Levelling-up and Regeneration Bill

Debate between Lord Davies of Stamford and Earl Howe

Report stage
Thursday 13th July 2023 Lords Chamber

[Earl Howe (Con)]

My Lords, the amendments in this group are all concerned in one way or another with devolution. To start, I beg to move government Amendment 61; I will also speak to Amendment 309. Taken together, they pick up a proposal made by my noble friend Lord Naseby in Committee about the voting rights of members of the Common Council of the City of London. Having considered the issue raised by my noble friend, the Government are of the view that there is merit in correcting the disparity that applies uniquely to members of the Common Council of the City of London, preventing them voting on housing matters when they are also tenants of the council. These government amendments will allow common council members to apply for a dispensation to vote, bringing the City of London into line with the disclosable interest regime that applies to all other local authority members via the Localism Act 2011. I commend them to the House and will be happy to respond to the amendment in the name of the noble Baroness, Lady Taylor, once she has spoken to it.

[Lord Davies of Stamford (Lab) (Valedictory Speech)]

My Lords, for the last two years a very nasty, cruel war has been waged only two or three thousand kilometres to the east of here by the Russians who attacked Ukraine quite gratuitously under the orders of Mr Vladimir Putin, the President of the Russian Federation. He is a man who, I think everybody knows, identifies with the most imperialistic Russian traditions of former tsars such as Peter the Great and Catherine the Great.

We could have flinched from our responsibilities when this invasion took place but we did not, and I congratulate the Government on the strong line that they have taken in support of Ukraine and the good example they have set, which has been followed by many other members of NATO, in supplying vital arms to the Ukrainian forces. It is very important to respond to aggression because, if one does not, one will quite clearly have more of it.

My reason for speaking today is that there has been a very important meeting in Vilnius over the past few days in which the leaders of NATO have set out the kind of policy we should adopt in relation to Ukraine over the coming months and possibly longer. I am glad to say there has been a large measure of consensus and some important developments—very important is the fact that Sweden has now joined NATO. Sweden is an influential country, much respected throughout the world, and a great asset to us in this difficult situation.

The other countries—most recently France and Germany, in the last few days—have also agreed to supply new weapons, which is very important. The West generally has shown that it will not be ignored in a matter of this kind, which threatens the fundamental sovereignty of the peoples of Europe and the peace of our continent. We must always remember—we learned it in the 1930s, of course—that aggressors invariably come back for more, and what one must never do is give in to them. What is very important is that we do not conduct ourselves in such a way as to send a signal to Mr Putin that he can get away with invasion with impunity and that he can alter the frontiers of Europe quite deliberately at his own behest. That must never happen.

There is something personal that I should mention. If I am alive today, it is thanks in large part to the remarkable work of the medical profession. I pay tribute to all those who work in it, most particularly in the NHS. My father was a GP all his working life and was devoted to the founding principles of the NHS. My eldest son has volunteered for years with St John Ambulance, and he gives me graphic and often disturbing accounts of what life is like on the medical front line. The emergency intensive care and trauma teams at Nottingham’s Queen’s Medical Centre defied the odds when they saved my life after my near-fatal car crash three years ago. I am eternally grateful to them, together with the wonderful rehabilitation team in London, who got me back on my feet.

I am gravely concerned at reports of insufficient numbers of staff and hospital beds, plummeting staff morale, crumbling buildings and other problems which beset the NHS. The Government owe it to the country to do whatever is necessary for the health of the nation, and the time for taking urgent action on this matter is now.

Counter-Terrorism and Border Security Bill

Debate between Lord Davies of Stamford and Earl Howe

Committee: 2nd sitting (Hansard): House of Lords
Wednesday 31st October 2018 Lords Chamber

[Lord Davies of Stamford (Lab)]

I think that the noble Earl would carry the whole House in saying that terrorism has become a greater threat to our society in the last 10 years and that Parliament should do something about this serious matter. I, for one, would be open to persuasion—as, I suspect, would many others in this House—that what is required, among other things, is to strengthen the hands of the courts and to give them the ability to increase the sentences that they impose for terrorist or terrorist-related offences.

However, I have noticed that the Minister has not even begun to answer the quite significant questions asked by the noble Lord, Lord Marks, and my noble friend Lord Rosser, about the principle on which this increase in sentences has been decided—if you like, the multiple which is being applied to existing sentences. What is the origin of this? The Minister mentioned the review. Has the review set out exactly what the increased sentences should be, and if so, on what basis has it come to that conclusion? Did it decide on a universal multiple? From the figures of the noble Lord, Lord Marks, it sounded as though it was about 50%. Is that applied across the board, or was it decided that a different multiple should be applied to different types of sentence, and if so, on what principle? I do not sense that we have heard enough about the methodology that the Government have used to come up with the proposals that they have put before the House today.

[Earl Howe]

I am sorry that the noble Lord did not take one of the central points that I was trying to convey: that the review into this area, instigated by my right honourable friend the Prime Minister, concluded that the kinds of offences that we are considering preparatory to terrorism—which in 2000 and 2006, when the previous Terrorism Acts were passed, were not considered to be as heinous as terrorism offences themselves—were given sentencing structures that reflected that point of view; but that since that time, the intensity and scope of terrorist acts has so increased that it is necessary to treat those former, lesser offences as much more serious and harmful than before. In that context, it is to enable society as a whole, through legislation, to make a more emphatic statement, through sentencing guidelines, of the seriousness of those offences.

[Lord Davies of Stamford]

I did not ask the noble Earl to repeat what he has said to the House before. The question I asked is very specific: on what principle had these precise multiples been arrived at?

[Earl Howe]

There is always a judgment to be made. Once one has reached the conclusion that I have just articulated, there is indeed scope for argument about whether the increase should take place at all—we believe that it should—and, if so, to what extent. The Government have taken a view. We are putting it to Parliament and we believe it strikes the right balance in this context.

--- Later in debate ---

[Earl Howe]

My understanding is that the consultation that took place was a wide one, but I can clarify that point having taken advice on it. It is of course not for the Sentencing Council to comment on or recommend statutory maximums; it issues guidance on the application of currently existing maximums. That clarification is important.

[Lord Davies of Stamford]

The Minister has been very helpful to the Committee, but would it not solve an awful lot of problems if he were to publish the review on which these revised sentencing guidelines were based so that we could all see what arguments were adduced and how the conclusions were arrived at that are reflected in the draft Bill before us?

[Earl Howe]

I am happy to take that request away with me and investigate whether it is possible.

European Union Referendum: Alleged Russian Interference

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 19th June 2018 Lords Chamber

[Lord Davies of Stamford (Lab)]

My Lords—

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

My Lords, it is the turn of the Liberal Democrats.

Defence Modernisation Programme

Debate between Lord Davies of Stamford and Earl Howe

Monday 29th January 2018 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. That is a very constructive idea, which I shall relay to the appropriate quarter.

[Lord Davies of Stamford (Lab)]

I second the admirable suggestion by the noble Lord, Lord Cormack. If we are serious about value for money in defence, is it not important that we seize every viable opportunity that presents itself for collaboration with allies in defence procurement? The F35 programme is a good example of that, though of course the size of the US defence budget means that it is hardly an equal relationship. Does the Minister agree that OCCAR has done, and is doing, a splendid job in managing the collaborative defence procurement of a number of European countries in some very important programmes, including the A400M? I declare an interest because I renegotiated and relaunched that project in its present form. Can he give the House an assurance that if we leave the EU, which I think would be a disastrous idea from every point of view, including this one, we will nevertheless remain committed to OCCAR in the work that it is doing in this field?

[Earl Howe]

I join the noble Lord in commending the work of OCCAR. He is absolutely right that many of our defence programmes are not directly related to our membership of the EU but are bilateral or multilateral, and we certainly wish to see those continue. That is why we at the Ministry of Defence are keen to ensure that the Brexit talks result in as frictionless a trading environment as possible between ourselves and the remaining members of the EU. Interoperability is one consideration in our support for these joint projects; another is value for money and a third is cutting-edge capability, a lot of which this country is in the lead in providing.

Brexit: Economic Analyses

Debate between Lord Davies of Stamford and Earl Howe

Wednesday 24th January 2018 Lords Chamber

[Lord Davies of Stamford (Lab)]

My Lords—

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

My Lords, if we are quick, we have time for both noble Lords, but I think that it is the turn of the Conservative Benches.

Royal Navy: Staffing

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 5th December 2017 Lords Chamber

[Earl Howe]

Yes, indeed. One of our objectives is to strengthen our bilateral relationships, not only with the French but with Germany and other countries in Europe. But, as the noble Lord will be aware, the UK and France have had a long history of working together on operations and exercises, and the Combined Joint Expeditionary Force is a realisation of the commitment made in the Lancaster House agreement for our forces to train and operate alongside each other.

[Lord Davies of Stamford (Lab)]

My Lords, following the Minister’s answer just a moment ago about foreign currency exposure and the procurement of military equipment, would it not be sensible—in the light of recent, rather uncomfortable experience—to extend the period of that hedging to cover the full delivery and payment period for the relevant project at the time when the contract is signed and the project is undertaken?

[Earl Howe]

Certainly, that idea is under consideration, but I am not qualified to make a judgment as to whether a particular form of hedging, or the timing of a hedging contract, is opportune. That is for more skilled minds than mine.

Type 31 Frigate

Debate between Lord Davies of Stamford and Earl Howe

Monday 3rd April 2017 Lords Chamber

[Lord Davies of Stamford (Lab)]

When can we expect a clear, authoritative and detailed statement on what is wrong with the Type 45 and what is being done about it?

[Earl Howe]

My Lords, a study was done in 2011 substantially to rectify the propulsion problems in the Type 45. Those problems have largely been addressed, although not completely. We will initiate Project Napier, which will deal with the propulsion problems once and for all. However, my advice is that the Type 45 destroyers are not now encountering the difficulties that they were.

