Care Bill [HL]

Lord Deben Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Deben (Con)]

My Lords, I support what my noble friend has just said. I have to say to the Minister that this amendment is rather necessary because there is a generalised belief that forces in our society are determined to marginalise that which has actually made our society and has had such an influence on the provision of healthcare for our people. The history of healthcare in Britain shows that it was fundamentally founded by those of faith. That does not say anything about anyone else, but it does say that if we want holistic medicine—I am not a great believer in anything other than orthodox medicine, so I am not encouraging all kinds of what I consider to be alternatives, which are best left alone—we have to understand that it is about the whole person, and for many people this is a most important part of the whole person. For this not to be in the Bill will be seen by many as another example of society specifically seeking to marginalise an important section of our community on whom we depend widely for many of our voluntary activities, and certainly on whom we have depended and do depend for our health services. I hope very much that the Minister will take this point seriously.

[Lord Cormack (Con)]

My Lords, I would like very briefly to support what my two noble friends have just said. Surely this is not the Government conceding to a secular society and surely they recognise that for many sick people, the spiritual dimension is extremely important. It is not a question merely of healing physical ills and curing physical diseases, it is a question of recognising that many people, particularly as they near the end of their lives, have a great need to fall back upon their faith, and that should be recognised and encouraged. For the life of me, I cannot see what the Government are doing here and I hope that my noble friend will be able to give us a satisfactory answer. I am only sorry that the Bishops’ Benches appear to be empty this afternoon because one would have liked to have heard a contribution from them.

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[Earl Howe]

First, we are not dealing with the NHS; we are dealing with local authorities and adult social care. Secondly, the NHS has not rowed back on this. We have debated hospital chaplains on many occasions and I have made very clear the Government’s view that hospital chaplains perform an important role in the spiritual context. So on the NHS front, I want to reassure my noble friend that here we are dealing with local authorities and adult social care. I was trying to explain that the way in which this Bill is framed is perhaps different from how my noble friend has construed it.

[Lord Deben]

If it does not make any difference to add this to the Bill, why cannot the Government accept that many people would feel much reassured by its addition?

I have been in my noble friend’s position—and he knows with how much respect I view him—and I cannot remember an occasion when I have said, “This does not make any difference” that it did not quite mean that. What worries me here is that it does not quite mean that. I should be much happier if he would please look again at this, because it is a matter which does concern people. If it makes no difference, surely we can do these things in order that people should not be concerned? Their not being concerned would make a difference.

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[Lord Deben]

My Lords, I declare an interest as chairman of the Association of Professional Financial Advisers. One of the areas that regulated financial advisers are most concerned about is that they should be able to do the job that they are there for. I am concerned that recent “reforms” have meant that there are fewer people available to give advice and fewer people getting advice. One of our problems is that this means that people get bad advice. They say something to their friend round the corner, or somebody says “I think so-and-so’s OK”, or they have read something in the newspaper. One of our difficulties here is that the perfect gets in the way of the good. People are frightened to say things like, “here is a list of people” or “here is somebody I have used”, in case they then incur some kind of responsibility. Yet if we do not help people to find someone who can give them advice, the very people who most need advice do not get it. I am concerned that this is becoming almost a social problem in the sense that those who are best off and least need advice get the best advice while those who are less well off and need advice do not get it because we have got ourselves into this mess.

I am not in a position to say that this or that amendment is ideal, but I hope the Minister will accept that, in today’s circumstances, unless we give clarity to people and make it relatively easy and simple for them to go to get advice, they will not go and will not be able to.

I have two more short points to make. First, we have concentrated on the simplicity of the advice when you get it, which seems to me to be the wrong place. It is the simplicity of getting the advice that really matters. Very often, the advice that is given may not be all that simple, because the circumstances may not be all that simple, but if the simplicity of getting the advice is right then it can be moved through more effectively.

Secondly, in considering these amendments and, indeed the Bill—at this stage and going forward—I hope the Minister will realise that one of the problems about seeking advice is that the language used is incomprehensible to anybody but the professional. I find this embarrassing: I once sat on an FSA committee designed to try to make more people more financially literate and spent my whole time asking superior people in the finance world to explain to me what they meant. I discovered that they did not always know what they meant. There is a sort of language which is used and batted backwards and forwards between these people. There is a terrible fallout in this. I remember that a friend of mine was asked for advice—not about finance, but about how to buy a theatre ticket—by a man had never gone to the theatre before but whose wife wanted to go to something. She explained and dealt with it but a friend of hers said, very superiorly: “Of course everybody knows how to buy a theatre ticket”. My friend asked, very simply: “Could you buy a football ticket”.

