(2 years, 2 months ago)
Lords ChamberMy Lords, further to my noble friend Lord Brooke’s Question about the drop-out rate and his suggestion of an independent review, what mechanism is there for assessing courses that clearly are not as successful as they might be if there is such a high drop-out rate?
The point is about what we learn. For example, some noble Lords will have seen stories about the impact of minimum alcohol pricing in Scotland. Clearly, it did not turn out as intended because the review found that people from poor communities were spending more on alcohol, rather than the alcoholism rate being affected. In this case, we have learned that the nine-month programme and some of the other processes behind it clearly lead to a drop-out rate. We are looking at other programmes. One of the great stories we have seen is the use of digital and other forms of access. If we can roll that out as well with community programmes, it might be a better way of doing things.
(2 years, 7 months ago)
Lords ChamberMy noble friend makes a valuable point about the cost of agency nurses, which is why we have the goal of recruiting 50,000 nurses. We are looking at completely different pathways to ensure that we can encourage people into nursing. I do not have the statistics with me, but I will write to my noble friend.
The Minister referred to ethical recruitment of health service professionals from overseas. Can he explain to us precisely what he means by ethical recruitment from overseas?
(2 years, 7 months ago)
Lords ChamberA number of noble Lords have made the very important point that there is clearly an impact on individuals of working at night, including fatigue, wider pressures and disruption to family life. The sleep review has looked at this and reported just before Christmas, after consulting a wide range of stakeholders. The Office for Health Improvement and Disparities will publish its report in the summer of 2022, I hope.
My Lords, given that so few people work night shifts from choice—some do but most do not—is it not ironic that, very often, these night-time jobs are quite low paid? Is it not a strange commentary on our society that, all too often, the people working in the least popular and more difficult and challenging jobs are also the lowest paid?
One of the issues of technology is how it has changed the nature of work. We have seen over time how older jobs have disappeared and new types of jobs and industries and different working practices have appeared. It is really important to make sure that workers, wherever and whatever times they work, get the best facilities and conditions possible. Sometimes that is done directly by unions, which work with employers and companies, and other times it is done directly, but it is important. One of the things we are looking at in the review is how deprivation of sleep affects many people, especially those who work at night.
(10 years, 1 month ago)
Lords ChamberCan the Minister confirm that one of the unarguable costs of the reorganisation has been the number of people previously employed by the health service as administrators who received their redundancy settlements and pay-offs but were subsequently re-employed by the health service? Will he tell the House how much this has cost—the initial redundancy settlements, the subsequent salaries that are being paid and the number of people involved? If he does not have that figure to hand, and as he will not publish the risk register, will he at least make available in the House the precise figures of the cost to the taxpayer of this aspect of the reorganisation?
I am certainly happy to write to the noble Lord with whatever figures I have on that front but, of course, those who were made redundant as a result of the reorganisation received payments of no more and no less than they were entitled to under their contracts of employment. There are more than 19,300 fewer administrative staff in the NHS than there were when we came to office, but more than 16,300 more clinical staff, including 7,400 more doctors and 3,300 more nurses.
(10 years, 6 months ago)
Lords ChamberMy Lords, it is the turn of the Labour Party.
As the Minister was tempted, perhaps a little unwisely, to go down memory lane by way of explaining the current circumstances in the health service, perhaps I could tempt him to go a little further back down it by reminding him that it was the Labour Party which built the National Health Service in the teeth of Tory opposition. If you want to have the health service maintained in future, the secret is to get a Labour Government.
(10 years, 8 months ago)
Lords ChamberWill the Minister, who is clearly not going to give the information from the risk register, perhaps give us a clue along the following lines? Given the experience of the reform in operation, have any of the risks that were identified in the private risk register come to pass, or is everything going wonderfully well?