The Role and Capabilities of the UK Armed Forces, in the Light of Global and Domestic Threats to Stability and Security

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 15th September 2015 Grand Committee

[Earl Howe]

My Lords, I think we would all agree that we have had a very constructive debate. I am exceedingly grateful for the contributions from all sides of the Chamber. I will try to deal with some of the points raised by noble Lords and noble and gallant Lords but I am conscious that I will probably be kept very busy writing letters for the next week or two as I do not think that I can answer in my closing speech every single question that has been put to me today.

The title of this debate asked us to take note,

“of the role and capabilities of the UK Armed Forces, in the light of global and domestic threats to stability and security”.

As all noble Lords are aware, that is a rather large field. We live in a world where, to use that almost eloquent Americanism, there are known unknowns and unknown unknowns. In looking at the ongoing strategic defence and security review, we are peering into a very dark glass indeed. However, we know for certain that this SDSR should be different from the last. Given the 2% commitment, it is certainly not about cuts. That enables me to start by addressing the defence budget.

My noble friends Lord King and Lady Fookes picked up on the sentence included in my opening speech which reinforced the Government’s recognition that defence must always be the Government’s number one priority. Lest there be any doubt on the matter, I re-emphasise that this is the view of government as a whole. The Summer Budget document published by the Treasury said:

“The first duty of government is to ensure the safety and security of the country and its people”.

That document formalised our commitment to spend 2% of GDP on defence until 2020. My noble friend Lord King questioned whether that would be enough. However, I remind him that that same document also committed to raise the MoD budget by 0.5% per annum in real terms over this Parliament. There will also be an additional £1.5 billion a year by 2020-21 in a new joint security fund.

The noble Baroness, Lady Smith of Newnham, took us to the issue of strategy and rightly challenged me on our thinking. The SDSR will be framed in the context of the national security strategy. The strategic context is fundamental to the work now under way. Our analysis suggests that the 2010 national security strategy judgment that we were entering an age of uncertainty, as the noble Lord, Lord Ramsbotham, mentioned, has been thoroughly vindicated in the intervening period. We anticipated that international terrorism would remain a major challenge and expected to see a range of domestic resilience challenges. Our decision to configure our Armed Forces to be flexible and adaptable to evolving threats has been proven correct.

However, we recognise that we have moved beyond the era of uncertainty to a period characterised best by heightened competition, instability and insecurity. I can tell the noble and gallant Lord, Lord Craig, that resilience is very much a principle that we are factoring into our deliberations. In general, procurement levels are set to allow for operational losses and sufficient reliance. I take his specific point about the need for credible, conventional combat power in addition to the deterrent. We are confident that the deterrent itself remains capable and effective and that we maintain sufficient and capable conventional forces.

The noble Baroness, Lady Smith, the right reverend Prelate the Bishop of Portsmouth and other noble Lords questioned whether it was the Government’s genuine aim for the UK to remain a major global player. We are clear that there will be no reduction in Britain’s influence overseas. Our military, security, diplomatic and development capabilities are respected globally. Our diplomatic network spans 268 posts in 168 countries and territories and nine multilateral organisations. The UK has world-leading intelligence agencies and Armed Forces, a strong police force and an impressive National Crime Agency. The UK led the EU’s response to the crises in Syria and Iraq, including responding to the threat from ISIL. The Government will continue to do more on forward defence, reducing the threats before they reach our borders.

The right reverend Prelate and the noble Lord, Lord Rosser, raised the issue of the SDSR process itself. In developing the NSS and SDSR, the Ministry of Defence, alongside the Cabinet Office, the FCO, DfID and the Home Office, has engaged with a broad range of internal and external stakeholders. We have met groups of external experts; hosted academic engagement sessions across the UK; participated in meetings with NGOs and industry round tables; we have briefed Back-Bench MPs, the House of Commons Defence Committee, interested Peers and the devolved Administrations. In total, we have discussed the review with more than 100 experts from nearly 40 different organisations and institutions. I can tell my noble friend Lord Selkirk that we have also engaged with international allies and partners and welcomed the public to write in with their thoughts. The right reverend Prelate, in particular, will wish to take note of the online poll that was conducted recently. We are serious about open policy-making. We have sought comments over the summer, as this gives us the time to analyse the results and feed them into the review process in a meaningful way. The poll is only one of several ways of engagement and offers the public another avenue for comment.

The noble Baroness, Lady Smith, my noble friend Lord Selkirk, the right reverend Prelate and other noble Lords spoke about the capabilities that we are reviewing in the SDSR. The SDSR is clearly an opportunity to re-examine our capability choices. In 2010, we highlighted that we would return to some questions in this review. Maritime patrol aircraft, ballistic missile defence and future combat aircraft fit into that category and they will all be considered. We also committed to considering NATO’s capability shortfalls and which ones we could help to mitigate. I am afraid it is too early to discuss options and decisions in detail, although I will comment on particular questions that noble Lords have raised in a second. The noble Lord, Lord Dannatt, asked whether defence engagement would become a formal military task. The framework by which defence activity is directed is currently being revised as part of the review. Defence engagement is clearly a very important defence function and is likely to be very prominent in the future framework for defence. I am afraid that is as far as I can go at the moment, but I hope he will take comfort from the fact that it is in our sights.

The noble Lord also asked me about army basing. The army basing programme enables the Army to reorganise into its new Army 2020 structures, and delivers the Government’s 2010 SDSR commitment to bring all UK military units back from Germany by 2020. The programme has been delivered jointly by the Defence Infrastructure Organisation and the Army. Although some units have already withdrawn from Germany to the UK, the majority of the 30 moves or re-roles conducted in 2013-14 were inside the UK. In the summer of this year, some 5,200 service personnel and their families, totalling 10,000 people, will have returned from Germany to the UK.

The final phase of the army basing programme involves the remaining units in Germany, principally 20th Armoured Infantry Brigade based in Paderborn, and completes a number of residual internal UK moves. The whole programme is still scheduled to complete by 2020. There are sufficient funds to complete the programme and it is on track. We were considering bringing it forward but have decided instead to leave the plans in place. There are no plans to leave any units or force elements in Germany.

The noble Baroness, Lady Smith, posed the question of why we are in Iraq and whether it was just because we had been invited by that country to provide assistance. Let me make it clear: ISIL threatens the people of the Middle East and poses a threat to our own national security. Defeating ISIL will take time and patience but it is a fight that we must win. The UK is part of a global coalition of over 60 countries, including Iraq, Arab nations, European partners and the United States, united to defeat ISIL. The UK contribution to the coalition effort is significant. We provide capability across the full spectrum of air power, including niche and highly advanced intelligence surveillance, reconnaissance and airstrike capabilities, and in many other areas. ISIL, as has been said, cannot just be defeated by military action. The underlying causes must also be addressed, which is why we are supporting inclusive governance in Iraq and political transition in Syria.

My noble friend Lord King rightly emphasised the importance of maintaining NATO as a strong and credible alliance to deter and face down any possible aggression. As I am sure he knows, the UK has made a significant contribution to NATO’s reassurance exercises since they came into being in May last year. NATO’s readiness action plan provides a comprehensive package of measures, including the development of the very high readiness joint task force and assurance measures to respond to changes in the security environment on NATO’s borders, including challenges posed by Russia. In my opening speech I mentioned the contribution that we were making and will continue to make in future. However, it is fair to say that the NATO summit in Wales in September last year demonstrated alliance solidarity at a time of tension on NATO’s borders, a tension that continues. It saw agreement on a number of key objectives, including NATO’s readiness action plan, which seeks to increase the responsiveness of allies through the development of the very high readiness joint task force, and by conducting assurance measures, particularly exercises in the eastern and Baltic states. Those exercises of course provide valuable training opportunities as well as contributing to the reassurance of Eastern allies.

The noble Lord, Lord Davies of Stamford, took me somewhat to task on several matters, including the so-called funding black hole in the MoD budget. I have no wish to irritate the noble Lord in the slightest. First, I readily acknowledge that many of the programmes that we are currently pursuing were initiated by the previous Labour Government. Ministers in that Government would perhaps not have been exposed to the £38 billion number, as it became apparent only during SDSR 2010 costing. The Government reported to the House of Commons Defence Committee on the figure of £38 billion in 2012. I am happy to write to the noble Lord with the figures that we provided to the committee at that time.

My noble friend Lord Attlee asked how we would ensure that no black hole would occur in the future. It is the job of Ministers to ensure that the MoD budget is in balance with its spending programme. The public spending envelope across government is now so strict and disciplined that it cannot be otherwise. It is our duty to report regularly and transparently to the Treasury and to account for our spending and our spending plans. Of course, we receive the benefit of its close oversight.

The noble Lord, Lord Davies, my noble friend Lord Selkirk of Douglas, and the noble Baroness, Lady Jolly, spoke about maritime patrol aircraft. We have acknowledged that we have a maritime surveillance capability gap following the decision not to bring the Nimrod MRA4 into service. However, we have also made it clear that it is one that we have chosen to accept. We have not sought to pretend otherwise. It is a gap that we have been able to mitigate through the employment of other assets, as noble Lords have mentioned, particularly also through co-operation with our allies who have deployed maritime patrol aircraft on several occasions.

We are conscious that this issue is in the sights of many people. It is very much in ours. It has been the subject of recent studies by the Ministry of Defence. We have received representations from a number of industrial organisations and those have allowed us to understand better the nature of the platforms currently in existence, as well as the timeframe in which novel technologies are likely to mature. I mentioned the support of our allies. Incidentally, that is not a one-way street. We supply support to our allies in return, such as air-to-air refuelling, surveillance and transport.

