County Lines Drugs Gangs

Lord Hunt of Kings Heath Excerpts

Wednesday 8th January 2020 Lords Chamber

[Baroness Williams of Trafford]

I am glad that the noble Lord has raised this issue. It is not just something that we are acutely aware of—as he and I will know from our local government days, it is long overdue for attention. He may also know that the Government commissioned my honourable friend Ed Timpson MP, who I am delighted to say is back in the other place, to undertake a review of alternative provision so that the quality of provision can be as good and effective—perhaps more so—as in a mainstream school, because these children need extra attention. To date there has been a £4 million investment in an innovation fund for alternative provision, and I am sure that the House will be kept updated on its success.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the noble Baroness comment on youth services funding? She mentioned family hubs, but since 2010 there has been a 69% reduction in the funding of youth services by local authorities. This must have had a negative impact on the lives of many young people. Will the Government now start to reverse that?

[Baroness Williams of Trafford]

The Government have already made quite a few inroads, particularly for vulnerable children. I have just mentioned the £165 million-worth of funding for troubled families for the next year. We have invested £3.6 million in the National County Lines Coordination Centre, which is absolutely essential for safeguarding young people who get into that sort of activity. Further, the £200 million youth endowment fund will be delivered over 10 years, in addition to the £22 million of the early intervention youth fund that is already funding 10 projects. But one of the most important aspects of funding is that into which we put into our trusted relationships fund. These children do not trust anyone, so it is very important that they are able to build up trust with those who are seeking to protect them.

Government Debt

Lord Hunt of Kings Heath Excerpts

Tuesday 9th April 2019 Lords Chamber

[Lord Bates]

I do not see how one can take it out of that figure. If it is public expenditure on infrastructure, it is government debt, so we need to reflect that in the numbers.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can I bring the noble Lord back to the NHS? He mentioned the NHS five-year spending agreement that has already been announced, but he will know that that does not cover education and training. The key issue facing the NHS is a large workforce problem, and part of the answer will be more training places. Can he assure me that, in the next spending review, the Treasury will not take the view that the NHS has received everything it is going to receive, and that it will look to increase the amount of money going into education and training?

[Lord Bates]

Obviously, there will be issues, which will be addressed in the spending review. Simon Stevens made that proposal about what is needed for the NHS, £20 billion—I think—was delivered to meet it, and there has been a significant increase with this further amount. However, we are aware of the pressures, which is why we have been clear that, when it comes to public services, the NHS is our priority.

Policing: Priorities

Lord Hunt of Kings Heath Excerpts

Thursday 15th November 2018 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of whether police forces have established effective priorities for fighting crime.

[The Minister of State, Home Office (Baroness Williams of Trafford) (Con)]

My Lords, police and crime commissioners are directly elected to set the policing priorities for their local areas and hold their chief constable to account. They must also have regard to national policing priorities and the strategic policing requirement. Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services periodically reports on police effectiveness. In its most recent effectiveness inspection report, the majority of forces were graded good.

[Lord Hunt of Kings Heath (Lab)]

While I am grateful to the Minister, I wonder what she made of the comments of the chair of the National Police Chiefs’ Council, Sara Thornton, in calling on police forces to refocus their priorities on what she described as “core policing”. Does the Minister accept that that highlights the appalling state that we have reached? Since 2010, there has been a 15% real-term, full-time equivalent reduction in the number of her police officers. Many crimes now go unrecorded and undealt with. The figures since 2015 show that there has been a 26% reduction in the number of charges or summons brought for recorded crime, resulting in 153,000 fewer criminals being brought to justice. What is the Government’s response to the appalling state that we have reached?

[Baroness Williams of Trafford]

My Lords, I think that I have stood at this Dispatch Box before and said that it is up to local police forces to set priorities for their local areas, because they will differ from area to area. It is important to note—I have said this before as well—that both the Home Secretary and the Policing Minister recognise the increasing calls on police time and the different demands facing them, particularly in light of events in the past year. There is an additional point about how the police operate. It will not be any surprise to the noble Lord that some police forces are far more effective than others, and it is important to think of ways in which they could collaborate, make better use of technology and be more efficient as time goes on.

Police and Crime Commissioners

Lord Hunt of Kings Heath Excerpts

Monday 15th October 2018 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the concerns raised by the National Police Chiefs’ Council about Police and Crime Commissioners and their impact on applications for Chief Constable positions.