My Lords, the risk register, as the noble Lord knows, is simply a tool that records the risk assessment process and the actions that need to be taken to mitigate those risks. However, to be effective, the process has to be robust and consider all likely implications—and indeed some that are not so likely—of a proposed course of action. The candid recording of risks enables them to be effectively managed. However, as the noble Lord knows, we have gone as far as we can in publishing the areas of risk that are contained within the risk register. I remind the noble Lord that in 2012 we published an extensive document that set out quite a lot of detail. That document is still available on the department’s website.
(12 years, 5 months ago)
Lords ChamberMy Lords, my next sentence was about to deal with precisely the point made by my noble friend. It can therefore be argued that publication now by the Government could, and would, wholly distort rational discussion about the Bill in its present form. The job of scrutiny carried out by your Lordships’ House is to look at every scenario and from the experience of its Members, which is considerable, suggest amendments which mitigate the problems identified. That is precisely what this House has carried out and, I would say, to good effect. However, the Motion is not suggesting that we delay the current Bill against the remote possibility that there is some risk in it which the Department of Health has identified and this House has not. It is saying that we should delay it pending the First-tier Tribunal’s reason for its decision being published.
What will passing this amendment to the Motion therefore achieve? When we know the details of the decision, the Government will still be fully entitled to appeal. They have already won with the strategic risk register, and may well take the view that they will be able to overturn Professor Angel’s decision on the transitional register. Do we want to deny them the right to appeal in the face of the very fact that with one limited exception, which the noble Baroness, Lady Royall, has mentioned, the Labour Government did not publish these risk registers when they were in government? Where would that leave us, even if the detailed reasons become available?
I was slightly taken aback by the use of the expression “rush” from the noble and learned Lord, Lord Falconer of Thoroton. I submit that a debate over revealing an up-to-date risk register might just have some merits, but not in these circumstances, where its contents are of historical interest only.
I am certain that the House wants to reach a conclusion, but that is a bad way to start.
Thank you very much. I will make one short point. All your Lordships, wherever you may sit in this House, know perfectly well that if this Bill is delayed, urgent requisite reform cannot be used or done, to the detriment of the public. For that reason alone, I oppose this amendment.
My Lords, I am sure that we are about to reach a conclusion. I want simply to make an obvious point which may have been missed. It is that we have had an interesting debate, going on now for the best part of an hour, most of which has not been about the amendment on the Order Paper. I know that this can be disturbing at times, but I would like to remind the House of what it is going to make a decision about—or, perhaps, what it is not making a decision about. It is not making a decision about the freedom of information legislation, on much of which I might find myself in complete agreement with the noble Lords, Lord Butler and Lord Wilson. It has many problems and difficulties associated with it, not least for Ministers. Ministers in this Government are finding that, just as much as Ministers in the previous Government did. However, it is not about the merits of the Freedom of Information Act—that is for another time. It is not about the merits of risk registers, good, bad or indifferent, and there are all those categories of risk registers. It is not about the merits of the Bill, where we are considering whether it should have a Third Reading now. It is about the momentous decision that the House must reach shortly: whether the Third Reading of this Bill should be delayed for, in my estimate, three weeks. That is the decision we are being asked to make.
With respect to previous speakers, that makes one or two of their contributions problematic, if not redundant: those who have suggested that somehow it will be very serious, if not cataclysmic, for the health service in this country if the Bill is further delayed. I have not been involved with the debates on the Bill, but it already seems to have been going on for most of my life, as far as I can see; certainly for 12 months. Are we really being asked to accept the proposition that a further three weeks—that is my estimate, and I will come to my question to the noble Earl, Lord Howe, in a moment—will somehow traumatise the health service? That is an unsustainable proposition. I would not have voted for the amendment had it not referred to the specific point at the end, which is that the House must be able to reach a decision on Third Reading before Prorogation. That is what we are being asked to do. As we all know, the Queen’s Speech is in May—I cannot remember the date—so Prorogation is not too far away.
