliamentary elections by virtue of their EU citizenship. If an EU citizen becomes a British citizen, they will be eligible for the parliamentary franchise from that point.

The Government stand by their commitment to EU citizens resident before EU exit, and the Bill ensures that any EU citizen who was a resident before the end of the transition period on 31 December 2020 and who has retained lawful immigration status will retain their voting and candidacy rights in England and Northern Ireland. This goes beyond our obligations in the withdrawal agreement. EU citizens who arrived after the end of the transition period will move to a position whereby local voting and candidacy rights rest on the principle of a mutual grant of rights through voting and candidacy rights agreements with individual EU member states.

On Amendment 156, the noble Baronesses, Lady Suttie and Lady Ritchie, and the noble Lord, Lord Dodds, referred to the Northern Ireland Human Rights Commission and the Equality Commission for Northern Ireland. As was rightly said, both those commissions have sought clarification on EU voting and candidacy rights in relation to the Northern Ireland protocol. The UK Government’s position is very clear and has been explained to both commissions. Removing voting and candidacy rights from EU citizens arriving in Northern Ireland after the implementation date does not run counter to article 2 of the Northern Ireland protocol.

Article 22 of the Treaty on the Functioning of the European Union confers a right to vote and stand as a candidate in municipal elections only in respect of EU nationals who are resident in another member state, having exercised their rights of free movement and residence. As the UK is no longer a member state, EU citizens self-evidently no longer enjoy the right to reside here, so the ancillary article 22 right to vote and participate in municipal elections is no longer applicable to it in this context. This is entirely consistent with part 2 of the withdrawal agreement, “Citizens’ rights”. I hope that is helpful.

I submit to your Lordships that the Government’s approach is a sensible and fair one, whereby established rights are recognised while moving to new bilateral agreements with individual nation states in the EU. I am afraid, therefore, that the Government cannot accept either of these amendments.

Amendment 155 is intended to extend the parliamentary franchise to foreign nationals with certain types of immigration status in the UK. The right to choose the next UK Government is rightly restricted to British citizens and those with the closest historical links to our country. In this respect, the UK is in line with international norms. Citizenship is the normal criterion for participating in national elections in most democracies, including the UK.

Amendment 155A in the name of the noble Lord, Lord Shipley, proposes to enfranchise all who pay council tax in the relevant local authority area. Taxation has never been the basis for representation in the UK in modern times. There is a long-standing principle in the UK, as originally recommended by the Committee on Standards in Public Life in 1998, that those who do not pay income tax, such as those earning less than the tax-free personal allowance, rightly remain entitled to vote. Similarly, full-time students are legally exempt from paying council tax but still have the right to vote in local elections. So, I submit that that connection between taxation and voting does not exist. The Government hold to that principle and therefore cannot support Amendment 155A.

The noble Baroness, Lady Bennett, asked me a number of questions. I will arrange for a letter to be sent to her, but I will comment on her point about credit scoring and being on the electoral roll. The noble Baroness is, of course, not wrong in pointing out that credit reference agencies use the electoral roll to enable lenders and other service providers to confirm someone’s identity. However, it is true to say that lenders look at the entirety of the information on a person’s credit side, as well as other factors, to decide whether to lend to somebody. Lenders and other providers of financial services can ask for other forms of identity and confirmation.

The noble Baroness also asked whether we were taking steps to inform local authorities about the measures being taken. The Government are very conscious of the competing priorities that local authorities have and, particularly, electoral registration offices, both in relation to their business as usual activity and in the new activity that will be conferred by the Elections Bill. We are committed to working closely with the electoral community throughout the development of secondary legislation and implementation planning. We will commit to funding all new burdens incurred by EROs as a result of implementing this policy, as is customary.

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[Lord Collins of Highbury (Lab)]

My Lords, we talk about piecemeal reform, and changes to this House have not necessarily been a result of legislative change or even reform. I have mentioned in previous debates the excellent book by Antonia Fraser about the debate on the Great Reform Act 1832. What I found most fascinating was that most Members of the House of Commons were sons of aristocrats and were put there by their fathers to have proper training to come into the House of Lords. Of course that was in the days when the powers of this House were great, as noble Lords have mentioned.

What recently shocked me even more—and I have cited this too—were the diaries of “Chips” Channon, who, when he was writing pre-war, leading up to the 1938 Munich debacle, mentioned that most of his friends in the House of Commons were sons of aristocrats who eventually ended up in this House. I hope things have changed. Constitutionally, things have radically changed, quite rightly, in the powers of this House, which can no longer challenge the democratic mandate of the House of Commons. The question is not simply about whether we are here for life or not; it is about what we do here. Even where we have particular circumstances of power, I am one of those people who would not use it to challenge the democratically elected House of Commons.

My noble friend made a very powerful case, and the point that struck me was that not many people in the public out there are aware that we have not got the vote. I remember campaigning in the 2017 election and a young, radical activist stopped me and asked if I had voted yet. When I explained I could not vote for Jeremy Corbyn, she nearly issued an internal disciplinary notice. Once I had explained, I was eventually forgiven. But I think it is a point worth making that most people assume that everyone in this country has a free and fair democratic right to vote, and it just seems ridiculous that we do not.

[Earl Howe (Con)]

My Lords, this amendment from the noble Lord, Lord Dubs, who is joined on the Marshalled List by my noble friend Lord Naseby, brings us to a topic on which each of them has tested government policy on a number of occasions in the past, including, as I recall and as the noble Lord, Lord Dubs, mentioned, through my noble friend’s Private Member’s Bill in 2019. On the latter occasion, my noble friend Lord Young of Cookham set out the Government’s response, and I therefore hope it will not come as a shock to the noble Lord, Lord Dubs, that my response today bears an uncanny resemblance to the one given to the House previously.

I understand and respect the case that noble Lords have articulated on this issue. However, I am afraid it is not a case I can accept, and the reason is clear and straightforward and was well articulated by my noble friend Lord Cormack. Noble Lords will be aware that although, as the noble Lord, Lord Collins, rightly said, the role of this House has changed over time, our place in Parliament still gives us a position of influence not held by other citizens. My noble friend Lord Sherbourne asked what the downside would be of accepting the amendment. Enfranchising noble Lords to vote in general elections would give Peers two ways of being represented in Parliament. Members of this House have an opportunity to debate and vote on legislation. To provide a vote for Peers in UK parliamentary elections would undermine the principle that all citizens are equally represented in politics.

--- Later in debate ---

[Lord Collins of Highbury (Lab)]

My Lords, I have some sympathy with the points made, but I wish this amendment could have been debated in the group of amendments we had on the entitlement to vote, because I do not really want to move away from the principle I articulated before. Not everyone wants to lose the status of their nationality. For example, my husband does not want to give up his Spanish citizenship, which he may have to do. A number of European countries have started to change but they did not allow dual nationality. A lot of people could lie about that, but he does not want to give it up. I certainly do not want to give up my nationality.

When we were in the EU, we were in the comfortable position of being, as we used to describe ourselves, EU citizens; we could locate and meet our families in our respective countries with ease. Now that has changed and we accept that, but I do not quite understand why we do not accept that there is a settled status, where someone has lived in the country for 27 years, paid tax, national insurance and everything else—they have taken the responsibility of a citizenship—but for one reason or another do not want to take formal citizenship, and why that should preclude them from having the right to vote.

It is crazy that, as I mentioned, an Australian student who comes over for their OE can immediately apply for the right to vote. I would rather the debate focused on what entitles somebody to vote. We have talked about taxation, we have talked about responsibility, and I say that clear levels of residence should establish some basic rights, so that we treat people who live here equally, and when they contribute to the success of our country we should acknowledge that.

I come back to what the noble Lord, Lord Green, said. One of the issues his amendment ought to probe and cause us to think about is: what is a British citizen? He says that British nationals (overseas) are not included. We can make commitments suddenly; for example, we made a commitment to Hong Kong citizens who are BNOs because of the breach of an international agreement. I have no doubt that in future, as we have done in the past, we will want to protect our legacy. The noble Lord, Lord Desai, spoke about the legacy of British Empire, which of course we cannot ignore, and things have changed.

I welcome the fact that the noble Lord, Lord Green, has tabled this amendment but we need to consider it in the light of all the amendments we have had on the right to vote and what the qualifications are. I do not think we should ignore residency.

[Earl Howe (Con)]

My Lords, with Amendment 154 we return to the franchise. The purpose of the amendment, as the noble Lord, Lord Green, explained, is to require the Government to confine the voting rights of Commonwealth citizens to citizens of countries that grant British citizens the right to vote in their general elections. The effect of this would be to limit the franchise to Commonwealth citizens from countries where British citizens are entitled to vote in general elections.