[The Minister of State, Home Office (Baroness Williams of Trafford) (Con)]

My Lords, we are committed to ensuring that policing continues to attract the leaders that it needs for the future. The 2015 College of Policing Leadership Review set the foundation, and we have built on this by funding a leadership hub. Chiefs, PCCs and the college are rising to this challenge.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for that Answer, but she will be aware that there is increasing concern about the rapid turnover of chief constables, particularly women. It seems to be a problem, too, that new appointments are often made from a shortlist of one—often, the deputy chief constable. She will be aware that Her Majesty’s Inspectorate of Constabulary has expressed concern that bright officers are not applying for these posts because they think police commissioners have already made up their minds. Will she use the powers that she has to determine that any appointment must be made from a strong shortlist, and that no one should become a chief constable unless they have also undertaken a senior post with another force, rather than simply being promoted from the inside?

[Baroness Williams of Trafford]

I certainly recognise the point that the noble Lord makes about the feeling that people are promoted from the inside and, therefore, that perhaps officers do not apply from other forces. On female turnover, we should welcome the fact that we have a female commissioner of the Met police, which is fantastic news. The chair of the National Police Chiefs’ Council is also a woman, and the director-general of the NCA is also female. However, I understand the noble Lord’s point. I also think that chiefs themselves have a role to play in attracting and encouraging talent coming up through the pipeline. The College of Policing published a code of ethics, guidance on flexible working and guidance on the use of positive action to increase the recruitment and retention of underrepresented groups, including females.

Immigration: International Students

Lord Hunt of Kings Heath Excerpts

Monday 26th March 2018 Lords Chamber

[Baroness Williams of Trafford]

The noble Lord is absolutely right. Earlier this year, the Royal Statistical Society agreed with that approach and said that,

“we believe it is imperative for due attention to be paid to the international definitions of migration, which lead to the inclusion of students in the figures”.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is it not a fact that the combination of Home Office measures has had a dampening impact on overseas recruitment and we are losing market share? Coming back to the issue of statistics, the Minister’s own department’s official statistics in August last year showed that 95% of international students coming from outside the EU were fully accounted for, either by leaving to go back home or by receiving an extension of their leave to be here because they are extending their studies. What is the problem with the Home Office in coming to a sensible resolution of this?

Immigration and Nationality (Fees) (Amendment) Order 2018

Lord Hunt of Kings Heath Excerpts

Tuesday 27th February 2018 Grand Committee

[Lord Paddick (LD)]

My Lords, I thank the Minister for explaining the order and for her confession about the error in it. We have a fundamental objection to the approach that the Government are taking to move to a position where fees are charged to cover the costs of providing border, immigration and citizenship services. The security of the UK border is one of the most important mechanisms by which the Government keep us safe and we should not expect those who want to do the right thing and apply for leave to remain and, eventually, citizenship, some of whom come to this country as destitute refugees, to be forced to fund what is fundamentally the duty of the Executive.

Having said that, I understand that these regulations make only one change to the overall fee structure, where the biometric capturing part of an application comes to you and where the eye-watering fixed fee of £10,500 is to be replaced by an extraordinary hourly rate of £2,600. Will the Minister confirm that this is not the actual cost of providing the service, but a fee based on what the market can bear? Will she also explain why the Home Office is not maximising the profit from such a service to enable it to reduce fees in other areas, rather than giving this lucrative money-earner away to a private company? I understand that there needs to be two people to carry out the biometric capture, but if this is purely on the basis of cost recovery are we paying Home Office officials £1,300 an hour? Can I apply for a vacancy?

We support these regulations as far as they go and we look forward to the main event, when the actual fee levels for 2018 are set out in the forthcoming regulations next month. I give the Minister notice that those regulations are likely to be a completely different ball game.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank the Minister for setting out the reasons behind this order and for the clarification she gave in her opening remarks. I too was fascinated by the level of fee charged changing from an overall maximum fee of £10,500 to a fee of £2,600 per hour. Some of us have occasionally done per diem work—I suppose we are not unused to it now—but our eyes can only water at the thought of such an hourly rate. It would be good to know where the justification comes from.