That is one of the problems, so I hope we can try to do this in a way which is comprehensible and simple and which does not mean that the most needy are unable to get the service they need.

Care Bill [HL]

Lord Deben Excerpts

Monday 22nd July 2013 Lords Chamber

[Earl Howe]

I can reassure the noble Lord that we are aiming to have uniformity. Merely because one local authority may present us with some rather maverick objections, I do not think that I could possibly envisage us capitulating to that kind of pressure. We want to see a system where people, wherever they live in the country, can rely on some clearly set-out rules and can thereby have peace of mind if they take out a deferred payment scheme. I hope and sincerely believe that the noble Lord’s fears will prove groundless, but I am happy to clarify as much of that as I can, given that we have only just gone out to consultation, in the letter.

[Lord Deben]

I wonder why the particular councils which were chosen by the noble Lord are all among the best councils in Britain, which would certainly behave in the most generous way.

[Earl Howe]

My noble friend is, of course, completely right. They are model councils of their kind. It is rather fanciful to present them as possible examples of councils that might wish to do badly by their residents.

This is a major reform that we have committed to introduce in this Parliament. While I am the first to agree that that in itself should not drive the timetable, we think that the timetable is achievable. We are consulting to get the details right and working with the care sector to ensure that implementation goes as planned. The noble Lord raised some important points. I am sure that he knows me well enough to accept that this is not the last occasion when I shall look at the points that he has raised. I shall do so further. For the time being, I hope that I have responded to his satisfaction, at least on some of the amendments, and that he will feel able to withdraw the amendment.

Health and Social Care Bill

Lord Deben Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Deben]

My Lords, I would like to share with your Lordships’ House, for the first time, my experience of trying to deal with the complicated matter of BSE as it makes clear this distinction. I committed myself to total openness; I knew nothing that the public did not know. It was the only way in which one could be sure of obtaining people’s trust. Nothing was hidden. We did not have risk registers in the sense that we do today but it would be quite wrong to say that we had not considered every possible risk.

I put it to your Lordships that there is a difference between what you know and the extreme cases which you ask about in order to make sure that what you know covers everything that you could know. If in the middle of that terrible crisis newspapers more interested in their numbers of sales had accused the Minister of uncertainty because he had asked about risk—and I do not need to go into the kinds of risk you had to ask about—it would have been impossible to make what were already difficult enough decisions. It turns out now, 20 years later, that the decisions were right but at the time they could only be what you knew, and what I knew I shared.

Consider also what it meant for my civil servants. Do your Lordships really believe that your civil servants would be able to be as frank and direct and complete if they found themselves and their relationships being used as part of a battle? There were some terrible battles at that time between people who had all sorts of other interests. Compare this to another case, which out of kindness I will not be too detailed about. For many years in the ministry of agriculture a particular view had been upheld and we had been told that it was true. When I sought further information I discovered it was not. It was at that point that I tried to establish a very clear distinction between what you know and what you have to ask about which you do not know.

The risk register has come into our governmental structure largely from private business. I sit on the boards of a number of companies and chair several; in all those cases we have a risk register. That risk register is only useful if it is kept entirely to the company itself, because you want to ask questions of a very extreme kind. I ask the noble Lord, Lord Owen, whether he can imagine a Foreign Secretary who had to reveal his risk register asking what would happen if this or that Government did this or that, or what would happen if some Middle Eastern state refused to allow our ships into the Strait of Hormuz at this moment. Would any Foreign Secretary be able to be Foreign Secretary?

[Baroness Thornton]

Does the noble Lord not think that the Information Commissioner and the tribunal have taken those points into account?