I take this amendment seriously but perhaps I could clarify the position as it relates to Commonwealth citizens. First, it is important for me to point out to the noble Lord, Lord Wallace, in particular, that there is no blanket voting right in this country for Commonwealth citizens. The right to vote applies only to qualifying Commonwealth citizens: those who have leave to remain in this country or have such status that they do not require such leave. The noble Lord, Lord Green, asked me to expand on that definition. The definition of “Commonwealth citizen” is a broad term and is not limited to citizens from Commonwealth countries listed in Schedule 3 to the British Nationality Act 1981. It applies equally to other types of British nationality defined in Section 37 of that Act. This includes Hong Kong British nationals (overseas), British overseas citizens and British Dependent Territories citizens. It also includes British Overseas Territories citizens.

I acknowledge that the approach adopted in relation to Commonwealth citizens is different from that that we take towards other categories of foreign nationals. However, there are sound and well-rooted reasons for that difference. The rights of Commonwealth citizens to vote are long standing and reflect the historic connections and well-established links with the Commonwealth of this country and Her Majesty the Queen, as the noble Lord, Lord Desai, outlined.

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[Earl Howe (Con)]

The noble Lord, Lord Desai, is once again perfectly right.

Successive Governments and Parliaments since 1981 have concluded that the existing voting rights of Commonwealth citizens should not be disturbed, and it is on this basis that the Commonwealth citizens are granted the right to vote in UK elections.

I have enormous personal sympathy with the noble Lord, Lord Collins, and his husband in the situation he has outlined. The best answer I can give him is to refer back to the speech of the noble Lord, Lord Desai. As a country, we have found ourselves at various times in our history as members of different families of nations; for example, the family of EU member states and the family of Commonwealth nations. It is therefore perhaps unsurprising that the links and historic traditions, and hence entitlements, relating to each such family are different from one another. Our formal ties with the EU have been severed. Our ties with the Commonwealth endure. The weight of history plays a very considerable part in all sorts of aspects of our national life—

[Lord Collins of Highbury (Lab)]

The noble Earl says that our ties with the Commonwealth endure. I agree with the sentiment but the reality, as the noble Lord, Lord Desai, said, is that the relationship with Commonwealth countries has changed fundamentally, and is continuing to change. As Prince William said yesterday in his press statement—I have forgotten the exact words but it seemed relevant to me—the relations endure but Commonwealth countries change. The fact is that we have not changed what we define. With all these different British nationals as a consequence of our imperial legacy, we find it very difficult to define citizenship in that regard. That is why I come back to this fundamental point. I am not arguing that my husband has a special right as a former EU citizen. I am saying that someone who has lived here for 27 years, and paid tax and national insurance, should have the right to vote. It is residence that I am arguing for, which is what a number of noble Lords have been making the case for.

[Earl Howe (Con)]

My Lords, I understand that. It is clear that this is an argument that runs very deep. We may or may not return to it on Report but if there is anything else that I can add to the remarks that I have made, I will ensure that a letter is sent to all noble Lords who have taken part in this short debate.

In short, it is for reasons of history and because of the well-established ties that we in this country have with the family of nations that we call the Commonwealth that the Government have no plans to change the voting rights of Commonwealth citizens. Therefore, I am afraid we cannot support this amendment.

Elections Bill

Debate between Lord Collins of Highbury and Earl Howe

Lords Hansard - Part 2 & Committee stage
Monday 28th March 2022 Lords Chamber

[Lord Collins of Highbury (Lab)]

Would the noble Earl acknowledge that trade unions are different? They are highly regulated and the law was changed to ensure that every individual who makes a contribution to a political fund has to approve it. It is contracting in now—a change this Government made without consultation with other parties. So to put trade unions in the category of a millionaire or a corporate company is totally wrong.

[Earl Howe (Con)]

My Lords, I am not casting aspersions on trade unions. I was seeking to suggest that making them a unique case, as the amendment seeks to do—

[Lord Collins of Highbury (Lab)]

I have explained why they are a unique case: you have already changed the law without consultation with any party. You changed the rules, forcing individual trade union members to contract in to their political funds. Their political funds are highly regulated and highly controlled, and were subject to a change in the law—so they are different.

[Earl Howe (Con)]

I do not contradict the noble Lord in any respect as to what he said about trade unions. I say again that I cast no aspersions on trade unions or their practices at all. I am simply saying that it seems unfair and undemocratic to have this distinction made in the way the noble Baroness seeks to do in her amendment.

Fundraising is a legitimate part of the democratic process. There is no cap on political donations because parties, candidates and other types of campaigner have strict limits on what they can spend on regulated campaign activities during elections.

The other amendment in the noble Baroness’s name—

Zimbabwe

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 11th March 2020 Lords Chamber

[Earl Howe]

My Lords, I acknowledge the noble Lord’s long-standing and close interest in Zimbabwe and its people, and I agree that we must continue to give hope and encouragement to all those who want to see genuine political and economic change in Zimbabwe. However, we have to face the reality that no package of external support will deliver for the Zimbabwean people without fundamental reforms, as he rightly says. Therefore, the onus must remain on the Government of that country to demonstrate true commitment to change. So far, we have seen limited progress.

[Lord Collins of Highbury (Lab)]

My Lords, the fact remains that Zimbabwe is still a very dangerous place for people to live and, as the noble Lord highlighted, security forces there are using draconian laws. Last week, President Trump went to Congress to extend sanctions. What are the Government doing with the EU and the US to build a stronger alliance to force the sort of changes to which the noble Lord has alluded? Will the Government also consider using their new powers under the Magnitsky clause to try to target those responsible for these human rights abuses even more effectively?

[Earl Howe]

My Lords, we will review our sanctions regime in connection with Zimbabwe at the end of this year, when we come to the close of the transition period. The noble Lord is absolutely right that we are seriously concerned about human rights in Zimbabwe. There are abductions, arrests and assaults on civil society and opposition activists. The country remains one of the UK’s 30 human rights-priority countries. We provide extensive financial and technical assistance to civil society organisations in their efforts to hold the state to account on issues related to human rights.

Integrated Security, Defence and Foreign Policy Review

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 8th January 2020 Lords Chamber

[Earl Howe]

My Lords, we aim to keep pace with whatever happens in Europe after we leave the EU. However, we have made clear that, while we are leaving the EU, we have committed to strengthen our co-operation with Europe on security, our intelligence services have highly effective co-operation to build on, and, of course, the foundation of European security since 1949 has been the NATO alliance, which will not change.

[Lord Collins of Highbury (Lab)]

My Lords, in yesterday’s debate—I do not know whether the Minister was present—I asked a question about the nature of the review and the fact that the three lead departments were the FCO, the MoD and the Cabinet Office. Development is a key part of this strategy, and I am concerned that DfID does not have the same lead role. I did not get a response yesterday; I hope I get one today. One of my old trade union general secretaries used to say, “If you want to knock someone’s shed down, tell them that you’re knocking the house down.” We have a problem here regarding the future of DfID. I hope that the Minister can give us some strong reassurance that it will remain a stand-alone department with its own Secretary of State.

Zimbabwe

Debate between Lord Collins of Highbury and Earl Howe

Thursday 23rd November 2017 Lords Chamber

[Earl Howe]

My Lords, I am very much in sympathy with my noble friend. Of course, the Government do not wish, nor intend, to interfere in the affairs of Zimbabwe. But approximately 113,000 Zimbabweans live in the UK, and the Foreign and Commonwealth Office has a regular programme of positive engagement with the Zimbabwean diaspora and will meet several of its representatives tomorrow to discuss the situation in Zimbabwe, including the need for deep and lasting economic reform.

[Lord Collins of Highbury (Lab)]

When the noble Lord, Lord Ahmad, responded to the Statement, he referred to the Foreign Secretary’s visit next month to the African Union. I fully support the noble Earl’s assertion that the only voice that really matters is that of the Zimbabwean people, and free and fair elections to take place early next year are the way to guarantee that that voice is heard. Will the Government work with the African Union to ensure that those elections are free and fair?

[Earl Howe]

My Lords, the Foreign Secretary and the Minister for Africa are engaging with the region and other international partners, especially South Africa and the African Union, the EU and the UN. In fact, my honourable friend the Minister for Africa is in Harare at this moment with the aim of engaging with leading figures from all parts of the political spectrum in Zimbabwe.

Chagos Islands

Debate between Lord Collins of Highbury and Earl Howe

Thursday 17th November 2016 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I thank the Minister for repeating the Statement. Yesterday’s decision is nothing less than a fundamental denial of the human rights of the people of the Chagos Islands. Their hopes were raised with the publication of the KPMG report about feasibility and those hopes and aspirations have, I fear, been cruelly dashed. On the issue of feasibility, will the Minister give us and the people of the Chagos Islands some indication of what factors were taken into account? Will he publish all the factors that were considered in reaching this decision, in order to ensure that there is full transparency?