I know that the House will not vote on the basis of the point that I am making. The proposition is simple and straightforward, and I cannot believe that it is of the cataclysmic significance that one or two speakers have suggested. I have no doubt that we have reached the stage, which we have all been around long enough to recognise with this kind of legislation, where government supporters just want to get it over with, for which I do not blame them, and the Opposition want to ensure, even at this eleventh minute of the eleventh hour, that they have a few more opportunities to point that this really is a bad Bill—a view held not only by the Opposition but by the whole of the medical profession and, as far as we know, most of the public.
The point was not about any length of time that the process of appeal might take. This Motion specifically rules out any delay on that basis. It states that Third Reading should take place whichever is the sooner—when the decision is made or whenever is the final date for consideration of Third Reading before the end of the Session. I put it again to the noble Earl: what is his estimate of the last date that we could consider the Third Reading in time for the Bill to become law in this Session?
My Lords, I take that to be the meaning of the Motion; in fact, it presents the House will an either/or decision, which if passed, would leave us in an uncertain situation. However, I take it that the Motion of the noble Lord, Lord Owen, means that, failing the first alternative, the second applies.
I have discussed the parliamentary timetable at length with my noble friends, as might be supposed. I am advised that in reality there is little time left in this Session, but there is a great deal of business left to complete: the Legal Aid, Sentencing and Punishment of Offenders Bill is on Report; the Scotland Bill is still in Committee; and we await our amendments to other Bills to come back from the other place, whose own schedule is complicated by the Budget, Easter and the Finance Bill. The clear advice that I have received from the business managers is that to delay Third Reading to await the tribunal’s reasons and a government response would put into serious jeopardy all the excellent work that this House has done to make this a better Bill.
I put it firmly to the House that we need to get on with the Bill. Today is the 25th full day on which we have been discussing it, and during that time it has been greatly improved. There is no major issue in it to which the House has not done justice. Delaying Third Reading would, in my submission, be wrong and wholly unwarranted. We need to get on with it, and the NHS needs certainty—the certainty of the Bill being on the statute book. I therefore urge your Lordships in the strongest terms to reject the Motion of the noble Lord, Lord Owen, and allow Third Reading to proceed this afternoon.
(12 years, 5 months ago)
Lords ChamberPresumably, part of the need for urgency is the Government’s scheduling of the Third Reading of the Bill. I know that we are close to the end of an unprecedentedly long Session of Parliament but it would be an intolerable situation if the information were finally published after the Bill had become an Act and the information were then judged to have been such that many Members who had voted in favour of Third Reading would regret it within weeks. Surely the very least that the Government could do is to postpone the Third Reading debate until the last possible date before the end of the Session.
My Lords, I am the first to acknowledge the concern among noble Lords to be fully and properly informed about the risks associated with the Health and Social Care Bill. As I say, we have done as much as we can to implement that intent without transgressing what we still see as a point of principle regarding risk registers. My answer to the noble Lord is that I do not believe it is necessary to postpone Third Reading but we clearly have to debate the Motion in the name of the noble Lord, Lord Owen. At that point, the House will decide whether it is content to give the Bill further consideration.
(12 years, 9 months ago)
Lords ChamberMy Lords, the first thing to understand is that the UK is not part of the stability mechanism that the eurozone is putting in place, and we will not contribute to specific bailouts. On the other hand, the eurozone takes about 40 per cent of our exports and it continues to be the principal interest of the UK Government to make sure that the eurozone and the whole of the EU prosper and grow, to the benefit of our own economy.
Could the Minister spell out the difference between a variable geometry Europe and a two-speed Europe?
My Lords, I think that I have already done so. The two-speed Europe that people seek to paint is one between the eurozone and the rest, but thanks to the work of the Prime Minister at the 23 October Council, the very important principle was accepted that those matters which relate to all EU members and the whole of the EU, such as the single market, will of course continue to be the province of the EU 27. That is the critical acceptance which has been made by the Council and the Commission at the prompting of the Prime Minister.