[Lord Deben]

I would not dream of suggesting that I know what the tribunal and the commissioner have taken into account. All I am saying is that if they have taken it into account and come to this decision, I think it is wrong, and if they have not taken it into account they ought to have done. That is why I come to the point that the noble Baroness raised when she said that it is all very good because the National Health Service has risk registers and publishes them. They are not risk registers, not in the sense that a business has risk registers. They are not risk registers in the sense that the Foreign Office has risk registers. They are such risks as the National Health Service believes will stand being in the public domain. The risk registers that a Government have are a wholly different kind of thing and need to be. I believe that we must protect them.

[Lord Harris of Haringey]

Before he finishes his remarks, will the noble Lord explain why the National Security Council publishes its own national risk register of security threats to the UK?

[Lord Deben]

For exactly the same reason that the National Health Service does.

[Baroness Williams of Crosby]

My Lords, what the noble Lord, Lord Deben, said is well worth listening to, but I shall add one other important factor before I come on to the amendment moved by the noble Lord, Lord Owen. As the noble and learned Lord, Lord Mackay of Clashfern, pointed out—and it is a crucial factor in our discussion—the risk register that was drawn up in autumn 2010 took no account of the changes made by your Lordships’ House. It could not because it could not foresee the future. That means that the risk register of 2010, the transitional register to which the chairman of the tribunal referred, is almost useless in enriching and informing the debate we are having in this House. Therefore, far from being helpful, it will in many ways be extremely misleading because it will confirm the incorrect beliefs of many members of the public who have not understood what has happened in this House. You only have to read the newspapers to see how widespread is the total ignorance of what we have done here, whether we talk about competition, training or constitutional change. That is the crucially troubling aspect of what we are discussing. It leads the general public and Members of this House and elsewhere back to an out-of-date and anachronistic finding.

I have one more thing to say about the amendment moved by the noble Lord, Lord Owen. The House needs to recognise that he has made a very substantial change of great importance in it: he has accepted that there will be a Third Reading in this House. He has accepted that the outcome of the Third Reading will be binding upon everybody in this House and beyond because it will be part of the system of law. What he has asked for is more time and opportunity to have the finding of the tribunal discussed in this House. In that, he is absolutely correct. I do not believe that we have gone anything like sufficiently far in trying to accommodate that reasonable request because there is time left in this Session of Parliament. It ought to be possible to transfer a day or two from the Scotland Bill to the health Bill so that it could be properly discussed; or there is something that the noble Lord indicated he would accept, which is a very narrow redaction of anything in the risk register that would be seen as desperately dangerous to public trust in the NHS.

My view is a rather curious one. It is that the noble and learned Lord, Lord Mackay, is right in pointing to the real dangers of treating the risk register as a source of knowledge and truth, but I also believe that the Government should have gone further in trying to find time somewhere, if necessary—dare I say it?—even taking a day off the sacred Easter Recess to enable this House to discuss in detail what is coming out of the chairman of the tribunal’s decision on the risk register so that we can get it straight.

Health and Social Care Bill

Lord Deben Excerpts

Monday 12th March 2012 Lords Chamber

[Earl Howe]

My Lords, I beg to differ with the noble Lord; this is an issue about routine release. I think I am right in saying that the department has received several dozen requests to release the risk register. If this were to become routine, as some people appear to wish it to become, policy formulation in any department would become virtually impossible.

[Lord Deben]

Does my noble friend agree that a number of the laws passed by the previous Government were also controversial? Can he point to occasions on which the risk register was released in those circumstances?

[Earl Howe]

I am grateful to my noble friend because I do not believe that there were any. The Opposition sometimes point to the risk register relating to the third runway at Heathrow, but the key difference with that was that it was to do with policy implementation rather than policy formulation. Once you know what you want to do, there are risks associated with rolling a policy out. It is a very different matter when civil servants wish to have safe space to think the unthinkable and then advise Ministers.

Health and Social Care Bill

Lord Deben Excerpts

Wednesday 21st December 2011 Lords Chamber

[Baroness Murphy]

My Lords, Section 141 of the Mental Health Act 1983 provides that where a Member of Parliament is detained under the Act, the Speaker must arrange for two registered medical practitioners—psychiatrists appointed by the president of the Royal College of Psychiatrists—to examine the Member of Parliament and report. Six months later, the Speaker must arrange for a second assessment by psychiatrists, and if in their opinion the Member is still suffering from mental disorder, the Speaker lays a report before the House of Commons and thereupon the seat of that Member shall become vacant. There is no appeal mechanism. This provision also applies to Members of the Scottish Parliament and the Welsh Assembly, but not to the House of Lords. There have been times in this Committee when I have wondered about that.