Turning to the £40 million that has been promised over 10 years, the Minister indicated that communities would be consulted. Can he give further guarantees about how the people of the Chagos Islands will be involved in spending that money? In particular, what proportion will be devoted to ensuring that they can return to their homes—I find it difficult to use the term “visit”? Finally, what assessment has been made by the Government of the impact this decision will have on other overseas territories, particularly Gibraltar, which are feeling very fragile at the moment in light of the decision to withdraw from the EU? I hope that the noble Earl will be able to respond to these points.

[Earl Howe]

My Lords, I am grateful to the noble Lord, Lord Collins. Clearly, we know that this decision will come as a disappointment to the many Chagossians who have expressed a desire to resettle. We recognise their emotional links to the island and their desire to go back to their former way of life. The manner in which the Chagossians were removed in the late 1960s and early 1970s was wrong; it should not have happened. We look back on that period with sincere regret, but we cannot turn back the clock. We have to be realistic about the challenges that a resettled community would face.

The factors that we took into account were many and various, including those cited in the KPMG report. We considered what could be done to respond to Chagossian aspirations, but the main factors were the potentially high and very uncertain costs, the long-term liabilities for the UK taxpayer and security considerations.

As regards the £40 million, we wish to work with the Chagossian communities and the Governments of Mauritius and the Seychelles to understand the challenges and to develop cost-effective programmes which will make the biggest improvement in the life chances of those Chagossians who need it most. The door is very definitely open to those conversations. As regards the impact on other overseas territories, I do not believe there are any. This is a unique situation.

Russia: Baltic States

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 2nd November 2016 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right. It is why we are standing by the Baltic states in a number of areas, not least in the sphere of defence. The noble Lord will know that the UK is leading on the enhanced forward presence that we are placing, as from next year, in Estonia, alongside the French and the Danes, to send a very clear message to Russia that it must not exceed its supposed sphere of influence.

[Lord Collins of Highbury (Lab)]

My Lords, the key thing that most people are concerned about is that, as the Minister rightly said, Britain has led the way in Europe on the common security and defence policy and in ensuring that Russia was clearly told what its actions would lead to. What assessment have the Government made of our relationship with Russia in the light of Brexit? What impact will that have on our security?

[Earl Howe]

My Lords, the UK’s decision to leave the EU has not changed our position on Russia. We will continue to protect the UK’s interests and those of our allies and partners. We will continue to engage with Russia in key areas of shared interest to promote our values—including the rule of law, human rights, and so on—and to build stronger links between the British and Russian peoples, as I have said. NATO will remain the bedrock of our security.

HIV

Debate between Lord Collins of Highbury and Earl Howe

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

My noble friend is right. I think that we have come a long way since my noble friend Lord Fowler was Secretary of State, when stigma and discrimination were very apparent in virtually all sections of society. We do not see that so much now, I am glad to say, as evidenced by the fact that we are reporting a continuing reduction in late diagnosis. It was down to 42% last year from 47% in 2012, and that is a key indicator in this context.

[Lord Collins of Highbury (Lab)]

My Lords, the UK is a leading supporter of research and development into universal prevention methods, including HIV microbiocides and vaccines. With 19 million people globally remaining unaware of their HIV status today, will the noble Earl tell us how the Department of Health is working with the Department for International Development to support this research and development work?

[Earl Howe]

My Lords, in November 2013 DfID conducted a review of our 2011 HIV position paper. The review paper highlighted three areas of particular focus in the international context. They were to identify the key affected populations—girls and women—and the integration of HIV responses into the wider health system, as well as broader development priorities. That of course includes tackling stigma and the unacceptable things that we see in certain overseas countries, including discriminatory legislation.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 3rd July 2013 Lords Chamber

[Earl Howe]

My Lords, I am aware of the issue that the noble Lord raises. He will know that NHS commissioners are statutorily required to fund clinically appropriate drugs and treatments which have been recommended by NICE. The Centre for Workforce Intelligence has been commissioned to review the ophthalmology medical workforce after discussions were held between the royal college and Health Education England earlier this year. That review is due to report in the summer and the results of it should, I hope, point the way to a resolution of the issue that the noble Lord has raised.

[Lord Collins of Highbury]

My Lords, as a type 2 diabetic, I benefit from annual retinal check-ups at UCH; it is an excellent service. However, despite there being a national screening programme, there is a large variation in take-up, which in some areas is as low as 65%. What steps are the Government taking to ensure a higher and more consistent take-up?

[Earl Howe]

In the end, accepting the offer of screening is a matter for each individual. There are some people who, for personal reasons, will choose not to take up the offer. However, as part of the process of continuous improvement, we would expect the gap between the number of people offered and the number of people receiving screening to reduce, and for there to be greater consistency in numbers offered and received across local screening programmes.

Autism

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th June 2013 Lords Chamber

[Earl Howe]

My Lords, the Children and Families Bill, which was introduced into Parliament this month, will usher in from next year new joint arrangements for assessing and planning commissioning services for children and young people with special educational needs. We realise the difficulties that young people with autism can face in making that transition to adulthood. Under the autism strategy, my department and the Department for Education funded the social policy research unit at the University of York to examine how statutory services are currently supporting young people on the autistic spectrum. Its report, published in February, points the way to some important lessons that we should take on board during the review.

[Lord Collins of Highbury]

My Lords, despite the strategy, only 63 out of 152 local authorities have a pathway to diagnosis. Will the Minister give an assurance that the department will produce a clear guide for CCGs on how to commission the right diagnosis and support services?

[Earl Howe]

My Lords, we are indeed currently supporting, along with NHS England, a practical guide for CCGs to support health professionals and others in implementing the adult autism statutory guidance, as well as the NICE guidelines on recognition, referral and diagnosis, and the management of adults on the autism spectrum. This will be published later in the summer through the Joint Commissioning Panel for Mental Health.

Health: Tuberculosis

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 24th April 2013 Lords Chamber

[Earl Howe]

My Lords, we are now introducing a system of pre-entry screening. We recognise the contribution that latent TB makes to the overall TB disease burden and that is why we have commissioned NICE to produce a clinical guideline on this. In the countries where TB presents the most significant risk, we shall in future insist that people are screened before they enter the United Kingdom.

[Lord Collins of Highbury]

My Lords, drug-resistant TB will not subside until the problem is controlled globally. That requires not only intergovernmental co-operation but cross-departmental working. Will the Minister update the House on the Government’s position on the replenishment of the global fund, which will be useful in tackling this problem globally?

[Earl Howe]

My Lords, the Government fully support the need to scale up efforts to deliver universal access to TB prevention and treatment, and care and support services. Our target date for that is 2015. We have made a long-term commitment of £1 billion between 2007 and 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a 20-year commitment to the international drugs purchase facility, UNITAID, which is helping to increase access to and the affordability of TB drugs.

Food: Fast Food

Debate between Lord Collins of Highbury and Earl Howe

Thursday 21st March 2013 Lords Chamber

[Earl Howe]

In fact, my Lords, 32 businesses have signed up to the pledge to help people consume fewer calories, which is a responsibility deal priority. They include seven of our major retailers and some of the nation’s biggest food manufacturers, as well as Subway, which is a fast food company—so we do have one. It is a deliberately wide-ranging pledge, allowing companies and their customers to reduce calories through a broad range of actions. I say to my noble friend, however, that we will have fast food companies very much in our sights over the coming months.

[Lord Collins of Highbury]

My Lords, helping people to make informed choices on what they eat is really important. However, we have learnt in recent times that what is on the label is not always what is inside. I have stated previously that so-called healthy products such as low-fat yoghurts and cereals are jam-packed with sugar, which has huge implications for the threat of diabetes. Will the Minister consider statutory food labelling which is easy to understand?

[Earl Howe]

My Lords, we certainly have not ruled out regulation in this area, but we can be encouraged by the progress that we have made to date through the responsibility deal in terms of calorie labelling. Some 47 businesses signed up to labelling calories at the end of 2012, while 5,000 fast food and takeaway outlets and around 9,000 high street outlets, including pubs, restaurants and coffee shops, will display calories.

Health: Anorexia

Debate between Lord Collins of Highbury and Earl Howe

Monday 25th February 2013 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank my noble friend Lord Giddens for initiating this debate. As we have heard, the causes of eating disorders are both complex and multifaceted. At times of stress many of us resort to what is euphemistically called comfort eating, and the consequential results impact on self-esteem that can cause a very negative spiral.

Whatever the physical or psychological factors are it does not help that in our modern society we are constantly urged on the one hand to look sleek yet on the other to consume fattening foods. More often than not the food industry through its advertising campaigns manages both in one ad. Why is it that only on television does the person stuffing a bar of chocolate down their mouths appear to be so thin?