I also add to a point made by the noble Lord, which is that essentially a commercial provider is going to do the work. Although the Home Office will retain full oversight and jurisdiction, the relevant fee will relate to the cost associated with the commercial partner travelling to the location of choice as requested by the applicant. The mind boggles. Can they go anywhere? Without detracting from the quality of the people who will be applying for this service, it makes one wonder what exactly the commercial provider is there to do. Is this rate seriously based on the cost of that commercial provider? Does it build in a profit? It must. I must say that the Explanatory Memorandum begs more questions than it answers on those details.

[Baroness Williams of Trafford]

I thank the noble Lords, Lord Hunt and Lord Paddick, who both asked questions about the rather lucrative £2,600 hourly rate. I absolutely understand why the noble Lords asked that question. It is not the actual fee; it is the maximum. The actual fee will be set in regulations later this year, but it is important to understand what the amount is modelled on. It is modelled on existing costs and location of customers using the current service. The average time is two hours and for security reasons it requires two members of staff actually to do the work. It is a maximum amount and that needs to be borne in mind in the context of what noble Lords are asking.

As regards the organisations working with vulnerable people suggesting that the destitution assessment applied to those who make applications on the basis of private and family life is too stringent, our policy states that a fee waiver will be granted to applicants who demonstrate with evidence that they are destitute. That may well bring in the point that the noble Lord, Lord Paddick, made. The onus is on the applicant to demonstrate by way of evidence, which I am sure that a refugee or asylum seeker could, that they meet the terms of the fee waiver policy. It is open to such individuals to re-apply for a fee waiver on the evidence that supports their request.

The question about the supplier ensuring that they give value for money and account strictly for the time taken in each case was a very valid one. The Home Office’s chosen commercial provider will be required to demonstrate a clear and transparent method of calculation of the service cost, based on the applicant’s location, to deliver an on-demand service. This is an on-demand and premium service to a customer at a location of their choice. The contractual clauses will require that partner to undertake open book accounting to allow visibility of costs and charges for services provided to customers, which in turn will be reviewed by robust commercial oversight. I hope that that answers the noble Lord’s two very simple questions.

International Development: Diseases of Poverty

Lord Hunt of Kings Heath Excerpts

Wednesday 24th July 2013 Lords Chamber

[Baroness Northover]

I remember colleagues being tested in one of those centres locally. I will take this back to the Department of Health and get an answer for the noble Baroness. It is obviously important to address TB here, where it is an increasing problem, as well as in developing countries.

[Lord Hunt of Kings Heath]

My Lords, I refer noble Lords to my health interests in the register. Does the noble Baroness think that the introduction of value-based pricing for pharmaceuticals in this country will lead to more research in those areas where at the moment there clearly is not a return for the pharmaceutical companies? They are often called orphan drugs. If they were incentivised it could lead to greater help for these diseases in poorer countries that noble Lords have been discussing.

[Baroness Northover]

I know that the noble Lord is very concerned about value-based pricing in the United Kingdom. We have to take a few steps back in terms of the support that needs to be given for the development of these treatments overseas. This is on a totally different scale. There is, in effect, no market, as the noble Lord’s colleague said, and we need to ensure that there is support for research and development before even the prospect of a market is taken forward.

Care Bill [HL]

Lord Hunt of Kings Heath Excerpts

Wednesday 12th June 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, my noble friend’s amendment is very penetrating. Under this clause the Secretary of State will appoint only the chair and other non-executive members while the CQC appoints its own executive members, including the chief executive. I draw the noble Earl’s attention to our debate on day one of Committee when we discussed the governance of Health Education England and the Health Research Authority. I still fail to understand why the Secretary of State has to approve the appointment of the chief executive of those bodies when he does not in relation to the CQC. I take from it that HEE and HRA are less independent than the CQC. It would be interesting to know whether he can confirm that.

I thought my noble friend made a very powerful point about the appointment of a chief inspector. I endorse his remarks about the appointment of Mike Richards. He commands great respect, but I wonder why it is not in the Bill. It seems to me that the relationship between the chief inspectors and the chief executive and the board of the CQC is going to be a delicate one. Once you nominate somebody as chief inspector the implication is that they are independent in their job. My experience when I was at the DWP and responsible for the Health and Safety Executive is that it had some chief inspectors. There was the equivalent of the Nuclear Installations Inspectorate, although that has now gone, and the Chief Inspector of Construction. It was felt necessary in some of the most important sectors to have a figurehead. My understanding was that when it came to issues to do with the regulatory function they were independent and could not be second-guessed by the board. The relationship between the chief inspectors and the board is very important. I wonder whether the noble Earl’s department is storing up trouble for the future by not making them statutory post-holders so that it is absolutely clear in legislation what their responsibility is. I can see problems arising in future on this.