The noble Lord, Lord Davies, mentioned the F35 joint strike fighter. That is the world’s largest single defence programme. We have played an important role in the system design and demonstration phase, as he knows, resulting in significant contracts and jobs for UK industry. To date, we have taken delivery of three F35B aircraft. A further five for the UK are in production and are scheduled to be delivered in 2016 and early 2017. UK F35 initial operating capability is scheduled for 2018 and remains on track.

[Lord Davies of Stamford]

How many?

[Earl Howe]

I am coming to that. The F35 programme has been established as an incremental acquisition programme with production contracts being led initially on an annual basis. We will order sufficient lightning aircraft to build up our initial carrier strike capability, but the overall number of joint strike fighter aircraft to be purchased will not be determined before the strategic defence and security review at the earliest.

The noble and gallant Lord, Lord Boyce, referred to the Type 26 global combat ship, which will progressively replace Type 23 frigates from 2022 onwards. We are implementing an incremental approach to approvals and commitment on the T26 global combat ship programme, with separate approvals covering demonstration and manufacture phases. On current planning and subject to a main gate decision, the manufacture phase will begin in 2016. He asked about the national shipbuilding strategy. The strategy announced by the Chancellor on 30 January this year is progressing well and its conclusions will form part of the forthcoming strategic defence and security review later this year. The aim of that strategy is to help deliver world-class ships for the Royal Navy while ensuring the best value for money for the taxpayer. It will also ensure that the Navy continues to have the capability that it needs to protect our nation’s interests and ensure continued investment in UK warship production.

The noble Lord, Lord Rosser, referred to cyber. I readily agree that, in defence, cyber is essential to preserve our freedom to operate despite cyber threats and to achieve military effects through and in cyberspace. The whole of the defence supply chain also faces cyber threats. In 2013, the Defence Cyber Protection Partnership was launched as a joint government/industry initiative to increase the resilience of the defence sector. Our Armed Forces depend on equipment and services provided by industry. In government we face similar challenges, and we believe that that partnership will be of considerable value; indeed, it is already proving to be.

I will write to the noble Lord, Lord Dannatt, on the issues around industrial policy because they are very important. I would simply mention in particular the Defence Growth Partnership, which I believe will see us achieve a more thriving defence sector in the UK underpinned by work to improve international competitiveness and to target research investment more efficiently and effectively.

I cannot finish without referring to personnel issues, which my noble friend Lady Hodgson and the noble Lord, Lord Ramsbotham, among others, emphasised with considerable persuasiveness. The Armed Forces are changing to meet the Future Force 2020 structure, which requires reductions in some capabilities and the growth of others. They are actively recruiting to sustain manning balance across all skill sets, preserve future operational capability and support regular and reserve manning ratios. Recruitment continues to be supported by significant marketing activity in the current financial year. I say to the noble Baroness, Lady Jolly, that we need to increase attraction rates for a number of key trades such as medics and cyber engineers, nuclear, maritime and aviation. These are a particular issue due to national skills shortages. The latter issue is being explored in collaboration with other government departments. A joint team with industry has now been established and is undertaking a pathfinder project to allow the movement of skilled people across the defence sector.

With regard to the reserves, the new employment model that emerged from the 2010 SDSR aims to produce a modernised offer that reflects modern society. This is a wide-ranging review of the terms and conditions of service for service personnel, both regular and reserves, covering four broad policy areas: pay and allowances, accommodation, training and education, and career structures and career management. I will write further on where we are on recruitment and retention but I believe, as a result of a short brief I received this morning, that we are heading in the right direction.

With time moving on, with the leave of noble Lords I will cover just a few more issues. The right reverend Prelate raised the matter of women in ground close combat roles. That is not strictly an SDSR issue, as I expect he knows, but, following a review of the exclusion of women from ground close combat roles, my right honourable friend the Secretary of State for Defence announced at the end of last year that defence welcomes the prospect of opening ground close combat roles to women subject to the outcome of further physiological research before a final decision is taken in 2016.

The noble Lord, Lord Burnett, referred to the much discussed case of Sergeant Alexander Blackman, and I listened carefully to all that he said. There is a proper limit to what I can say in my ministerial capacity, as I know he recognises. But it is common knowledge that Sergeant Blackman appealed to the Court Martial Appeal Court, which incidentally is a wholly civilian court made up of the same judges who sit in the civilian Court of Appeal. The fairness and objectivity of that process was reflected by the decision on 22 May last year by the Court Martial Appeal Court, chaired by the Lord Chief Justice himself, which decided not to overturn the conviction of a life sentence. The court did reduce the minimum term Mr Blackman must serve from 10 to eight years. The full reasoning behind that judgment was published on the Ministry of Justice website, and it was based on the consideration of a range of factors that I will not go into. The MoD has, and can have, no view on Sergeant Blackman’s guilt or innocence. It would be improper for us to express a view. There is a legal process to determine that question. The MoD will however of course fully co-operate with the judicial process.

The noble Lord, Lord Dannatt, referred to the issue of Afghan interpreters and locally employed civilians. Our policy offers a redundancy relocation option that does not require local staff to prove that they are at risk. The policies of other NATO nations are largely based on asylum criteria. I would just say that the way that the Government’s policy and the implementation of that policy have been portrayed in the press has been wrong and misleading. We are the only nation with a permanent team of trained investigation officers in-country to investigate claims of intimidation. These experts have provided support to over 200 former local staff. A total of 500 local staff are eligible for relocation to the UK under the redundancy scheme, out of whom 170 have already moved to the UK along with their families, bringing the current total to 400. I am happy to write further to the noble Lord but I would add that the intimidation policy, which is quite separate from the ex gratia redundancy policy, allows for all current and former local staff members, regardless of dates or length of employment, whose safety has been threatened to approach us to consider relocation.

I have been advised that I have overshot my time. I will write to noble Lords about the other subjects that I have not been able to cover, notably the Armed Forces covenant. I listened very carefully to the comments from my noble friend Lady Buscombe on the Border Force command and listed buildings in Portsmouth.

I am conscious that I am in danger of exhausting the Committee’s patience, if I have not done so already, so I conclude by thanking all those noble Lords and noble and gallant Lords who have taken part in the debate. I look forward to writing to them over the next few days.

Defence: Budget

Debate between Lord Davies of Stamford and Earl Howe

Wednesday 17th June 2015 Lords Chamber

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

My Lords, I thank my noble friend Lord Sterling for giving us the opportunity to debate a topic of fundamental importance for the security and prosperity of this country. He brings to our deliberations a wealth of experience in both business and politics, and I listened to him, as I always do, with the closest attention. However, he has also enabled me, as the new Minister on the block, to benefit from the wisdom of the other speakers here this evening, and I am grateful to all of them for their contributions. I shall of course write on those questions that I am unable to address tonight.

As this debate has shown, the House recognises that the first duty of government is to protect its people and promote our interests around the world. Therefore, I preface my remarks by making clear that the influence that this country continues to exercise globally and the respect that we command through our military, diplomatic and development capabilities are major national advantages that the Government are committed to maintain.

The defence budget, and the way we use that budget, are of course key components in the way we achieve this. Listening to noble Lords this evening, I cannot fail to be aware of the anxieties that exist in some quarters about current and future defence funding. At the same time, I suggest that we need to take a realistic and measured view, both of what we are doing currently and of what we plan to do. At present, the UK has the fifth-largest defence budget in the world, the second-largest in NATO and the largest in the EU. That budget has enabled us to commit our Armed Forces, as we speak, to 21 operations in 19 different countries. It has enabled us to achieve genuine global reach in Iraq, Afghanistan, the Baltic, west Africa and, most recently, Nepal and the Mediterranean, to name only a few examples.

In Iraq we bring niche capabilities such as intelligence, surveillance and reconnaissance, air refuelling, counter-IED, and command and control to the US-led coalition which few other nations can replicate. We are the US’s largest partner in the coalition air effort against ISIL.

In Afghanistan we can be proud of what we have achieved in our largest coalition operation of recent times, Operation Herrick. We have helped to set the conditions for a more viable state, improving the lives of ordinary Afghans, while substantially reducing the terrorist threat to the UK from this region.

This year, our contribution to NATO assurance measures will be as significant as last year, with more than 4,000 UK personnel set to deploy on various reassurance exercises, including a number in eastern alliance territories.

In Nepal we demonstrated our disaster relief capabilities when we deployed one C130 Hercules transport aircraft, two C17 transport aircraft and more than 250 personnel to the region to support relief efforts, on top of our existing Gurkha presence. In Sierra Leone we led the fight against Ebola, committing 900 troops. In the Mediterranean we have demonstrated other elements of our naval capability, deploying HMS “Bulwark” along with three Merlin helicopters to rescue—so far—2,900 migrants in difficulty.

These are our Armed Forces as they are today—capable of responding to a complex variety of challenges quickly and effectively. But, as my noble friend has emphasised, we need to pay equal attention to the defence needs of the future. That is indeed why the Government are in the process of carrying out a full strategic defence and security review, along with a refreshed national security strategy. I say to the noble Lord, Lord Dannatt, that this is not prevarication. The SDSR will take as its starting point a hard-headed appraisal of our foreign policy, our security objectives and the role that we wish our country to play on the world stage. It will be informed also by a full evaluation of the risks and challenges facing us as a country.

Not all these risks can be foreseen but, through the work of the National Security Council and by ensuring that the national security strategy builds on the progress made since 2010, we will be well placed to define the military and other capabilities we need to ensure that Britain has the broad range of capabilities and strategies to respond to threats and maintain its position as a global leader. The noble Baroness, Lady Dean, can be reassured that this will indeed factor in the well-being of our personnel.