The excellent work of the All-Party Parliamentary Group on Body Image has shown that the constant portrayal of the man with the perfect six-pack or a young woman in a bikini does have an impact. It has highlighted the growing evidence that body image dissatisfaction is high, and on the increase. It is associated with a number of damaging consequences for health and well-being. We should contrast this with the way we are encouraged to eat foods packed with calories and made up of saturated fat and simple carbohydrates, the two food types most likely to make us put on weight. I remain concerned that so many so-called low-fat products are packed with sugar and calories.

Eating disorders can stem from a combination of issues, including distorted body image and low self-esteem. As I know from personal experience, someone with an eating disorder is very good at hiding the fact, often using a great deal of deception to fool the person or people to whom they are closest. This partly explains why there is a lack of data on the number of people who suffer from eating disorders. However, as we heard tonight, the numbers are great and the costs to the individual, their family and society can be devastating. Although eating disorders are considered to be a young girl’s disease, they can affect anyone at any stage in life, and up to 20% of sufferers are male.

It is clear that early intervention is vital. However, that relies on greater openness and understanding of the issues on the part of all of us. The excellent campaign launched by the eating disorder charity Beat just two weeks ago used as its theme, “Everybody Knows Somebody”, to flag up the fact that these illnesses are far more common than most people think. The Minister for Women and Equalities, Jo Swinson, in supporting the campaign, highlighted the fact that we are bombarded with all kinds of images, and that we need to equip young girls and boys to be more resilient to these pressures.

The Government’s Body Confidence campaign has worked for the past 18 months to identify non-legislative solutions to tackle the causes of low levels of body confidence. It is a great initiative that includes representatives from the health and fitness, fashion and retail, youth and education, media and advertising, and beauty sectors. That is to be welcomed, but we still have a fashion industry that portrays extremely thin women and girls, and we have also heard that we face a proliferation of websites promoting images of anorexic girls. What assessment has been made of the impact of the Body Confidence campaign? What action will the noble Earl’s Government take against these appalling websites? What action are they taking about the growing number of eating disorders among men?

The NICE guidelines on the treatment of eating disorders, published in 2004, are due for review in 2014. Many excellent services exist—we have heard about them tonight—but what impact will the new commissioning arrangements have on the fragmentation of these services? In my own area there is now a six-month waiting period for the first appointment for someone referred by a GP. Will the Minister ensure that best practice is maintained and that the gap between youth and adult services is addressed? Is it not time for a more coherent government strategy that encourages us all to understand better that what, when and how we eat really matters?

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

My Lords, perhaps I may begin by thanking the noble Lord, Lord Giddens, for securing this short debate on eating disorders, not least because it affords us a twofold opportunity: first, to let sufferers and their families know that their voices and experience are influencing what we do at the highest levels of government; and, secondly but no less importantly, to give prominence to a range of disorders that so often are hidden.

The noble Baroness, Lady Crawley, described eating disorders as desperately sad. I agree with her. The statistics are grim. Anorexia nervosa has the highest mortality rate of all psychiatric conditions. It disrupts education and quality of life, and in 20% of cases continues to create difficulties in independent living for up to 10 to 20 years after the onset of illness, as a number of speakers said.

Although relatively little research has been done into long-term outcomes for bulimia nervosa, binge-eating disorders and other less well known conditions, anecdotal evidence suggests that these disorders can, for a significant cohort of patients, have equally life-limiting, long-term consequences. These disorders can affect anyone at any time, regardless of gender, but most cruelly the peak age at onset for the majority of sufferers is the mid-teens.

The noble Lord, Lord Giddens, asked what the Government’s policy is in this area. The answer to that has several strands to it. Early intervention is vital, and that is why it is a key national priority for the Government. Our cross-government mental health outcome strategy, No Health Without Mental Health, takes a life course approach, recognising that the foundations for lifelong well-being are already being laid down before birth and that there is much we can do to protect and promote well-being and resilience through the early years, into adulthood and on to a healthy old age.

The strategy’s implementation framework, published last July, sets out that public services intervening early is one of the 10 key changes that will be needed to turn the mental health strategy into reality and the specific actions which local organisations can take to achieve this, including: children and their parents receiving evidence-based health promotion from birth; public services, including GPs, recognising people at risk of mental health problems and taking appropriate timely action; and schools taking a whole school approach to supporting all pupils health and well-being, including both universal approaches and targeted services for those at risk of developing mental health problems.

We are investing £54 million over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme to drive service transformation, giving children and young people improved access to the best mental health care by embedding evidence-based practice and making sure that whole services use session-by-session outcome monitoring. In February 2012 the Government announced a further £22 million over three years to the CYP IAPT programme. Some of this money will be used to extend the training offered by CYP IAPT to two further therapies—systemic family therapy and interpersonal psycho therapy. These therapies are invaluable in addressing some of the major mental health problems of adolescence, including eating disorders, as well as providing much needed support for the families of those affected.

The noble Lord, Lord Giddens, mentioned the tragic case of Laura Willmott. I, too, saw that coverage. I know that transition can be a huge issue, often pitching sufferers and their families into crisis at a critical time. Sudden changes in treatment and services can be bewildering and dangerous for patients and their families, and parents can find themselves excluded from decisions about care. I was very struck by the powerful remarks of the noble Countess, Lady Mar, on this theme. Charities such as Beat and Anorexia & Bulimia Care, which do so much to raise awareness as well as provide support and advocacy in action, are working with experts in the field on the feasibility of improvements to the care system, with a specific focus on introducing the option for students to receive care wherever they are.

It is this kind of grass-roots action that will make the difference the Government envisage when we have freed up health and social care services from micromanagement, empowering localities to make vital decisions that are tailored to meet the needs of their communities.

My noble friend Lord Carlile referred to the variation in services. I recognise his concern. New arrangements for the commissioning of services for eating disorders should also result in better planning and co-ordination of specialised services, greater equity of access, care and outcomes for patients, and a more proactive and systemic approach to service development, research and innovation. The child and adult specialised eating disorder services will be commissioned by the NHS Commissioning Board from April this year.

Within the board there will be a central team that will have a clear focus on specialised services organised around programmes of care. The team will develop a national service specification for each service while at the same time ensuring that it is sensitive to local needs. Work on eating disorders services has been underpinned by expert clinical reference groups on eating disorders and child and adolescent mental health services. The groups have explicitly recognised that targeted work is needed on the issue of transition.

However good our intentions, beneficial change does not always keep pace with the urgent desire of patients and families to feel the impact of those changes, but there are areas where direct action can yield swift dividends. The Time to Change programme, England’s most ambitious programme to end mental health stigma and discrimination, now has the potential, with funding from the Department of Health and the Comic Relief fund, to reach 29 million members of the public with its vital messages on mental health. As is so often the case, it is the courage of individuals as evidenced recently in a debate in Westminster Hall in which Mr Brooks Newmark spoke. Events like that do much to challenge stigma and secrecy, and I think the honourable Member is to be commended for shining the light on an underreported aspect of eating disorders. The fact is that they are not simply the preserve of teenage girls. Male sufferers are growing in number, and I shall have something more to say about that in a moment.

The noble Baroness, Lady Gale, asked what we are doing to work with the fashion industry, a question echoed by the noble Lord, Lord Collins, and the noble Baroness, Lady Crawley. I commend the assiduous work of the All-Party Parliamentary Group on Body Image under the expert chairmanship of Caroline Nokes. The Government’s own Body Confidence campaign has made great strides over the past two years in encouraging a more open and public conversation about body image. Working with a range of representatives from health and fitness, fashion and retail, youth and education, media and advertising, and the beauty sectors, we have been active in a number of areas: research, parent education, resources for teachers, industry awards and promoting public debate.

The noble Lord, Lord Giddens, my noble friend Lord Carlile and the noble Baroness, Lady Gale, spoke powerfully on the theme of websites. I am aware of the growing evidence of pro-eating disorder websites. They attract impressionable young people and intensify weight/shape anxiety as well as, disturbingly, introducing users to new methods of losing weight, as the noble Baroness, Lady Gale, told us so graphically. What can the Government do about this? Legislation is not the answer. Many of these websites are set up by young people with an eating disorder and we would not want to criminalise an already vulnerable group, while other websites are hosted overseas. However, we are committed to joint working with charities and the internet industry to speed up the reporting of damaging web-based content and the blocking of harmful websites. In January, my honourable friend Norman Lamb hosted a round table with key stakeholders on this very issue where, encouragingly, the development of a concordat was discussed. The Government will support this joint endeavour in whatever way we can.