This issue about putting primary and community healthcare together will also be very important. The breakdown in the NHS over the past few months has been a breakdown in integration between different parts of the service. Putting primary and community care together would be very helpful.

[Baroness Wall of New Barnet]

I support the amendment and in particular the argument for the chief primary and community care inspector. Many of us who operate within the service—even people who use it—know that often the weakness has been in the delivery of primary care. We talked earlier about reconfiguration. The only way that that would be successful is if we had better primary care facilities and care that people could access nearer to home—all aspirations that the Government have. I strongly support having that watchful eye on making sure that primary care works effectively.

[Baroness Northover]

My Lords, I thank noble Lords for their contributions to this mini-debate on Amendment 73. We are sympathetic to the view behind this amendment —or what seems to lie behind it—which seeks to ensure that the new chief inspectors will be given a place on the board of the CQC. I echo here the praise of the noble Lord, Lord Warner, for Professor Mike Richards. I know that the professor’s cancer colleagues will miss him in that field.

Noble Lords are absolutely right about the importance of improving quality and in particular of trying to drive up quality within primary care. The Secretary of State announced the appointment of a Chief Inspector of Hospitals as part of the Government’s response to the Francis review into Mid Staffs. As has been referred to, since that time the Government have also announced the positions of a Chief Inspector of Social Care and a Chief Inspector of General Practice. These three chief inspectors will sit within the CQC and lead for it on the inspection and regulation of all registered providers of health and adult social care. They will be high-profile positions—as the appointment of Mike Richards demonstrates—and will speak for the CQC on the quality of care that they find. As such, it is likely, as noble Lords have indicated, that they will have a lot to offer the CQC board in knowledge, experience and leadership.

The noble Lord, Lord Warner, asked about the areas that the Chief Inspector of General Practice might cover and whether the post might be drawn more widely. In some ways, that rather bears out my point: setting this in stone in statute may not be the best way to make everything link up so that the new positions work as effectively as possible. The CQC needs to move this forward so that it can best drive up quality. It will be for the CQC to determine the exact remit of each of the chief inspectors. All providers of registered health and adult care services will fall within one of the chief inspectors’ remits. Perhaps that will reassure the noble Lords, Lord Warner and Lord Hunt. The CQC is working up detailed proposals. No doubt it will pay attention to what noble Lords have said. Broadly, the Chief Inspector of Hospitals will cover acute trusts, including mental health trusts; the Chief Inspector of Social Care will cover providers of regulated adult social care, including care homes and domiciliary care agencies; and the Chief Inspector of General Practice will cover GP and dental practices as well as walk-in centres, private healthcare and independent ambulance providers. Clearly, the CQC will look at how it gets comprehensive coverage.

We have deliberately avoided requiring that these inspectors should have a seat on the board for two reasons. First, the aim of Clause 79 is to give the CQC more autonomy in determining which executive members sit on its board. This is in line with best practice, as no doubt noble Lords will recognise. We would not wish to remove this new autonomy by requiring that any executive, other than the chief executive, must sit on the board. Secondly, we have designed the chief inspector roles to be non-statutory. They are internal to the CQC, and the CQC will have the power to design, shape and adapt the roles in a way that best enables their operational effectiveness. I hope that that helps to reassure the noble Lord, Lord Warner.

[Lord Hunt of Kings Heath]

I am very grateful to the noble Baroness. Does that mean that at the end of the day the chief executive of the CQC can overrule the chief inspectors? That must be the implication of what she said.

--- Later in debate ---

[Lord Warner]

Clearly the noble Baroness has clarified matters, but whether she has reassured me is another question. I think the Government underestimate the profile of the Chief Inspector of Hospitals in particular. There is no doubt that this will be a very powerful and important post with an enormous profile. The idea that this person can be overruled by the chief executive and the board, as this legislation sets out, poses a problem I certainly want to think more about.