This clause has never been invoked. In fact, the last use of the preceding section was for the removal of Reverend Charles Leach MP in 1916. It was very interesting to read about his case. He was clearly suffering from what we would call multi-infarct dementia and was not actually refusing to give up his seat, although it is clear to me that he would not now be detained in the way he was in those days. The Victorian legislation was introduced by the Lunacy (Vacating of Seats) Act 1886, a Private Member’s Bill to deal with one particular issue, although it was too late for that and therefore post hoc. The legislation was transferred, word for word and process by process, substituting lunacy commissioners with two psychiatrists in 1959 and again in the 1983 Act, and here we have it still.

We know from a survey conducted by an all-party parliamentary group in 2008 that one in five Members of Parliament admits privately to having had personal experience of mental ill health. That is not significantly different from the general population. The majority of those would be mild forms of mental distress, but some of us are aware of serious breakdowns where Members of Parliament have recovered fully and returned to work with few people being much the wiser. Surprisingly, there is a very inclusive, supportive environment in the Commons for people who have suffered periods of mental ill-health.

There is widespread agreement that this stigmatising and discriminatory legislation is not fit for purpose. None of us would tolerate such discrimination against people with physical ill-health who were away from the Chamber of the Commons for six months or more—for example, with a cancer or following a stroke. I am sure that the Minister will remember his own words along these lines in our debates on the Mental Health Bill in 2007, when the noble Baroness, Lady Wilkins, tabled an amendment similar to this one. Unfortunately, we did not have an opportunity in those 2007 debates to pursue the matter at great length because the previous Government reached the end of their term.

The repeal of this section was recommended by the Speaker’s Conference in January 2010—I think that 68 per cent of those who voted were in favour. In February this year, Deputy Prime Minister Nick Clegg announced that it would be repealed when a suitable vehicle could be found. I pay tribute to him and to the Cabinet Office Minister, Mark Harper, for their continuing commitment to this cause. This Bill is a suitable vehicle. I thank the clerks in the Public Bill Office for finding the right place to include it.

We should get this measure off the statute book and demonstrate the House's commitment to the continuing campaign to reduce the stigma to which the voluntary organisations and the Royal College of Psychiatrists have given so much time and energy to make a success. It is time for change and I hope that the Government will respond positively.

The noble Lord, Lord Stevenson of Coddenham, has introduced in this Chamber an important Bill to repeal four pieces of legislation that discriminate against people with mental health problems, of which this was one. The others refer to jury service, governors of schools and directors of businesses. I am totally supportive of that Bill and hope that it is successful. I understand, however, that it is unlikely to be able to proceed through the Commons this Session and will therefore have to be reintroduced in the new Session. If this amendment were accepted today, it would require a simple revision to that Bill, but the major practical provisions are of much more widespread significance and would, I believe, continue to attract government support.

I had considered withdrawing the amendment and waiting for next Session to get that whole Bill through, but my anxiety is, as Harold Macmillan said, “Events, dear boy, events”. We have an opportunity now to get this right and we do not know for sure whether the opportunity will appear again soon. I would very much like to see the repeal of this section enacted this Session. What a Christmas present for the mental health world that would be. I beg to move.

[Lord Deben]

My Lords, the parallel is that things amazingly go on in this country until they are stopped. The Girls’ Friendly Society long ago lost any reason for existing because the girls with whom it was friendly no longer existed in the situations and houses in which they were, yet it took a good 40 years to decide that it was time for it to go. I remember sitting next to a person who explained to me that the trains from Ipswich did not go to Manchester direct but went down to London because there was a row in about 1850 between the Great Eastern Railway and the Grand Central Railway. No one knew that that was the reason, so the trains still went along that route. It was only on privatisation that people started to look again and discovered why that was.

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[Baroness Masham of Ilton]

What sort of bells are we not allowed to ring?

[Lord Deben]

No bells to summon Catholics to worship are allowed, because it was illegal at that time.

[Baroness Masham of Ilton]

My Lords, I, too, support the amendment. Having supported the Bill of the noble Lord, Lord Stevenson, it would seem wrong not to do so. I hope that the Government can speed up this legislation.