The noble Lord, Lord Giddens, asked whether we recognise the link between these disorders and obesity, while the noble Lord, Lord Brooke, also spoke on that theme. The answer is that we do recognise it and we are doing a whole host of things to combat obesity, some of which I have referred to in your Lordships’ House before. Weight management funding will in future be addressed through the new public health system, but most data on eating disorders come from charities such as Beat, particularly in its report on the costs of eating disorders in England, as well as surveys and reports from the royal colleges and other professional bodies. The Health and Social Care Information Centre published its annual mental health bulletin last Tuesday. It provides information on eating disorders for the first time, and I commend it to noble Lords as a reference point.

The mandate to the commissioning board makes it clear that the NHS should measure and publish outcome data for all major services by 2015, broken down by local clinical commissioning groups. To support that, the Government will strengthen quality accounts, which all providers are legally required to publish.

I have a great deal more material, but signals are being sent to me that my time is running out. I would like to address all these issues in letters to noble Lords, particularly those concerning men with eating disorders; my noble friend Lord Alderdice’s question on research that we are helping to fund; and the role of schools, which my noble friend Lord Carlile and the noble Baroness, Lady Gale, asked me about.

In my own researches in this area, I have been much struck how many of those affected talk about how worthless and disempowered they feel. I think it is appropriate for me to use this opportunity to send a clear message to them: you are valued, you are not invisible, and with the right, targeted support, recovery is not only possible but probable.

Children: Obesity

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, it is very much linked.

[Lord Collins of Highbury]

My Lords, I am going to take two bites of the cherry because I shall also briefly address the second Question. The noble Lord, Lord McColl, constantly reminds me that eating too many calories, not simply not exercising, is what causes me to be overweight, although I do exercise. However, when I pick up and eat a tub of low-fat yoghurt, which I have been doing for the past few years, thinking that I am eating healthily, I have not been able to read the very small print that states that this “low-fat, healthy” tub of yoghurt is packed full of sugars and calories. Actually, just before Christmas, I stopped eating low-fat yoghurts and I hope that noble Lords will appreciate the effect it has had on me. However, my specific question is: when will the noble Earl take the necessary statutory steps to ensure proper food labelling?

[Earl Howe]

My Lords, as the noble Lord will know, food labelling is largely governed by EU law and, at the moment, the EU directive is permissive about front-of-pack labelling. However, I take his point that it is very important that consumers are properly informed about what they are eating, and we are working with food manufacturers and retailers to ensure that there is much greater transparency in this area, across the piece, whether it relates to sugar, fats or salt.

NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 5th February 2013 Lords Chamber

[Earl Howe]

The noble Lord’s first point is a fair one. I was coming on to address it as it is quite clear that at least part of the wording of these regulations has seemed complicated and unfathomable to many noble Lords. I have to acknowledge that that is the case.

To address the noble Lord’s other point, we are talking about the difference between being a genuine voice for local people and simply being an adjunct of a political party. Local Healthwatch organisations should not be swayed or influenced by the activities of any political party. They must act independently. The only influence that matters to them is that of local patients and the public in seeking ways to improve the quality of care for people.

In that sense, the regulations tie down a local Healthwatch no more and no less than any other social enterprise. The wording of the regulations has been constructed in a very similar manner to the wording applied to other social enterprises in regulations. Regulations 36(1) and (2), against which so many missiles have been hurled this evening, are designed simply to reflect the standard community benefit test.

[Lord Collins of Highbury]

My Lords, if I have read Healthwatch England’s briefing correctly, it says that social enterprises are being treated differently in this statutory instrument, particularly as regards the 50% that could be retained. Perhaps the Minister could clarify that.

[Earl Howe]

I am surprised to hear that. My understanding is that that is not so and that local Healthwatch, as a social enterprise, is being treated on the same footing. My advice is as any other, but if I am wrong about that, naturally I will write to apologise to the noble Lord and copy all speakers into my letter. As I have said, I completely understand that the wording of parts of these regulations appears complicated. In answer to the noble Lord, Lord Collins, I should say that for that reason I can commit to my officials working with Healthwatch England and the Local Government Association to publish clarificatory material on this.

Having said that, I was slightly surprised that the noble Lord, Lord Warner, cast aspersions on Regulation 41. He asked how small organisations could understand the requirements set out in it. The matters set out in Regulation 41 are matters to be included in local authority contracts with local Healthwatch. In fact, these are based largely on the existing regulations on LINks. I have to say that it has not been previously suggested to us that these have been difficult to understand or are disproportionate.

The noble Lord, Lord Collins, asked me who was consulted before the draft regulations were published and whether Healthwatch England was consulted. We consulted a range of stakeholders, including LINks, local authorities, voluntary and community organisations, NALM, Social Enterprise UK, the Charity Commission and providers on the issues relating to the drafting of the local Healthwatch regulations. That included the Healthwatch England interim team.

--- Later in debate ---

[Earl Howe]

They are two different things, and I say to the noble Baroness that we are dealing here with a relationship that she may characterise as overly arm’s length. It is in the direct interests of a local authority to make sure that it has a good, thriving relationship with its local Healthwatch but that it is not tarnished by party political considerations that are irrelevant to the concerns of local people. The very fact that a local Healthwatch comes out with a political statement is not to damn its activity. What makes it vulnerable is if that local Healthwatch cannot show that it is truly representing local people as it speaks out. That is a matter of evidence and of fact.

The independent arbitration that the noble Baroness talks about should not be necessary. The matter could, in the final analysis, be decided in a court, although one hopes that that would never happen. However, in the end, the local authority has to exercise its judgment, and in doing so has to act reasonably and in good faith as a public authority. If it does not, it is acting unlawfully. I hope that that is of help to the noble Baroness.

I was asked a number of other questions by my noble friends Lady Jolly and Lady Cumberlege. My noble friend Lady Cumberlege asked me whether, if there were a controversial policy, say, to close an A&E department, a local Healthwatch would be permitted to provide evidence about patient experiences to campaigners on that issue. Yes. In that scenario, we would envisage a local Healthwatch taking those very views and evidence of good standards of service directly to the commissioners or decision-makers. A local Healthwatch can also make a referral to the health scrutiny function of the local authority, which would be required to keep a local Healthwatch informed of any action taken. If a local Healthwatch thought, as part of its Section 221 activities—patients’ public involvement activities—that local people need to know what their community’s experience of its A&E is, we would certainly expect the local Healthwatch to be transparent and make that evidence known.

My noble friend asked whether people who had been active in a national campaign could be decision-makers in local Healthwatch organisations. The regulations do not set out membership of a local Healthwatch, so it will be down to the local Healthwatch to decide whether such people can add value to the outcomes that it wishes to achieve for its local people. Local Healthwatch has to be different; it has to build up its reputation and credibility in order to secure the public’s confidence that it can have a mature relationship with local authorities, which was the point that I made just now. The regulations seek to ensure that local Healthwatch does not carry out the relevant political activities as its only or main activity. That would not meet the community benefit test.

Would local Healthwatch be subject to purdah? No, it would not. I repeat that it has been set up to be the local consumer champion, and as such its role becomes very important in getting people’s serious concerns listened to and acted upon.

My noble friend Lady Jolly asked me several questions. She expressed the fear that the regulations would render local Healthwatch a mere proxy voice. I emphasise to her in the strongest terms that that is not so. As I have explained, we have sought through the regulations to be as inclusive as possible of people who may wish to give up their time to do what they feel passionately about doing. To be frank, LINks, which is the arrangement that we have at the moment, have all too often been associated with white, middle-class men, and we need local Healthwatch to embrace diversity much better.

Could the manager of a care home sit on its local Healthwatch? Yes, he or she could get involved in their local Healthwatch, but it would be good practice for the Healthwatch in its governance arrangements to have procedures for a code of conduct, and, as set out in Regulation 40, it would be required to have and publish procedures before making any relevant decisions. That is essentially about transparency.

Could a local profit-making provider of primary care be a local Healthwatch contractor, and could its manager sit on the local Healthwatch decision-making group? Again, it would be up to the local Healthwatch whom it wishes to contract with for their expertise to help it deliver its statutory activities.

On the role of local Healthwatch to provide information and signpost people to choices, the decision rests with that individual seeking out the options available to them. We would expect local authorities’ arrangements with local Healthwatch to be robust so that it acts effectively. The local authority will be under a duty to seek to ensure that the arrangements are operating effectively and provide value for money.

My noble friend suggested that the department’s interpretation of lay involvement boils down simply to the foot soldier role. I do not agree. It would be a wrong picture to paint to the public about how a local Healthwatch discharged its obligations. The obligations are quite clear. Engagement, consultation and participation are all words that can be used to describe different types of involvement activity. Referring to “involvement” therefore provides for flexibility, as I indicated earlier.

Could the decisions listed in Regulation 40(2) be made by a decision-making body within a local Healthwatch composed of a majority of people who happen to be health or social care managers? No. Regulation 40(2) must be read with Regulations 40(3), 40(4) and 40(1)(a). The requirement to be imposed on local Healthwatch in the contracts is to have and publish a procedure for involving lay persons or volunteers in such decisions. As stated in the advice to the Secondary Legislation Scrutiny Committee, the plain provision of information would not in most cases comply with the obligation to involve; the involvement has to be in the making of the decisions.