I also think that there is a gap here. Community health services are not clearly in anybody’s remit. I am sure my noble friend Lord Hunt would agree that if we were to identify one black hole where there is not a great deal of data on performance and quality, it would be community health services. It is an area that has not been probed well by independent inspection, and as far as I can see the game plan is to have no inspector looking into that area. Given everybody’s concern about integration, it seems a bit of a missed opportunity for there not to be some linking up there.

I want to consider this much further. It would be helpful if Ministers sent the Committee the job description for the three inspectors they propose. In my experience, it is rather difficult to appoint anyone to anything without a job description. It would be very helpful to our deliberations to have that before Report.

[Lord Hunt of Kings Heath]

It seems to me that unless this is sorted out there will be problems in the future, notwithstanding the calibre of the current leadership of the CQC, which I readily acknowledge. If the chief inspector does not have total operational independence when acting as chief inspector, I see a recipe for potential trouble. We will not reach Report until October, so there is plenty of time. My noble friend and I would be very interested to have at least some discussion about how the CQC will avoid the kind of conflicts that clearly we would rather not have, if at all possible.

[Baroness Northover]

I am very happy to take back to the department the request for further descriptions of the jobs in these cases. We should also bear in mind that the aims of these chief inspectors, as part of the CQC, are to maintain safety and effectiveness and drive up quality. They have shared aims; it is not as if they have different ambitions in this regard.

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Moved by

[Lord Hunt of Kings Heath]

73A*: After Clause 79, insert the following new Clause—
“National Reporting and Learning System
The National Reporting and Learning System shall come under the control of the Care Quality Commission.”

[Lord Hunt of Kings Heath]

My Lords, we come to a very important clause, which I think the Government might describe as a Francis clause since it clearly seeks to respond to the Robert Francis inquiry into the Mid Staffordshire hospital problems. In fact, judging by the rigour of the Government’s initial response to Mr Francis, one might have thought that there would have been a series of clauses reflecting the 290 recommendations. It would be helpful to know why the Government consider that this is an adequate legislative response. Can the Minister say whether there is likely to be further legislation or whether, in effect, this is the definitive legislative response to the Francis report?

Clause 81 creates a new offence so that providers of health services and adult social care that supply, publish or otherwise make available information that is “false or misleading” could be subject to criminal sanctions. The offence applies to a care provider as a corporate body, not to individual directors or employees. Clause 81 outlines the scope of the offence, including where care providers are potentially subject to it and the type of information to which it relates. I understand that further detail will be specified in the regulations as appropriate.

Let me say at once that this clause is welcome, as far as it goes. However, I have two questions to ask. First, is it possible to be rather more explicit than the Explanatory Notes are as to what information is likely to be covered by the offence? This is important as I have received a briefing from NHS employer organisations, which recognise the seriousness of the potential offence in this clause and would like to see clarity as to the kind of information that is embraced.

It is disappointing that the clause does not contain a provision to enact a duty of candour, as recommended by Robert Francis. That is the subject of my Amendment 76B. He said that a statutory duty should be imposed to observe such a duty of candour on healthcare providers who believe, or suspect, that treatment or care provided to a patient has caused death or serious injury to inform that patient or another duly authorised person as soon as is practicable. At Second Reading, the noble Earl said that the duty of candour would be dealt with through CQC registration via regulations. I am very puzzled that such a key recommendation—it was almost the headline recommendation—of the Francis report is not going to be dealt with in the Bill when the Government clearly have the vehicle to put it there, so I am very sympathetic to my noble friend Lord Warner’s Amendment 77, which I think is consistent with my Amendment 76B. It is always nice to feel that I am consistent with my noble friend.

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[Lord Campbell-Savours]

But does the noble Baroness recognise that that might then determine the policy of nursing homes concerning whether they are prepared to take on the responsibility of carrying NHS patients? They will then be chargeable with an offence which otherwise—if they were not to take on those patients—they would not be subject to.

[Lord Hunt of Kings Heath]

Perhaps I may ask my noble friend whether that then comes to the point that the noble Baroness raised earlier about needing to extend this duty to GPs and social care providers. The reality is that if the duty were extended to social care providers, most of those homes would not be viable unless they accepted either local authority-funded clients or clients from the health service. Is not the answer to extend the duty to make sure that we cover GPs, community health and so on?