However, in so doing, the SDSR will need to balance strategic challenge with fiscal realities. It is unrealistic to think that any part of government can operate in a vacuum, without having regard to the resource constraints that the country faces. Economic security and national security are two sides of the same coin. I cannot therefore comment on what our defence spending will be after this financial year. Such decisions, as my noble friend will understand, will be determined by the spending review later this year, running alongside the SDSR. However, he should, I hope, be reassured in one respect at least. By its very nature, the SDSR will look ahead at the longer term as well as the short and medium term. And here, I suggest, we start from a good position. This Government were elected with a mandate to maintain the size of the Regular Armed Forces, to increase the equipment budget in real terms every year and to renew our four nuclear ballistic submarines.

We have committed to spending more than £160 billion on equipment and equipment support over the next decade; including on new joint strike fighters, more surveillance aircraft, hunter-killer submarines, two aircraft carriers and the most advanced armoured vehicles. We continue to spend 20% of our defence budget on major equipment and equipment support—one of only four NATO members to do so.

This equipment will be innovative and high technology, giving our Armed Forces a battle-winning edge. For example, our procurement of the Scout Specialist Vehicle will transform the way that the Army undertakes operations, enabling commanders to engage at ranges and at a tempo not previously possible.

The F-35 Joint Strike Fighter is a fifth-generation multi-role combat aircraft and marks a step change in capability for the UK. The Queen Elizabeth-class aircraft carriers will be the largest, most capable and powerful surface warships ever constructed in the UK, able to meet the widest range of tasks around the world. All these programmes have a positive impact on the UK’s defence industry, either through their manufacture or through many years of future support.

I assure my noble friend Lord Lyell that the equipment and weapons currently fielded by the British Army are genuinely second to none.

I have read the paper published by King’s College London and mentioned by my noble friend Lord Sterling. We know how important it is to be able to act independently. That is why key principles of the 2012 White Paper, National Security Through Technology, are open procurement and technology advantage. Where essential on grounds of national security, we will do whatever is necessary to protect our operational advantage over our adversaries and our freedom of action. This means being able to conduct combat operations at a time and place of our choosing with the assurance that capabilities will perform as required, when required.

We will spend 2% of GDP on defence in this financial year. But as my noble friend Lord Howell emphasised quite rightly, it is not just the size of the defence budget that is important but also how you spend it. That is why we are continuing with our successful defence transformation programme, which has balanced the defence budget, removing the £37 billion black hole left by the last Labour Government, and committed the department to finding £5 billion of efficiency savings over the last five years, reducing administration costs and critically examining our defence equipment needs, helping us to achieve better deals with our contractors.

[Lord Davies of Stamford]

I am aware that the Minister is very new to this brief, but I regret very much that he is continuing to mention this complete nonsense and propaganda about a £35 billion black hole deficit. If defence expenditure had gone on increasing at the rate of 1.5% per annum in real terms, which we were committed to, there would have been no such black hole at all.

[Earl Howe]

My Lords, I totally repudiate that comment. Not only was there a black hole of that size, but I was briefed on it the other day and it is even greater than that figure—but we will not go into that now, if the noble Lord will allow.

There is no point in having a £34 billion defence budget if it is not spent efficiently. That is why it is important that we continue our work from the previous Parliament so that we can maximise defence spending on our Armed Forces. This is demonstrated in our 10-year fully funded equipment plan which we published in January. That plan gives industry certainty over MoD investment in different areas for the next decade, helping us to deliver the equipment we need for our Armed Forces. I say again, the fiscal challenge that has faced defence has not impacted on our ability to conduct operations to support our foreign policy objectives —far from it—as I have already indicated with examples of our many military operations around the world.

As has been said, we are not only using military intervention to protect our interests and promote our values; we have a leading diplomatic network which spans 268 posts in 168 countries and territories, and nine multilateral organisations. These unique capabilities have enabled the UK to play a leading role in talks to address Iran’s nuclear programme, disarming Syria of its declared chemical weapons stockpile and establishing a global arms trade treaty. We are also the only G7 nation to meet the UN OECD target to spend 0.7% of gross national income on international development, building stability and supporting economic growth overseas and contributing, importantly, to the security and prosperity of the UK.

The achievements of our defence and diplomatic services speak for themselves. The UK can be proud to have such world-renowned services to call upon. As my noble friend Lord Glenarthur said, the upcoming SDSR is an opportunity to look again at our foreign policy objectives and ensure that we have the assets necessary to address these in the context of the resources available to us. As I said to this House earlier this month, in the words of Churchill, we will do what is necessary to keep Britain safe and will remain part of the international effort to defeat the adversaries that threaten us.

Armed Forces: Airborne Maritime Patrol

Debate between Lord Davies of Stamford and Earl Howe

Thursday 4th June 2015 Lords Chamber

[Earl Howe]

My Lords, it is important to emphasise that the SDSR will be underpinned by a very robust assessment of the threats that face us and the needs that we have to meet those threats. On the noble Lord’s wider point, the Ministry of Defence is just one organisation with a role in the security of the UK’s territorial waters. Under the UK national strategy for maritime security we have a ministerial working group chaired by the FCO. That has been established to focus on maritime security in its entirety.

[Lord Davies of Stamford (Lab)]

My Lords—

NHS: Five Year Forward View

Debate between Lord Davies of Stamford and Earl Howe

Monday 1st December 2014 Lords Chamber

[Earl Howe]

My Lords, my noble friend, as ever, has rightly identified the likelihood of greater and greater demands on our health service over the coming years. Certainly, building a non-partisan consensus is something to be desired regarding the way that we fund our health service. Having said that, I can tell my noble friend that there has been no thinking whatever on the part of Ministers to depart from the current model of funding for the NHS. We believe passionately that the NHS should be free at the point of use, regardless of ability to pay. That is one of the core principles on which the NHS has been founded since 1948 and it is paid for out of general taxation. While I take on board my noble friend’s desire to look afresh at this area, I think that we have some way to go before cross-party talks need to take place. We are clear that we can proceed on the current basis.

[Lord Davies of Stamford (Lab)]

The noble Earl has always taken a very serious attitude towards his ministerial responsibilities and he has just spoken about the desirability of moving to an all-party consensus on health matters. Does he not therefore rather regret, in retrospect, that the Government decided to spin this announcement, leaking it in advance of the Statement in the House of Commons and putting it about that there was £2 billion of new money for the NHS—the implication being that this was the result of more buoyant government revenues because of a higher growth rate? In fact, it is nothing of the kind as the noble Earl has now revealed to the House. It is roughly £1 billion being reallocated within the NHS budget and £1 billion being reallocated from other department budgets, including from defence where there has been underspend, which is very damaging to this country’s interest. Would it not have been better, and easier to develop a consensus in this country—to which the noble Earl quite rightly looks forward—if in fact the Government were slightly more straightforward and candid with the public over announcements of this kind?

[Earl Howe]

I do not think one can develop a consensus prior to a government Statement—that is probably wishing for the moon. The charge that the noble Lord levels against the Government is also, if I may say so, misplaced. We have never pretended that all the money being announced today is new money. I do not seek to suggest that, as I have already explained. As regards the timing, I think it is standard practice for key elements of the Autumn Statement to be trailed ahead of the formal announcement. However my right honourable friend the Chancellor will confirm everything we have said today in the Autumn Statement on Wednesday, and that is as it should be.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 6th March 2012 Lords Chamber

[Earl Howe]

My Lords, the case for regulating prices for NHS services is strong. Many academics agree that competition should be on quality and not price and that this will increase the standard and quality of healthcare services and protect patients’ and taxpayers’ interests. This requires prices to be fixed. Therefore, it is vital that there is an effective system of price regulation that can deliver these improvements and help sustain a universal and comprehensive NHS, free at the point of use. However, a number of problems with the current system have been identified, including by the previous Administration, which mean that it is not as effective as it could be.

In particular, I will mention two things. First, prices are subject to potential political interference. This means that providers are more risk averse. That inhibits investment and innovation in the sector. As the noble Lord, Lord Warner, said, the methodology for setting prices is not transparent. This makes the system unpredictable—again, inhibiting investment and innovation. Secondly, prices can be inaccurate and may not always reflect best practice models of clinical service delivery. This may result in cherry picking and may hinder providers from expanding and improving quality. Therefore, the case for change is clear and compelling. The Government’s vision is for an independent, fair and transparent system of NHS price regulation that reflects best practice and extends the scope of the tariff when it is in the interests of patients; that ensures that competition is based on quality and choice, and not on price; and that addresses the problems of cherry picking. To deliver this vision, prices will continue to be regulated through a national tariff. This will build on and improve the system of payment by results—which the previous Government said that they would improve but failed to do so.

Perhaps it would be helpful for me to explain in a bit more detail how the Bill will support this vision. In other healthcare systems around the world—for example, in the Netherlands—Governments have delegated price setting to independent organisations. The noble Lord, Lord Warner, cited another example: that of Germany. Such bodies create a transparent and stable environment for pricing.

[Lord Davies of Stamford]

Before we get on to the important matter raised by my noble friend of who is going to fix the tariff, if there is a tariff, and the issues raised by my amendment, will the Minister agree to meet privately me and, I hope, my noble friend Lord Warner—there has been no collusion between us but I hope he will come to that meeting—to discuss in greater detail the technical but important matter of the circumstances in which it is right to accept a lower price bid in the National Health Service?

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 13th December 2011 Lords Chamber

[Lord Davies of Stamford]

My Lords, I do not want to hold up the House for too long, but I feel that someone should respond to my noble friend Lord Warner’s amendment on behalf of what he rather dismissively described as the elected political class. I am proud to say that I was a member of that elected political class for 23 years, representing Grantham and Stamford. In the course of those 23 years I had to take action to save both Grantham hospital and Stamford Hospital, separately and at different times, when they were threatened with closure. I used all the methods which my noble friend is no doubt familiar with: meetings with Ministers, lining up local government support, petitions, threatening judicial reviews—even potentially funding a judicial review—and heading major marches. I remember leading over 9,000 people through the streets of Grantham and 5,000 through the streets of Stamford. We won in both cases. Grantham is still a very successful local district hospital and Stamford is a smaller hospital—what you might call a cottage hospital.