I hope that I have covered satisfactorily all the questions put to me, and I hope that the noble Lord, Lord Collins, will be sufficiently reassured to withdraw his Motion.

[Lord Collins of Highbury]

I thank all noble Lords and particularly my noble friends for their comments. I also express my appreciation to the noble Baronesses, Lady Jolly and Lady Cumberlege, who drew attention to some fundamental issues here. They are fundamental in relation to the conflicts of interests, particularly in local authorities. The noble Baroness, Lady Cumberlege, referred to the draconian restrictions and reminded us that guidance does not have statutory force. Here I take the words of Healthwatch England: the Department of Health could and should have done better with these regulations. In my opinion, they have failed. I am afraid that the Minister has not given me satisfactory reassurances, certainly not in relation to the issues that the noble Baronesses, Lady Jolly and Lady Cumberlege, raised. In the light of that, and of the briefing we had from Healthwatch England itself, it is important that the department should think again. The only way I can do that is to ensure that we pass this Motion of Regret, and therefore I would like to test the opinion of the House.

Health: HIV Strategy for England

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to publish a cross-departmental HIV Strategy for England, in line with the Political Declaration made at the United Nations General Assembly in 2011.

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

My Lords, tackling HIV remains a priority for the Government. We believe the way forward is to develop a framework that covers both HIV and broader sexual health issues. We therefore plan to publish a policy document on sexual health and HIV shortly.

[Lord Collins of Highbury]

I thank the Minister for that response. One issue that is obviously of big concern is testing. Half of the people diagnosed with HIV are diagnosed late. With the commissioning of HIV testing being highly fragmented under the new NHS arrangements in England, how will the Government ensure that HIV testing recommendations from NICE and the British HIV Association are implemented consistently across the country?

Health: Hearing Loss

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend for raising a very important issue about war veterans. My department is doing a lot of work in this area. I will write to him if I have anything more specific.

[Lord Collins of Highbury]

My Lords, I note what the Minister said in terms of the previous review but we now have an increase in retirement age and people are working longer. Hearing loss is not simply a personal health issue; it also becomes a bigger public health issue and a health and safety issue. Can the Minister therefore better understand the importance of national screening?

[Earl Howe]

My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.

Health: HIV

Debate between Lord Collins of Highbury and Earl Howe

Thursday 29th November 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government whether they intend to endorse the standards of care for people living with HIV published by the British HIV Association on 29 November.

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

My Lords, the Department of Health commends the British HIV Association for these important standards, which we welcome. The NHS provides excellent care for people living with HIV. These standards are important in setting out best practice to support continuing high-quality HIV care services for all HIV patients. They will provide a valuable resource and inform the commissioning of comprehensive HIV care services.

[Lord Collins of Highbury]

I thank the Minister for that response. One recommendation made by BHIVA related to self-management. As with many other long-term conditions, this approach can help people with HIV to gain confidence, skills and knowledge to manage their own health, with resulting improvements in the quality of life and independence. In the light of changes in the commissioning process, who will now have responsibility for funding the excellent self-management services currently provided by organisations such as the Terrence Higgins Trust and Positive East?

[Earl Howe]

My Lords, the noble Lord is quite correct. Self-management is one of the BHIVA standards. I agree that self-management and supporting patients to manage their own care, both for HIV and, for that matter, any other long-term condition, are very important for promoting the best treatment outcomes for individuals. A variety of approaches will be needed to support individuals to self-manage their HIV. There are already some innovative programmes, such as the online resource, My HIV, for people living with HIV, delivered by the Terrence Higgins Trust. The key to this is for commissioners of services to work together in future to ensure that self-care is part of the HIV care pathway, and GPs will have a role to play in that.

NHS: Walk-in Centres

Debate between Lord Collins of Highbury and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government how many NHS walk-in centres have been closed or had their opening hours restricted since May 2010, and how many are scheduled to close or have their opening hours restricted.

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

My Lords, since 2007, the local NHS has been responsible for NHS walk-in centres. It is for primary care trusts to decide locally on the availability of these services. No information on walk-in centre closures or opening hours is held centrally.

[Lord Collins of Highbury]

My Lords, I was expecting that response. Will the Minister acknowledge that these closures will channel, unnecessarily, patients towards accident and emergency departments at times when GP surgeries are also closed? This will almost invariably increase NHS costs in the medium term. Or is the Government’s strategy to blame local clinicians for cuts in NHS services?

[Earl Howe]

My Lords, the Government’s clear policy is that people should be able to rely on high-quality, 24/7 urgent and emergency care that is right for them, when they need it. That is our starting point.

I say to the noble Lord that since walk-in centres were invented the array of services available to patients has been considerably enhanced. It is not just a case of going to an A and E department as an alternative. There are now many GP health centres, minor injuries units, urgent care centres and, in the extreme case, ambulance services, so I do not necessarily accept the premise of the noble Lord’s question.

Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My noble friend draws attention to an area of concern. Cereals of that kind are particularly attractive to children, although I would say that the good news here is that added sugar consumption among children has fallen during the past few years, which is perhaps a sign that the messages on the levels of sugar that children can safely consume is getting through to parents.

[Lord Collins of Highbury]

My Lords, I am grateful to the noble Earl for reminding us that a small reduction in weight maintained over time can reduce the risk of developing type 2 diabetes. I must admit that I wish that I knew that when I stopped smoking and piled on the weight. As a consequence, I am type 2 diabetic. It is true that small improvements in eating and drinking habits can reduce the risk. I ask the noble Earl, as I asked him last November, whether the Government will take this threat seriously and undertake to lead a major awareness programme about what to do to avoid type 2 diabetes.

[Earl Howe]

My Lords, there is a great deal going on in this extremely important area. I am grateful to the noble Lord for emphasising its importance. There is a ring-fenced budget for public health, and weight gain is one of the key indicators in the public health outcomes framework. There is the Change for Life campaign, which has, I think, gained enormous credibility among the public and professionals. We are engaging with the food industry through the public health responsibility deal to take forward the calorie reduction pledge. There are NHS health check programmes, which are being rolled out throughout the country, and at GP level there are the nine tests which GPs are advised to undertake with diabetic patients. The rate at which those tests are being done has gone up very encouragingly over the past few years.

NHS: Definition of Exceptional Case

Debate between Lord Collins of Highbury and Earl Howe

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.

[Lord Collins of Highbury]

My Lords, the Minister said that this treatment is not routinely carried out. The doctor concerned, who works in the NHS, is aware that pancreatectomy is carried out in other PCTs. Can the noble Earl explain where it is being carried out so that we can understand what is routine and what is not?

[Earl Howe]

My Lords, I hope that my earlier answers gave a clear indication of the definition of exceptionality, which should demonstrate to the House that something that is exceptional is not routine. Our advice is that that treatment is not routinely available in the NHS. There is a handful of centres in England with doctors who are trained to carry out the operation, but although the technique has been in use since 1977, it is available only in a few centres worldwide, which does not suggest to me that other countries are ahead of us in this area.

Health: Local Healthwatch Organisations

Debate between Lord Collins of Highbury and Earl Howe

Monday 11th June 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what progress is being made on establishing local Healthwatch organisations and what steps they will take to ensure that their commissioning and administrative costs are kept to a minimum.

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

My Lords, 75 local Healthwatch pathfinders have generated learning for all local authorities to use. The Local Government Association is working with all local authorities, including holding a series of master classes, and the Government are undertaking targeted engagement on local Healthwatch regulations until mid-June. The Government have made £3.2 million available for start-up costs and information is being made available on commissioning and procurement options.

[Lord Collins of Highbury]

I thank the Minister for that response. Only one local Healthwatch organisation will be contracted in an individual local authority, but the body itself will be permitted to subcontract most if not all of its activities. What are the department’s estimates for the overall cost of multiple contracts, solicitors’ fees and all the other on-costs of commissioning? Can the Minister also explain how fragmenting local Healthwatch organisations in this way will provide the strong and co-ordinated voice for patients and their carers that we need for real local scrutiny and accountability?

[Earl Howe]

My Lords, the noble Lord is absolutely right to raise the question of the cost-effective commissioning of Healthwatch and I have no doubt, from the Local Government Association, that both the efficient and effective functioning of Healthwatch is something that is well within its sights. The noble Lord has raised a series of hypotheses which I think are somewhat extreme, of local Healthwatch organisations parcelling out their functions all over the place. Our aim is to have as locally inclusive a body as possible in each local Healthwatch area to enable Healthwatch to perform its functions as much by itself as with the aid of others. Indeed, the pathfinder events to which I have referred have been clear that there is a local appetite to do that.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 1st February 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the National Diabetes Audit Mortality Analysis 2007–08, published by the NHS Information Centre, which estimated that up to 24,000 deaths from diabetes per year could be avoided by the condition being better managed.