[Baroness Northover]

In terms of the division that the noble Lord pointed to, if a provider decides that it does not want to take on NHS patients because it will have to reach higher standards than for private patients—which appeared to be part of what he was saying—once that is publicised and becomes apparent, that will not exactly encourage people to use those providers.

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[Baroness Northover]

My noble friend says no. I can see that the van advertising litigation probably does not want to encounter the noble Lord, Lord Campbell-Savours, as he comes out of whichever hospital it is.

In the light of what I have said, and anything else that we need to clarify, I encourage noble Lords not to press their amendments.

[Lord Hunt of Kings Heath]

My Lords, we are extremely grateful to the noble Baroness for that reply. There are obviously a lot of issues that we may want to return to, but clearly the main debate is about the duty of candour. It has been a good debate because noble Lords have identified the problems of a statutory duty on individuals. This presents some real challenges, which clearly need to be thought out with great care and attention. I very much accept that there is a real risk of perverse incentives and discouraging staff doing the right thing because of the fear of prosecution.

However, I am puzzled about the duty of candour. I do not understand why the Government have included this offence of supplying false or misleading information in the Bill when the duty of candour, which is clearly much more important, will be relegated to secondary legislation. From the debate and the comments of all noble Lords who spoke, clearly this is not easy. It has to be got right. The best way to get it right is through primary legislation.

The problem with secondary legislation is that, at best, we will have an hour and a half of debate and we are not allowed to amend it. This issue is so complex and important that it warrants more. I strongly recommend that the Government to look at this again and bring back an amendment on Report in the light of Professor Donald Berwick’s recommendation. I think that they will find that the duty of candour is the flagship of the Francis report. Not to have it included in the Bill means that we are missing something. I suspect that patients will miss out in the end.

Having said that, this is a good way to conclude our discussions tonight and I beg leave to withdraw my amendment.

Amendment 73A withdrawn.

Herbal Medicines

Lord Hunt of Kings Heath Excerpts

Wednesday 24th April 2013 Grand Committee

[Lord Hunt of Kings Heath]

My Lords, I should first declare an interest and I refer the Committee to my health interest in the register.

I am delighted to speak in this debate. I had ministerial responsibility for the regulation of herbal medicines a long time ago, but it was at the time when we first discussed the European directive. While I actually agree with almost everything that the noble Lord, Lord Pearson, has said, I do not quite agree with his opening remarks about the benefits or otherwise of the European Union. However, he speaks with a great deal of wisdom about a problem that we face.

I usually agree with the noble Lord, Lord Taverne. I have always enjoyed his interventions in your Lordships’ House on the side of rational thinking. However, I must depart from him today. Whether or not herbal medicines are effective, and that is of course open to legitimate debate, the issue we face is that an MHRA survey has shown that about a quarter of the population use over-the-counter herbal medicines. If that is going to continue, as I suspect it will, surely there is a responsibility on the part of the Government to make sure that arrangements are in place to ensure that they are safe as far as they can be, and that those people who prescribe and dispense such medicines are appropriately qualified and regulated. If the statutory register is not now to go ahead, one is left with the problem of the public continuing to purchase such medicines, as I am sure they will, but without the necessary statutory regulation. It is therefore important that we get a clear view from the Government today as to whether they will continue with proposals on statutory registration.

We were left with a very difficult problem with the European directive. To an extent, the provisions around traditional herbal medicines dealt with herbal medicines that had been on the market for a good many years—some 15 years, I think. However, it does not deal with the issue of new herbal medicines coming to market. For instance, if they had to go through the whole panoply of clinical trials, the cost would be prohibitive for a market that traditionally comprises small businesses. Even the licensing provisions for new herbal medicines are likely to cost several thousands of pounds. Again, that is very difficult for an industry that is essentially small-scale.

As a result of herbal medicines being brought within the Medicines Act 1968, which has been replaced by the European directive on traditional herbal medicinal products, this now prevents third-party manufacturing of herbal medicines being prescribed to patients by practitioners, as well as individualised herbal medicines prescribed by practitioners and manufactured by a third party. Both have been essential components in the supply chain for the past 40 years, with many practitioners relying on such services. Now those practitioners have to prepare medicines on their own premises. That is a real problem if those practitioners are not to be statutorily registered, especially in terms of public confidence.