The point I wanted to make is this: I would have welcomed the sort of report from Monitor which my noble friend is suggesting. If one wants to save one’s local hospital, and one wants to make sure that the right decisions are made about the health of one’s constituents, one wants a warning as early as possible about the financial or clinical problems—or both—that may be arising. There are often all sorts of alternatives that one can find to closure. It is important for democratic confidence in the NHS that all the possibilities are thoroughly explored and everybody is content that the decision has not simply been taken behind closed doors and then announced to the public when there could have been some initiative that might have saved the day. On behalf of the—slightly dismissed—elected political class, I thoroughly support the amendment of my noble friend.

[Earl Howe]

My Lords, may I say to the noble Lord, Lord Warner, that I am very pleased that—

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 13th December 2011 Lords Chamber

[Earl Howe]

My Lords, I think we will rely on Monitor to make its own arrangements and, as the Committee will appreciate, there are limits to how far it is sensible to prescribe in legislation what the arrangements should be. Nevertheless, picking up the noble Lord’s prompt, I am sympathetic to the concerns that have been raised in this general area and I undertake to discuss the matter further with Monitor.

To create legal certainty, Clause 63(3) clarifies Monitor’s arrangements to resolve conflicts further, so when preventing anti-competitive behaviour and setting and regulating prices, Monitor must ignore its transitional regulatory functions relating to foundation trusts. I hope that addresses Amendment 274ZB, tabled in the name of my noble friend Lady Williams. The meaning of this provision—

[Lord Davies of Stamford]

My Lords, the noble Earl keeps on referring to Monitor’s responsibilities towards foundation trusts as being transitional, but I recall that earlier today he accepted that in fact they would possibly continue beyond 2016, which is five years away. It hardly seems possible that he should be saying that at one moment and then at the next using the argument that since these responsibilities are only transitional, the conflict of interest will rapidly resolve itself.

[Earl Howe]

I refer the noble Lord to the remarks I made earlier. The provisions are partly transitional and partly not. It depends on which functions we are looking at.

I come back to the point I was making on the amendment tabled in the name of my noble friend. This provision says that in preventing anti-competitive behaviour that is against patients’ interests or in setting prices, Monitor must ignore the transitional functions it has as the regulator of foundation trusts. If the subsection were left out as the amendment proposes—although I know that it is only a probing amendment—when undertaking its anti-competitive behaviour or pricing functions, Monitor could also consider its transitional intervention powers. That could result in Monitor treating struggling foundation trusts preferentially by, for example, not subjecting them to its anti-competitive powers. I hope that that is helpful to my noble friend.

My noble friend Lord Clement-Jones spoke about the designation of specialist centres and expressed his view that that should not conflict with the prohibitions on anti-competitive behaviour and that, in essence, patients’ interests have to be paramount. I am with him on this and I would like to reassure him that patients’ interests would be the paramount consideration for Monitor in resolving conflicts that arise in the exercise of its functions in this way. Monitor need not take issue with decisions to designate specialist centres where this would improve quality and protect patient safety, even if it reduced competition.

I hope that those remarks are helpful and that my noble friend will feel content to withdraw his amendment.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 13th December 2011 Lords Chamber

[Lord Davies of Stamford]

Can I take the Minister back to the all-important matter of Monitor? I think he said this morning that he recognised that there were potential conflicts of interest in Monitor’s role. Monitor will continue to have its role of oversight over foundation trusts until 2016. The Minister has said today that that can be continued beyond 2016. Monitor will now be given responsibility for competition policy: in other words, for all the supply side, whether private sector, independent, or foundation trust. Is there not a conflict with Monitor having this responsibility for foundation trusts and then being responsible for the oversight of the rules of competition and the supply side? Monitor will also be responsible for oversight on the other side: the commissioning and customer side. Is this not an intensely problematic situation, and will the Minister say how he intends to resolve these issues?

[Earl Howe]

My Lords, the noble Lord, not for the first time, is ahead of me. It is no accident that we have a group of amendments that deals with potential conflicts and how these are to be resolved. It might be better, if the noble Lord agrees, to wait an hour or two until we reach those amendments.

My noble friend Lord Newton indicated from his own personal experience that mergers, when they occur, are far too bureaucratic. I fully agree with him. The Department of Health, the Co-operation Competition Panel and, if it involves a foundation trust, Monitor, all currently play a role and may have conflicting views which lead to uncertainty and delay. Our proposals would create a simpler and much more streamlined process for the NHS.

My noble friend indicated his strong view that safety and quality—not competition—should be paramount. I am sure it will not have escaped his notice that improving quality is what these reforms are meant to be about. We have been clear that patients’ interests, especially their safety and the quality of the services they receive, have to be paramount. That is why Monitor’s overriding purpose is to protect and promote patients’ interests. It is why the board will have a duty to improve quality, why the CQC will underpin quality; and why competition will be used only as a means to improve quality. Where there are better ways to improve quality—and there may be—they will be used instead.

My noble friend Lord Clement-Jones, in his extremely interesting and—I do not mean to sound patronising—well-informed speech, took us through some of the intricacies of competition law. Although he did not say this, there has been a suggestion from a number of quarters that we are in a knowledge-free zone when we look at competition laws applied to the NHS. In one sense that is true because there is no case law that can guide us, but in another sense it is not true.

We can say many things with confidence. The point of competition law is to protect people from self-serving abuses like collusion or abuse of market power by restricting access to services. These self-serving abuses that harm patients are already prohibited in the NHS by the principles and rules for co-operation and competition, as introduced by the previous Government. This is not something new introduced by the Bill. Competition law applies to foundation trusts only in so far as they are acting as an undertaking, as my noble friend indicated—in other words, only where they are providing goods and services within a competitive market. Given the lack of directly applicable case law to NHS providers, there is some uncertainty about where that line is drawn.

A body can be an undertaking for some activities and not others. That is very clearly laid out in the OFT’s recent guidance, Public Bodies and Competition Law. For example, the foundation trust might be an undertaking for elective surgery, if it were provided in a competitive market, but it would be very unlikely to be an undertaking when providing NHS services in the absence of competition and while under a licensed obligation to maintain service continuity, which it could well be if Monitor chose to build that into its licence. In so far as foundation trusts may in the future be found to have abused their market power, what would then follow? It is important to understand what the consequences would be. In that situation, Monitor—

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 22nd November 2011 Lords Chamber

[Lord Davies of Stamford]

I am most grateful to the Minister for giving way. Could, or would, the mandate include any way to prioritise between the potentially 35 different tasks that are being imposed on the board?

[Earl Howe]

It could do. However, that is to be determined. I would welcome the views of the noble Lord on that, if he has particular examples in mind.

This brings us to the question the noble Lord, Lord Hunt, asked about the period which the mandate will cover. It will be a multi-year document, updated annually, which is intended to provide a stable policy context for the board. There may be circumstances which call for the mandate to be updated in-year, including after a general election, to ensure that an incoming Government could start to implement their manifesto commitments for the NHS in-year. Any revisions to the mandate will be open and transparent. If the mandate is revised, it must be published and laid before Parliament with an explanation of the changes.

I will now comment on Amendments 98 and 100, tabled by the noble Lord, Lord Warner, and Amendment 100A, tabled by the noble Lord, Lord Hunt. These rightly highlight the importance of transparency and parliamentary scrutiny of the mandate. I completely sign up to transparency as a principle. In the first place, there will be a public consultation. Alongside that, we will engage with stakeholders, including the board, to ensure that we set ambitious but achievable objectives. It is essential that the Government hold the board to account for objectives that are achievable. It is not in anybody’s interests to set the board up to fail. At the same time, where there is scope for improvement in the health service within the resources available, the mandate should and will ask the board to drive such improvements.

Ministers have a legitimate right to be ambitious on behalf of citizens and taxpayers, but we know that getting the balance right and setting objectives that are affordable and ambitious will not be straightforward. Much of the answer lies in transparency. There will be open public consultation on the Government’s objectives for the NHS. I can assure noble Lords that the process of developing the mandate will be open and consultative, including a formal 12-week public consultation. We intend to publish a consultation response as well as a summary of the responses we receive.

I point out that the Bill places a duty on the Secretary of State to consult the board and HealthWatch England before specifying the objectives and requirements in the mandate. We should be clear about how that changes the current arrangements. At present, decisions about the Secretary of State’s priorities for the NHS can be decided without reference to, or consultation with, anyone, as we saw under previous Governments. Top-down targets can be set without consultation. The priorities for the NHS are issued around this time every year through an operating framework without any need for consultation. Under the Bill, for the first time parliamentarians and the public will have the opportunity to consider and challenge the Government's objectives for the NHS every year. No previous Government have ever allowed this. It will highlight and reinforce, year by year, Ministers’ overarching responsibility for a comprehensive National Health Service free at the point of need.

The consultation will provide a period in which Parliament will be able to scrutinise the Government's proposals—as will the Health Select Committee if it chooses. It is appropriate that this consultation should take place before the mandate is published. We must provide clarity of purpose for the NHS. A period of additional parliamentary scrutiny after the mandate is published, which is what the amendment proposes, would be disproportionate and very disruptive. It would reduce the time the NHS has for planning and would create uncertainty in the service.