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

My Lords, we are working with the National Diabetes Information Service and National Health Service organisations to ensure that local services have the audit data for their own areas to show how they compare with others and where improvements can be made. NHS Diabetes has a suite of tools that can be used to help drive improvements and reduce avoidable deaths.

[Lord Collins of Highbury]

I thank the Minister for his response. Diabetes UK estimates that about 26 per cent of the 450,000 residents in nursing and care homes in England have diabetes. Care home residents are a highly vulnerable group of people and, without regular screening for diabetes, they are at an increased risk of complications such as heart disease, stroke, kidney failure, blindness and amputation. What are the Government doing to ensure that residents in care homes receive the appropriate screening that they need for diabetes?

[Earl Howe]

My Lords, much will depend on the way in which primary care engages with those in social care to ensure that the residents of care homes, who need diabetes care management, receive it properly. We very much want to see that joined-up commissioning arise from the reforms that we are currently in the process of debating in your Lordships' House. The noble Lord makes a very good point. We have many tools at our disposal. There is no shortage of guidelines in this area. Much will depend on the training of care home staff and a lot of work is going on under the aegis of the National Clinical Director for Diabetes in this area.

Health: Early Diagnosis

Debate between Lord Collins of Highbury and Earl Howe

Monday 21st November 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes an extremely good point. The answer to his question is, yes, I believe that it will have the capacity to do that. He rightly mentions advances in genomic science, which of course will have a major part to play in the field of diagnostics. As regards rarer diseases, as he will know, we are placing responsibility with the national Commissioning Board for the commissioning of specialised services for rarer conditions.

[Lord Collins of Highbury]

My Lords, as the Minister is aware, the reduction of 10 per cent in weight maintained over a period can reduce the risk of developing type 2 diabetes by 50 per cent. Small improvements in eating and drinking are needed. Will the Minister accept that the country needs a major awareness programme, led by the Government, on what to do to avoid developing type 2 diabetes; and, under the new legislation, will he continue to use his powers?

[Earl Howe]

My Lords, the Government have no current plans for a specific national campaign to raise awareness of diabetes. On the other hand, as part of Change4Life, which we are continuing with, we aim to raise awareness about diet and physical activity, and to create what we hope will be a mass movement to help to reduce obesity and related conditions, including diabetes. The campaign encourages everyone to,

“eat well, move more and live longer”.

There is also the very important ingredient of the NHS Health Check in this area, which the noble Lord is familiar with, for people in England aged 40 to 74. We think that this has the potential to prevent over 4,000 people a year from developing diabetes.

EU: Economy

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

[Lord Collins of Highbury]

NHS: Private HealthcareQuestion3.22 pmAsked By To ask Her Majesty’s Government whether general practitioner practices are permitted to advertise their own private healthcare services using the NHS logo.

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

My Lords, the Department of Health does not permit organisations, including general practitioner practices, to use the NHS logo to promote their non-NHS services, including private healthcare services.

[Lord Collins of Highbury]

I thank the noble Earl for his response, but of course most of us in the Chamber have read in the newspapers recently about the case of a GP practice writing to its patients. I believe that what happened there goes straight to the heart of general practice; that is, the relationship between the doctor and the patient. It is a relationship that I fear the Government show no sign of understanding. Will he give an assurance that the proposed form of commissioning in the health Bill will not result in the nightmare possibility of the doctor changing from the person who decides the best medical treatment for the patient to the person who decides what can be afforded?

[Earl Howe]

My Lords, I can give that broad assurance, but the noble Lord will know that it is already within the GMC code that doctors have to consider the totality of the resources available to them and take account of the needs of all their patients. With that qualification, of course our reforms are designed to ensure that the highest-quality care is delivered to every patient according to his or her needs.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 1st November 2011 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the nearly 50 per cent rise, since 2005, in the number of people diagnosed with diabetes in the United Kingdom.

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

My Lords, the increasing prevalence of diabetes is one of the reasons we remain committed to the NHS health check programme. The programme has the potential to prevent over 4,000 people a year developing type 2 diabetes. We are also continuing to improve treatment and support for diabetes. Earlier this year, NICE published a diabetes quality standard, which provides an authoritative definition of good quality care for use by clinicians and commissioners.

[Lord Collins of Highbury]

I thank the Minister for his response. I agree that the biggest benefit of the NHS programme is the prevention of diabetes. However, despite its being in place for two years, very few people have heard of it or used it. Will the Minister explain what action he will take to ensure that the scheme is properly provided and promoted? Can he guarantee that such schemes will not be the first casualty of the proposed NHS reforms?

[Earl Howe]

My Lords, we are completely committed to the NHS health check programme, so I can reassure the noble Lord that we are clear that it has a major part to play. It is a very cost-effective way of both preventing and detecting early those who are at risk of diabetes or who may have recently contracted it. Health checks are part of the current operating framework. It is true that the figures for the first quarter of this year were a little disappointing, but PCTs are fully engaged in the process.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011

Debate between Lord Collins of Highbury and Earl Howe

Monday 31st October 2011 Grand Committee

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

My Lords, the regulations before the Committee today relate to the registration of providers of NHS primary medical services with the Care Quality Commission. The effect of the regulations is straightforward. It defers the registration of most providers of NHS primary medical services by 12 months, until April 2013. The registration of a small number of out-of-hours providers of such services will still go ahead in April next year, and the commission has started the process of registering these providers.

As the independent regulator, the Care Quality Commission has a key role in assuring the public and people who use services that health and social care providers of “regulated activities” meet certain requirements. In order to be registered, providers must meet a series of essential safety and quality requirements on an ongoing basis. Where a registered provider fails to meet these requirements, the CQC has a range of enforcement powers that it can use to bring a provider back into compliance. In the case of the most serious failings, the CQC is able to cancel a provider's registration, which would result in the provider's closure.

The Committee will be familiar with some of the criticisms that have been levelled recently at the CQC, in particular that the number of inspections of providers that it carries out has fallen to unacceptably low levels and that it failed to respond appropriately to serious service failings, most notably in the case of the appalling abuse of residents at Winterbourne View, a hospital for people with learning disabilities.

The Government attach the highest importance to the role of the regulator in carrying out its statutory functions in an efficient and effective manner. The regulations before us are part of the process of how we and the CQC respond to these issues. Deferring the registration of around 9,000 providers of NHS primary medical services will give CQC additional time both to improve the registration process for this tranche of registrants and to increase the compliance activity of providers that are already registered with it.

Implementing the new registration system has required the Care Quality Commission to register around 21,000 providers already, bringing in, first, NHS providers; then independent sector healthcare providers and adult social care providers; and then independent ambulance and primary dental care providers. This has been a major programme of work for the CQC, which it has carried out well. However, given the scale of the task, it is perhaps not surprising that the number of compliance inspections carried out by the regulator fell. The current timetable set in regulations brings providers of NHS primary medical services into the registration system in April 2012. This would bring in around 9,000 additional providers and includes GP practices, out-of-hours primary medical care providers and some NHS walk-in centres.

Although we remain committed to the registration of providers with the CQC and are confident that this will provide effective levers to tackle providers who deliver sub-standard care to patients, we have reconsidered the timing of registering the majority of these providers in the light of the challenges that the CQC has faced. Following a consultation that came to an end in July, and engagement with key stakeholder representatives, we have decided that providers of NHS primary medical services who provide out-of-hours care to patients who are not registered at their practice will be required to register with the CQC as planned from April 2012.

Out-of-hours services tend to treat unfamiliar patients in unfamiliar surroundings and see a higher proportion of vulnerable patients with urgent care needs that are often more complex than those generally found in daytime general practice. As such, there is a more pressing need to register these services than other NHS primary medical services, which is why we are forging ahead with the registration of this group of providers. All other providers of NHS primary medical services will now be required to register in April 2013. The regulations before us amend the regulated activities regulations in order to achieve this delay.

In parallel with our consultation on the proposed changes, the CQC has reviewed its registration process, looked at streamlining its registration systems, and is increasing its scrutiny of providers that it already registers. Consultation responses made clear that a streamlined process would be welcomed. I am pleased to assure the Committee that the commission is taking steps in this direction. On the registration process for primary medical services, I am informed that the CQC is overhauling its online application process so that providers will be able to start completing the application sooner than in previous application rounds. The website will contain full information on the registration process and will provide updates on the progress of an application and how long it is anticipated that it will take for key decisions to be made. The CQC will also put in place a central team to handle applications, avoiding the risk of the registration of NHS primary medical care providers impacting on the CQC’s ability to monitor the compliance of other registered providers. Noble Lords may recall that there were delays in registering dental practices earlier this year due to the volume of Criminal Records Bureau checks required. The CQC is considering a different approach, which I am assured will go a long way to resolving these problems.