There will of course be formal parliamentary control over any legal requirements set for the NHS through the standing rules and any other regulations. The Bill not only gives Parliament an unprecedented role in setting out the roles and responsibilities in the NHS but increases parliamentary scrutiny by requiring detailed parameters and requirements to be set in regulations rather than in ministerial directions that have no scrutiny at all. I hope that noble Lords will give the Government credit for that package of proposals.

In addition, we have accepted the recommendation of the Delegated Powers and Regulatory Reform Committee that the requirements in the mandate should have the force of legislation and should be in an instrument subject to the negative procedure.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Monday 14th November 2011 Lords Chamber

[Lord Davies of Stamford]

My Lords, what I want to say might have been a little long as an intervention in the Minister’s speech but it will be very short as a speech. I simply want to ask the noble Earl, when he replies to this debate, to address in a considered way how the Government intend to deal with an enormously significant and worrying conflict of professional interest that could arise in this context. Anyone who is a member of a clinical commissioning group, whether he or she is a GP or not, must presumably be committed and signed up to the priorities, policies and plans of that clinical commissioning group. However, where that individual is also a GP who has his or her own patients, some of those patients may have conditions that do not get a very high priority in those plans and policies. Surely there is an immediate conflict of interest. In the present circumstances, the GP can say to his or her patient: “I am doing my best to battle with the PCT to get the treatment that I really think you need”. However, in the situation that arises as a result of the structure in this Bill, that GP would be on both sides of the table. He would be arguing with himself and making representations to himself. Surely the noble Earl would agree that it is a thoroughly unsatisfactory situation. Can he assure the Committee that it will not arise and, if it does, that the Government have a clear set of rules or procedures for dealing with it?

[Earl Howe]

My Lords, we have had another well informed and stimulating debate. I will start by going back to the beginning. On paper, clinical commissioning groups can seem like a dry concept, but I would encourage your Lordships to look beyond the words and duties on the page and consider what CCGs will be able to achieve in practice. GPs and other front-line professionals already make the clinical decisions that determine how most NHS resources are used. Putting them in charge of shaping services will enable NHS funding to be spent effectively to provide high-quality care.

I have seen at first hand the work of primary care clinicians—GPs, nurses, allied health professionals and others—in leading the commissioning of services. I have been struck on numerous occasions by their dynamism, innovation and their absolute dedication to ensuring that their patients receive high quality care. It is in that context that we should consider our debates on this topic, including this one, which have focused primarily on ensuring that CCGs have effective governance arrangements, but have also touched upon CCG boundaries.

I do not agree with the noble Baroness, Lady Armstrong, that the arrangements are weak. We have already responded to the Future Forum’s recommendation to strengthen the Government’s arrangements for CCGs and made it a requirement for every CCG to have a governing body. We recognise that good governance will be critical to the design and operation of CCGs, in order that they act transparently, manage conflicts of interest and have the proper checks and balances in place to provide assurance that decisions are taken in ways that protect patients' best interests, promote continual improvements in quality and provide assurance that public money is well spent.

That is why I believe that the Bill already achieves the intent of Amendment 60, which would place the Secretary of State under a duty to publish a code of conduct for CCGs, incorporating the Nolan principles on public life. I am fully in support of CCGs adhering to the principles established by the Committee on Standards in Public Life. However, new Section 14L already states that the main function of a governing body of a CCG includes ensuring that the group complies—and these were the words quoted by the noble Lord, Lord Warner—

“with such generally accepted principles of good governance as are relevant to it”.

The Nolan principles, or any successor principles which the Committee on Standards in Public Life or another body was to issue, would be foremost among these. However, the provision in the Bill will also encompass any other relevant, generally accepted principles of good governance issued by appropriate bodies, such as the Institute of Good Governance, and therefore has the potential to be of wider effect. That is why I feel that Amendment 171 is also unnecessary, as it appreciably narrows the field of vision of the governing body.

In addition, the Bill already sets out other provisions which relate to a CCG’s conduct. For example, with respect to the constitution of a CCG, the constitution must include arrangements for ensuring absolute transparency. It must specify the arrangements for discharging the CCG’s functions, its decision-making process, how it will secure transparency about the decisions of the group, and how it will deal with conflicts of interest of members and employees of the CCG or members of the governing body.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

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

My Lords, all the amendments in this group have the entirely laudable aim of improving the integration of services across health and social care and improving access to services. I agreed strongly with many of the messages which the noble Lord, Lord Warner, delivered in his excellent speech, and with so many of the powerful contributions from other noble Lords. The only person with whom I felt seriously out of sympathy was the noble Lord, Lord Davies of Stamford. I would simply say to him that the Bill contains a number of provisions to encourage and enable the NHS, local government and other sectors to improve patient outcomes through far more co-ordinated working.

For example, the reformed system that this Bill will give form to—the provision of high-quality, efficient and fair services—represents the fundamental goals of the health and care service. This clause puts on to a statutory footing the three domains of quality identified by the noble Lord, Lord Darzi, in his next stage review: effectiveness, safety and experience. Every aspect of healthcare quality fits into the Darzi domains, and that is a tribute to the noble Lord’s work in co-producing the quality framework with patients and the professions, and it is also why the domains still provide the framework for quality.

In answer to my noble friend Lady Jolly, or at least to give her a partial answer, we seek to measure success in meeting these fundamental goals through the transparent accountability mechanisms of the outcomes frameworks for the NHS, public health and social care. Integration and access, though laudable objectives that I share with all those noble Lords who have spoken about them, are a means to this end. If integration and access help the NHS to meet the quality and fairness duties—and by fairness I mean reducing inequalities—then integration and access will need to be factored in to commissioners’ plans. Commissioning guidance will set out how best to achieve this based on the accredited evidence of what works best that NICE is developing in its quality standards and other guidance.

The point is often made that high-quality care must surely be integrated care. Integration is not an outcome, it is a possible feature of the process. Where it will improve outcomes and reduce inequalities, integration should most certainly happen, and this Bill provides for that. But we must not sacrifice outcomes for process. I thought the noble Baroness, Lady Armstrong, injected a welcome dose of reality on that theme borne out of her considerable experience, and although I did not fully agree with everything that the noble Baroness, Lady Wheeler, said, she also made some very sensible comments on that point. Indeed, the NHS Future Forum’s Phase 1 report highlights well the practical rather than legislative challenge of bringing about more integrated services for patients. I shall quote from its summary report, which states that,

“legislating or dictating for collaboration and integration can only take us so far. Formal structures are all too often presented as an excuse for fragmented care. The reality is that the provision of integrated services around the needs of patients occurs when the right values and behaviours are allowed to prevail and there is the will to do something different”.

[Lord Davies of Stamford]

My Lords, I am most grateful to the noble Earl for giving way. Of course we all agree about the importance of the right values and behaviours. I know he did not like my questions, but perhaps he would answer at least two of them. First, what concrete, specific measure in this Bill, if any, addresses the perversities currently existing in the integration of social care and NHS care? Secondly, what about Northern Ireland? Why is the system that exists in Northern Ireland, where the provision of the two is entirely integrated, not suitable for England?

[Earl Howe]

My Lords, if the noble Lord will be patient, I will proceed and answer his questions at the end, as I normally do.

It was in recognition of these practical challenges that the Government asked both the NHS Future Forum and the King’s Fund, jointly with the Nuffield Trust, to provide further advice on the practicalities of achieving more integrated services around the needs of patients. We look forward to receiving their advice later this year. So we share entirely the intentions of noble Lords, and that is why Clauses 20 and 23 contain proposed new Sections 13M and 14Y to create duties for national and local commissioners to promote integration across health and social care—that is the first part of my answer to the noble Lord, Lord Davies.

New Section 13M creates an NHS Commissioning Board duty to promote integration. Rather than simply requiring the board to encourage clinical commissioning groups to work closely with local authorities, as under this amended duty, the board is required to promote integration by taking specific action to secure that services are provided in an integrated way where it considers that that would be beneficial to the people receiving those services. The duty requires the board to exercise its functions with a view to securing that health services, health and social care services and health and other health-related services are provided in an integrated way where it considers that this would either improve the quality of health services and the outcomes they achieve, or reduce inequalities in access to and outcomes from health services. By other health-related services, I mean services such as housing, which may have an effect on the health of individuals but are not health services or social care services.

This requirement would cover both integration between service types—for example, between health and social care—and integration between different types of health services. Whatever the combination and however they are integrated, the practical effect should be that services are co-ordinated around the needs of the individual. This would apply to all the board’s functions not just when exercising its commissioning functions, including when it exercises public health functions under arrangements with Public Health England.

The duty also requires the board to encourage clinical commissioning groups to enter into partnership arrangements with local authorities under Section 75 of the NHS Act 2006 where this would secure the provision of services in an integrated way, or that the provision of health services is integrated with the provision of health-related services or social care services. Proposed new Section 14Y creates a similar duty for local clinical commissioning groups.

The changes to the regulatory framework give Monitor a role in Clause 59 in relation to improvement in quality and fairness as well as efficiency.

The question then is: what actual risk exists of fragmentation at the national level? There is no such risk. Our outcomes frameworks span public health, the NHS and social care; the Secretary of State will aim to improve outcomes in all three components of the care system; NICE will provide quality standards across the whole patient pathway that will push for integrated care; and the care system, nationally as well as locally, will have to pay attention. The Secretary of State’s duties and his actions are, in other words, an embodiment of integration.

Our reforms are firmly focused on improving quality and outcomes for patients. We are not in the business of dictating the processes by which this improvement might be achieved, or trying to measure success in terms of whether a particular process has been put in place regardless of whether it actually delivers a good outcome for patients. I make no apology for that. We are of course committed to enabling and facilitating integration, but integration is neither a necessary nor a sufficient condition of a good outcome.

Perhaps more importantly, our reforms aim to encourage measurement and reporting throughout the system that will tell us whether it is achieving what we have said it should achieve. Accountability should finally have arrived at all levels in the system. Improvement should result and will be understood through the outcomes frameworks in terms of the actual outcomes achieved and those that matter most to patients, service users, their families and carers and the wider public.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Earl Howe

Tuesday 25th October 2011 Lords Chamber

[Earl Howe]

No, my Lords, that is not the case. I completely reject not only that remark but also the remark of the noble Lord, Lord Davies of Stamford. Our plans for education and training have been moving forward ever since the election. The White Paper in July 2010 set out the broad principles underpinning education and training reforms. A consultation paper was then published in December last year, with the consultation finishing in March of this year. The Future Forum then listened to further views. It recommended the new duty which we are discussing today in the form of Amendment 43, and we accepted that recommendation. Meanwhile, the Future Forum continues to listen to the views of the wide range of stakeholders and its report will feed into future legislation on this topic. We have consciously deferred the meat of this issue to a future Bill, because we have to get it right. We have committed to publishing further proposals on education and training once the Future Forum has concluded its report and there will be a chance for noble Lords and others to feed in at that point if they so wish.

[Lord Davies of Stamford]

I am afraid that I must stress this point a little further. This debate has revealed a fundamental contradiction in the Government’s position. The Minister argues that Amendment 43 adequately defines the responsibilities that the Secretary of State will have for ensuring that there is an adequate system of medical training and education in this country. It may or may not be the case that the formulation in Amendment 43 is adequate, and we must decide on that matter today.

At the same time, though, the Minister is confessing that the powers that will be given to the Secretary of State in order to fulfil those responsibilities have not yet been defined. We do not know what they are. They have not been decided yet. Surely it is a fatal mistake in life to give anyone responsibility without being clear that they have the powers to undertake it. That is precisely the position in which the Government are placing the Secretary of State.

--- Later in debate ---

[Lord Davies of Stamford]

My Lords, I congratulate the noble Baroness, Lady Williams, as she could not possibly have come forward with an amendment that is more pertinent, necessary and urgent in the light of the discussion that we have had already this afternoon on medical training and education. It was clear from that discussion that some extraordinary things are happening as a result of this Bill. One extraordinary thing is that duties are being placed on the Secretary of State without any consideration having been given, or certainly no decision having been made, as to what powers he will need in order to carry out those responsibilities. That is a very serious matter and I will come back to it in a moment.

The second serious matter is becoming clearer and clearer. One of the agendas of this very curious Bill—and one asks oneself what its real meaning and hidden agenda are—is obviously to decouple the Secretary of State steadily from political responsibility for the management of the NHS by creating an insulating barrier and a series of quangos. The Minister said this afternoon, in answer to the case put to him by the noble Lord, Lord Warner, about a repetition of the crisis in jobs for junior doctors that occurred a few years ago, that the Secretary of State would not be able to intervene, or to do anything at all, until he had determined that there was a failure by Health Education England. That means that, if he had Questions in the House, he would simply say, “It’s not my fault, Guv. Go and talk to the quango. I don’t know anything about it. I haven’t yet determined that there is a crisis”. That is an extremely unsatisfactory situation.

[Earl Howe]

My Lords, the noble Lord is caricaturing the position. The Secretary of State, in the case of education and training, would continuously hold Health Education England to account against a set of pre-agreed outcome measures. That is not standing at a distance from what Health Education England does. It is being intimately concerned with what it is doing. I do not want the noble Lord to caricature the Government’s position. I understand that he is not happy with the separation of functions, but that is a matter of policy; his policy differs from that of the Government. I do not want him to go away thinking that this is a totally hands-off affair. The Secretary of State will have legal responsibility and accountability for what Health Education England does and that will be manifested through the outcomes framework.

[Lord Davies of Stamford]

I am very grateful to the Minister. I will just respond to him before giving way to the noble and learned Lord, Lord Mackay. Indeed, I must not caricature the Government’s position; believe it or not, I do not want to do so. I want to reveal the Government’s position. I am trying to draw out the Government. We succeeded in doing that this afternoon; perhaps the latest intervention from the Minister is part of that. It was extremely useful, but I think it is clear that the Bill imposes certain duties on the Secretary of State and we have often heard, when it comes to the powers that he has, that it is not quite clear what the position is.

What I am particularly concerned about in the area of health education and training, but also in other areas, is, first, that the Secretary of State will be in a position to answer parliamentary Questions about anything to do, in this case, with health education and training. It might be on planning for numbers, public health or whatever, but there should be no sense in which he will simply say, “That is the responsibility of somebody else. I cannot answer that”.

Secondly, I am concerned about the actual powers that the Secretary of State will have to intervene—the ability he will have simply to give directions to one of these quangos, to override it in certain circumstances. The circumstances in which he would be able to override it need to be clearly defined. They should, of course, be defined already so we can look at them at the same time as we look at the new duties. However, they are not defined and we need to know that they will be. I will give way to the noble and learned Lord, Lord Mackay.

[Lord Davies of Stamford]

That is a very tactful way of putting it. I do not intend to speak for very much longer, but I want to complete my remarks. I simply want to say that any self-respecting person—and I am sure that the Secretary of State is one—would not accept being given duties and responsibilities without being clear about the powers that he or she had to fulfil them. I would not do so. This is a very anomalous position, where we are told that future consideration will be given to what exactly the powers will be, that future Bills will define them. I do not think that is a satisfactory situation at all, if that is the position.

[Earl Howe]

I made that point in connection with education and training where, as I have said repeatedly, we are still in consultation. As regards the Secretary of State’s powers and duties in this Bill, they are very clear; there is no ambiguity about them. We are going to be debating an amendment in the name of my noble and learned friend Lord Mackay, and I do not want to pre-empt that, but that amendment seems to set out very satisfactorily what the Secretary of State’s powers are. It draws them together very well.

[Lord Davies of Stamford]

It seems to me that the text of the amendment put forward by the noble Baroness, Lady Williams, differs from the Government’s position in the Bill in that it makes it absolutely clear that the Secretary of State has the duty to intervene. That is stronger wording, and I just wonder why the Government cannot accept it.

NHS: Standards of Care and Commissioning

Debate between Lord Davies of Stamford and Earl Howe

Thursday 31st March 2011 Lords Chamber

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

My Lords, I begin by thanking the noble Lord, Lord Turnberg, for tabling a Motion which has occasioned such a fascinating and often moving debate. As has happened previously, the breadth and depth of the contributions create their own problem in that, when there is such a short time available for me to reply, I am up against the clock. To the extent that I am unable to answer specific questions today, I apologise but I will of course happily follow them up in writing.

There are many reasons why we believe it is necessary to modernise the National Health Service. With rising costs of new treatments, an ageing population and rising public expectations, the system is simply not sustainable in its present form. Most importantly, however, the NHS must modernise in order to focus relentlessly on what matters most to patients: improving health outcomes. In so many ways it is a wonderful service, but we know that it can do better and we believe that it must do better. For our ambition is not limited to maintaining the current quality of services, it is far greater—to have health outcomes that are consistently among the very best in the world. I suggest to the noble Baroness, Lady Thornton, who said that now was not the time to do any of this, that the financial situation that we face provides even more of a reason to modernise swiftly. I hope that she and other noble Lords will agree with me that this debate is really about quality.

The noble Lord, Lord Turnberg, began by raising the Parliamentary and Health Service Ombudsman’s report, Care and Compassion? I am sure that all of us can identify with the concerns that he raised about nurse training and accountability for what happens on the hospital ward. I am sure I was not alone in being very moved by the noble Lord’s speech. I fully intend that we should learn from the ombudsman’s report, which is why its findings have been highlighted to NHS boards and why the Care Quality Commission will be commencing unannounced inspection visits shortly. However, I also submit that the changes that we are making to the NHS—placing the patient at the heart of everything we do—will help to guard against this happening in the future.

As the noble Lord, Lord Warner, rightly reminded us, effective commissioning is a key piece of the jigsaw. Currently, commissioning decisions are taken by primary care trusts—remote organisations that frankly few people have heard of and fewer still understand. We propose to hand responsibility for commissioning to GP-led consortia. Why are we doing so? It is because GPs and their clinical colleagues are the people who best understand the health needs of their local populations, and, in partnership with healthcare professionals from across primary, community and secondary care, they are ideally placed to design clinical services that provide more effective, integrated and preventive care.

[Lord Davies of Stamford]

I am very grateful to the Minister for giving way. Will the present system of “choose and book”, which seems to me to be working extremely well, be perpetuated under the new commissioning consortia regime?

[Earl Howe]

Yes, my Lords. However, if the noble Lord will forgive me, I do not propose to take many interventions as the time is limited. As I say, the answer to his question is yes.

Those who question the effectiveness of these arrangements should focus on the new framework of accountability that we are proposing as it is central. The new NHS will be more directly accountable than it is now. Because of that our reforms introduce a stronger national framework for driving quality improvement than ever before. How will this accountability work? The Secretary of State will hold the NHS Commissioning Board to account for delivery against the NHS outcomes framework, published in December. The NHS Commissioning Board will then hold individual consortia to account for their performance against the indicators set out in the more locally focused commissioning outcomes framework. There was widespread and strong support for such a framework during our consultation.

The NHS Commissioning Board will decide on the shape and content of the commissioning outcomes framework over the next two years, working closely with emerging consortia and with professional and patient groups. To help maintain momentum, the department will shortly publish a discussion document, seeking more detailed views on possible features of the framework. The Health and Social Care Bill contains a new duty of quality. The NHS Commissioning Board and GP consortia will be required continually to improve the quality of NHS services. Underpinning that, the Care Quality Commission will regulate providers on safety and quality, with wide-ranging enforcement powers to protect patients should providers fail to meet requirements. Accountability works in its fullest sense only if there is transparency. We will publish clear, easy to understand information on the quality of healthcare services and the progress being made to reduce health inequalities. We also propose, subject to the passage of the Bill, that the NHS Commissioning Board be able to make payments to consortia in recognition of the outcomes they achieve collaboratively through commissioning and the effectiveness with which they manage their financial resources.