The CQC will engage with providers of medical services over the coming months to ensure that they have a clear understanding of what registration will entail and how compliance with the registration requirements will be assessed. The CQC’s compliance inspections have been increasing steadily since the spring. and I am confident that the delays proposed and the arrangements the commission is putting in to handle registration in April 2013 will allow this to continue and be sustained.

Looking beyond initial registration, the CQC is also proposing changes to strengthen and simplify its regulatory model. Importantly, the commission is planning to increase the number of inspections that it carries out. These proposals would see all registered providers of hospitals, social care providers and independent healthcare providers being inspected at least once a year, with primary dental care providers inspected at least once every two years.

I hope that the Committee will be reassured by the progress that the CQC is already making to improve its registration processes and to increase its focus on compliance and inspection. The delay to the registration of providers of NHS primary medical services that we are considering today will allow the commission the space and time that it needs to move further in this direction more quickly. I commend the regulations to the Committee.

[Lord Collins of Highbury]

I thank the Minister for his remarks about the regulations. I must admit that when I read the words:

“These Regulations may be cited as the … Regulated Activities … Regulations”,

I felt as if I was participating in a Marx brothers’ movie, as you wonder which part relates to which. However, behind the regulations lies a very important human story. I want to focus my comments and questions on some of those issues. The Minister referred to the fact that in respect of NHS primary care services there is clearly a risk that the problems which the Care Quality Commission faces now could still apply in 2013. Apart from simply delaying the requirement to register again, has the Minister any other contingency plans to deal with the capacity problems in the CQC?

A human-issue story concerning out-of-hours services relates to the report that the CQC wrote arising out of the Daniel Ubani case, where the real risk posed to patient care from out-of-hours services was apparent. I would like the Minister to spell out how the small number of—

Medicines Act 1968 (Pharmacy) Order 2011

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th October 2011 Grand Committee

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

My Lords, the Medicines Act 1968 (Pharmacy) Order, being debated today, will remove the restriction placed upon pharmacists registered in Britain by virtue of a pharmacy qualification awarded by a relevant European state that prevents them being in charge of a newly established pharmacy. This refers to any pharmacy that has been registered for less than three years and is commonly known as “the three-year rule”.

The relevant European states referred to are Iceland, Norway, Liechtenstein, Switzerland and the European Union (EU) member states. It is not relevant to pharmacists who qualified in the United Kingdom.

I should first give the Grand Committee some background. All pharmacists practising in Britain must be registered by the General Pharmaceutical Council, as must all pharmacy premises. Some pharmacists are registered to practise in Britain under arrangements for the mutual recognition of pharmacist qualifications awarded by EU member states or other relevant European states.

EU Directive 85/433—now 2005/36/EC—includes provision for member states to place restrictions on the recognition of the qualifications of such pharmacists in the case of pharmacy premises registered for a period of less than three years. In Britain, the restriction applies to the pharmacist in charge of such pharmacies, known as the “responsible pharmacist”. In other words, while all pharmacists registered in Britain under the mutual recognition arrangements may work in any British pharmacy, however long it has been registered, such pharmacists cannot hold the position of responsible pharmacist in a pharmacy that has been registered for less than three years. The current restrictions on visiting pharmacists owning pharmacy businesses or acting as superintendents are not affected by this order.

The derogation in the directive was originally put in place in the mid-1980s for economic reasons, following concerns by UK MEPs. They believed that, given the UK’s comparatively open arrangements in relation to pharmacy ownership, there was a risk that the mutual recognition arrangements would put existing UK pharmacies at a disadvantage. Since then, however, much has changed both in terms of pharmacy arrangements in other EU member states and the evolution of domestic policy in Britain.

We have conducted a full public consultation on removing the restriction, both for established pharmacists—those fully registered with the General Pharmaceutical Council in part 1 of the register—and for visiting pharmacists—those temporarily practising in the UK and registered in part 4 of the register. However, the restriction has not affected any visiting pharmacists as, to date, none has been registered.

The response to the public consultation has been very much in favour of removing the restriction. The proposal has support from the General Pharmaceutical Council, the pharmacy regulator, the Royal Pharmaceutical Society, the professional body for pharmacists, as well as all the main pharmacy representative organisations, including the Pharmaceutical Services Negotiating Committee, Community Pharmacy Scotland, the Company Chemists Association and the devolved Administrations.

The proposal will encourage flexibility, efficiency and continuity of care within pharmacy. It will end the situation where a responsible pharmacist, registered here by virtue of the mutual recognition arrangements, can no longer continue in that role if their pharmacy relocates, even if it only moves next door, and therefore becomes a newly registered pharmacy. Removing this restriction will mean that patients can enjoy greater continuity of care in such circumstances; that all registered pharmacists will be placed on a level footing in terms of their employment prospects; and that employers will have a deeper pool of potential employees to draw upon and less bureaucracy to deal with when filling vacancies.

I should now explain the revision of the draft Explanatory Memorandum laid before your Lordships today and the change required to the final version of the Explanatory Note on the order. In undertaking preparatory work for this debate on the draft order, officials in the Department of Health realised that, contrary to previous understanding, “visiting pharmacists”, a sub-category of registrants from relevant European states who do not go through the full registration procedure, are covered by the removal of restrictions that the draft order would achieve. It will not, therefore, require a separate legal instrument to remove the restriction upon their acting as “responsible pharmacist” at new pharmacies. Up to this point, it had been thought that a separate legislative instrument would be required to achieve this. The confusion appears to have arisen in the understanding of the differences between the restrictions applying to those who either may own, or carry on, a pharmacy business or act as superintendent, on the one hand, and the provisions relating to the responsible pharmacist on the other. A superintendent manages a pharmacy on behalf of a company. A responsible pharmacist is in charge of a pharmacy at a given time, and takes on responsibility for the effective management of pharmacy law and practice within a single branch at a particular time. If the draft order is approved, it will still not be possible for a visiting pharmacist to carry on—that is, to own a new pharmacy—or act as a superintendent in relation to a new pharmacy.

However, a visiting pharmacist, and any other pharmacist registered by virtue of the mutual recognition arrangements, would, upon the coming into force of the order, be entitled to be the responsible pharmacist in charge of a newly registered pharmacy in Britain. It is the similarity between the different concepts of control that appears to have led to the confusion. The intention has always been to remove the restriction on responsible pharmacists for all those registered to practise in Great Britain under the EU mutual recognition arrangements, whether visiting or not. The consultation reflected this and the order as currently drafted would achieve this.

Because of the misunderstanding, the earlier version of the accompanying draft Explanatory Memorandum, and the Explanatory Note on the order itself, suggested that the order did not remove the restriction in relation to visiting pharmacists. In fact, the substantive provisions of the order achieve the intention and a further instrument is not, therefore, required. However, the text in the Explanatory Note that refers to the register was incorrect, and the reference to part 1 of the register will not appear in the final version. I apologise for any confusion caused by this late change. I commend this order to the Committee.

[Lord Collins of Highbury]

As the noble Earl stated, a lot has changed since the derogation in the directive was put in place. Much has changed in pharmacy arrangements in other EU member states and in the evolution of domestic policy. The reasons, as the Minister stated, were commercial.

In England, for example, there has been a welcome change over the past few years making it easier for people to get to a chemist, given that there are new pharmacies with longer opening hours. Clearly, such market restrictions are not appropriate today, and their removal will assist by increasing the pool of available pharmacists and ensure improved continuity of service delivery. I note that the change has also been welcomed by the key representative bodies of pharmacies.

I of course recognise that the restriction affects a relatively small number of pharmacies—just over 10 per cent, and just over 5 per cent of all pharmacists registered to practise in Great Britain. I also understand and accept the reasons for the change in the Explanatory Memorandum. However, these changes in the legislation raise broader issues relating to the competencies of the pharmacist and the person’s ability to manage a pharmacy. For example, the report on the consultation noted that concerns were expressed by respondents on competency in English. The Department of Health in its response stated that in the UK a check on the language knowledge of a pharmacist from outside the UK who is seeking work within the NHS is applied by the prospective employer, but that there is no check made at the point of registration.

This leads to three specific questions to the Minister. First, are there plans to introduce a standardised competency test to ensure that any pharmacists from the countries mentioned in the order who are in charge of a new pharmacy have all the required skills and competences? Secondly, are there plans to ensure that those in charge of a pharmacy will have a sufficiently high standard of English to avoid all risk of a patient misunderstanding any advice given? Thirdly, how can an employer determine whether the pharmacist in question is qualified in their own country and has no pending fitness-to-practise cases to answer?