How will quality be driven through the commissioning system? Quality standards, prepared by NICE, will be at the centre of it. Quality standards bring clarity to quality, providing definitive and authoritative statements of high-quality care, based on evidence of what works best. Quality of care does not cover just the effectiveness of that care but also includes patient safety and patient experience. The three domains of quality are interconnected: they cannot exist in isolation. The Royal College of Physicians reflected on this point in its response to the consultation on the NHS outcomes framework and acknowledged that healthcare that is not safe could not be described as efficient, effective or sustainable.

Our reforms will allow a re-established NICE to produce a broad library of quality standards that will cover the majority of NHS services. NICE will also develop quality standards for social care and public health. The Secretary of State and the NHS Commissioning Board will be able to commission quality standards jointly, which will open up the opportunity for standards to cover the whole care pathway, from public health interventions in primary care through to rehabilitation and long-term support in social care, and will support the integration of health and social care services. It is important to understand that quality standards will do more than just bring clarity to quality: they will have real traction within the system, underpinning the duty of quality and linking with the new best practice tariffs that will see providers paid more for better care.

GP consortia will have a duty to support the NHS Commissioning Board in continuously improving the quality of primary medical care services. That does not alter the board's overarching responsibility for commissioning GP services and holding GP contracts. But it does mean that consortia will play a systematic role in helping to monitor, benchmark and improve the quality of GP services, including through clinical governance and clinical audit. It means also that consortia will have a core role in improving patient care across the system. That will include both the quality and accessibility of the care that GP practices provide and the wider services that consortia commission on behalf of patients.

Where does the Secretary of State sit in all this? The Health and Social Care Bill strengthens the accountability of the Secretary of State to Parliament for the provision of the comprehensive health service. For the first time, the Secretary of State will have to report each year on the performance of the health service, consult on the annual objectives set for the NHS through a mandate, and lay both documents before Parliament. The NHS Commissioning Board will be accountable to the Secretary of State for delivering against that mandate.

Nursing has been a strong theme in the debate. The noble Baroness, Lady Emerton, asked when the Government's response to the report of the commission on nursing will be published. I can assure her that the Government will respond soon to the commission's report and I apologise for not having given her an undertaking to that effect sooner. The noble Lord, Lord Turnberg, and the noble Lord, Lord Winston, raised concerns about nursing standards in hospitals. As they know, we now have matrons in post. They have a specific remit for quality of patient experience and should be accessible to patients and carers. Matrons are directly accountable to directors of nursing, who should present ward-to-board reports. We launched the Principles of Nursing Practice in November last year. This sets out an agreed set of standards and behaviours that were developed by the Royal College of Nursing in association with patient groups. These principles reinforce the NHS constitution.

The noble Lord, Lord Turnberg, asked about the duty of consortia to improve the quality of care for older people. There is no specific duty in the Bill relating to consortia and older people. However, we propose a new duty for consortia to seek continuous improvements in the quality of services for patients and in outcomes, with particular regard to clinical effectiveness, safety and patient experience. That extends to all aspects of care.

The noble Baroness, Lady Sherlock, spoke about the recent King's Fund report. The report highlights particular variation in relation to patient involvement in decision-making, and in co-ordination and continuity of care. It also highlights the need for changes in leadership and culture. We have a strong system of general practice in this country, but we agree absolutely with the report that there is too much variation in quality. This reinforces the case for GP decommissioning, because one of the key aims behind the development of GP commissioning is for consortia to play a central role in helping to reduce variation and drive up the quality of general practice. There will be strong incentives for GP consortia to want to tackle these variations, because with lower-quality primary care one achieves poorer outcomes for patients and one has greater pressure on more expensive secondary care services.

The noble Baroness, Lady Sherlock, questioned whether the Government were allowing enough time to see whether the changes would work. With the introduction of shadow bodies and early implementers, we are allowing almost three years to consult, to dry-run and to put our reforms into practice on the ground, so that by 2013 the new organisations will have had time to secure capability collectively. Therefore, it is wrong to say that the house is being demolished; in many senses, we are refashioning some parts of the existing edifice.

On that theme, the noble Baroness, Lady Pitkeathley, asked how consortia will be authorised, given their different states of readiness. The pathfinder programme is, I think, central to sharing learning across emerging consortia, and it is a crucial part of their development to take on full commissioning responsibilities. Consortia will not have statutory responsibility for commissioning until April 2013, so the intervening period will allow all consortia to be ready by that time.

We listened to an impassioned speech from the noble Lord, Lord Owen, who criticised the Health and Social Care Bill on a number of fronts. Time prevents me setting out a detailed set of counterarguments but perhaps I may just say to him that we have tabled amendments to the Bill that will put beyond doubt that competition will be on the basis of quality and not price. Far from challenging the principles of the NHS, we have consistently made it clear that we are absolutely committed to a comprehensive National Health Service which is free at the point of use and is based on need rather than ability to pay. Nothing in our plans changes that.

The noble Lord criticised the policy of “any willing provider”, or “any qualified provider” as we are now calling it, because we think that that is a better description of the policy. The noble Baroness, Lady Thornton, did the same. “Any qualified provider” is about empowering patients and carers, improving their outcomes and experience, enabling innovation, and freeing up clinicians to drive change and improve practice. Introducing a choice of any qualified provider will give patients more control. That is what all the research evidence tells us they want and increasingly expect from the NHS. Why should not someone with MS be able to choose the physiotherapist they want and be treated at the time and in the setting that best suits their need? Why should not a patient, at the end of their life, choose their hospice provider? Patients are already able to choose from any provider that meets NHS standards and prices when they are referred for a first out-patient appointment to a consultant-led team. That was an innovation brought in by the previous Government. “Any qualified provider” will extend that principle to more providers and more services, including social enterprises and charities, particularly in community care. For the life of me, I cannot see what is wrong with that. Money will follow the patient and the choices they make about where and by whom they are treated.

The noble Lord, Lord Owen, indicated his belief that the policies that the Government are advancing will damage clinical professionalism and remove the intimacy inherent in the doctor/patient relationship. I say to the noble Lord gently and with huge respect that I do not believe he has any basis whatever for suggesting that. I would argue, on the contrary, that clinically-led commissioning brings the design of services closer to patients.

NHS: Global Health

Debate between Lord Davies of Stamford and Earl Howe

Monday 20th December 2010 Lords Chamber

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

My Lords, I thank the noble Lord, Lord Crisp, for calling this debate and express my gratitude for his strong and continuing commitment to issues of global health. I found his speech extremely helpful and thought provoking.

The Government are deeply committed to issues of international development. In this year’s spending review we confirmed that, as well as protecting the NHS budget, we will keep our promise to spend 0.7 per cent of gross national income on aid from 2013, helping the billion people who live in extreme poverty around the world. We are equally committed to doing everything we can to meet the millennium development goals. In particular, we are taking bold action to tackle malaria and to improve reproductive, maternal and newborn health. In answer to the noble Baroness, Lady Thornton, we are currently reviewing the previous Government’s cross-Whitehall global health strategy to ensure its relevance and effectiveness in the coming years.

The noble Lord, Lord Crisp, has linked issues of development with those of the appropriate education of health professionals, which itself has enormous implications both for our nation’s health and for that of the rest of the world. As he knows, there are many aspects of the education of health professionals, encompassing pre- and post-registration training, as well as continued professional development. The responsibility for setting the standards required for professional pre-registration sits with the professional regulators. The higher education institutes then design training curricula to meet these standards in partnership with NHS service providers and the regulators. The Department of Health, along with the local NHS bodies that commission professional training, continues to work with the regulators and higher education institutes to ensure that their standards and curricula reflect the changing needs of patients and service delivery.

In terms of pre-registration education for doctors, we look to the General Medical Council for leadership. Its 2009 publication Tomorrow’s Doctors provides the framework that UK medical schools use to design detailed curricula and methods of assessment. I was glad to see the framework was well received by the authors of the recent Lancet Commission publication, Health Professionals for a New Century. The framework also highlights the importance of a global dimension. New graduates must be able to demonstrate awareness, from a global perspective, of the determinants of health and disease and of the variations in healthcare delivery and medical practice. Postgraduate medical training curricula are developed by the medical royal colleges for approval by the GMC. Most of the topics highlighted in this debate are covered in the foundation programme curriculum and core competence framework for doctors developed by the Academy of Medical Royal Colleges.

We have come a long way since the noble Lord wrote his report on medical training, Global Health Partnerships, in 2007. My noble friend Lord McColl is absolutely right that there is already significant good practice in the UK in terms of incorporating the global dimension into pre- and post-registration training. This is one part of the answer to the noble Lord, Lord Crisp, who asked me to consider what more might be done to support this type of activity. Medical students can study global health; they can spend a year studying international health as part of an intercalated degree or can choose to travel to developing countries for the elective component of their undergraduate training. There are also opportunities for post-registration medical doctors to spend part of their specialty training in developing countries, as part of the out-of-programme training and research arrangements. Here, I reassure my noble friend Lady Tonge and the noble Baroness, Lady Hollins, that, if prospectively approved, training of this type counts towards the certificate of completion of training. Details of this initiative are provided in the Gold Guide, a guide for postgraduate specialty training in the UK agreed by the four UK health departments for core and/or specialty training programmes. This sets out a clear process as a guide for post-graduate deans.

My noble friend Lord McColl—

[Lord Davies of Stamford]

I am extremely grateful to—