The noble Lord, Lord Pearson, mentioned the ECJ ruling against Poland. I thought that this ruling was in relation to the parallel import of medicines. For the life of me, I cannot see why that should have an impact on the proposal for the statutory registration of herbal medicines. I know that there is an issue with parallel imports which the Government are right to be concerned about, but this is not essentially a matter of parallel imports.

Not having a statutory register will not curtail the use of herbal medicines, but it will increase the scope for unqualified herbalists to offer treatments and for customers to purchase unprescribed medicines over the internet. I know that the fear of the noble Lord, Lord Taverne, is that statutory regulation would legitimise a practice which he has cast doubt upon. However, I would ask him to consider the other problem, which is that if 25% of us use herbal medicines, is it not better to accept that they will continue to do so and put some statutory safeguards around that practice?

The benefit of regulation is that practitioners would be regulated by an independent regulator. I understand it is likely to be the Health and Care Professions Council. Of course, the HCPC is in expansionist mode, having just taken on social workers, much against my and many others’ better judgment. If it can take on social workers, it can certainly take on herbal medicine practitioners. Of course, the benefit of that is that it can strike someone from the register, prevent them from being called a herbalist, and thus give more confidence to the public. The noble Lord, Lord Taverne, will say that I am arguing his point for him and I recognise that by having statutory regulation the public are likely to have more confidence, but I think it is better that way than allowing herbal medicines to be purchased over the internet with all the problems that can arise. Many legitimate herbalists may go out of business, which would be a great pity.

I will end by making two points to the noble Baroness. First, why is her department refusing to meet the campaigners and indeed the noble Lord, Lord Pearson? As a Minister, I always met parliamentarians if they wrote to me asking for a meeting. I am very surprised that Ministers in the department have refused to meet the noble Lord, Lord Pearson. That is extremely bad form. Certainly they should meet with Michael McIntyre. I do not understand why the department has run away from such a meeting.

Secondly, there are obviously some very strong rumours that the department is going to drop this proposal. If that is the case, all that I would ask the noble Baroness is this. Would it not be sensible to meet with the noble Lord, Lord Pearson, and Mr McIntyre before a final decision is made? It would be only fair if there was some debate before such a decision is announced.

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[Baroness Northover]

I am afraid that I cannot answer that very simple question. I may be inspired to do so shortly, but in the mean time I should say that this is a more complex area than that. Although I will be happy to come back to my noble friend, I think that there are a number of wider issues to look at.

[Lord Hunt of Kings Heath]

Perhaps I may also intervene briefly. I am most grateful to the noble Baroness for her answers, but can she be absolutely clear? Mr Lansley, when he was Secretary of State, announced an intention to implement a register by 2012. Does that mean that the Government are not going forward with it? I am not clear about this. The noble Baroness has said that she is not in a position to consult and has suggested that the Government are taking a new look at the relative risks. Can she help the Committee to understand whether in fact these rumours that the proposal has been dropped are correct?

Children: Developmental Care and Autism

Lord Hunt of Kings Heath Excerpts

Tuesday 19th March 2013 Grand Committee

[Lord Hunt of Kings Heath]

My Lords, I, too, thank the noble Lord, Lord Maginnis, for allowing us to have this important debate. He made some important points in his opening speech and I, too, should like to focus on early intervention. Both noble Lords made it clear that they regard it to be of importance. I agree.

I should also be interested in the Minister’s response to the point made by the noble Lord, Lord Addington, about the need for regular assessment after the initial early intervention. I was particularly taken with his remark that if you can have early intervention and regular assessment, your chances of helping people to have much better life outcomes is good not only for them, their families and loved ones but in terms of the likely demands on the state over the years. There must be a persuasive economic case for up-front investment. Perhaps the noble Baroness can respond to that.

As to the experience with health visitors in Northern Ireland and the comparison with England, it was extremely interesting to hear the ratios mentioned by the noble Lord, Lord Maginnis. I suppose that it raised a bit of prejudice about the funding that goes to Northern Ireland, but I shall desist from making further comments on that. Does the noble Baroness recognise those ratios because, on the face of it, your chances in Northern Ireland of having health visitor support is clearly much greater and more intense than in England? I do not know if the noble Lord knows the answer to this but, given the importance of speech and language therapy, I wonder if there is a similar issue about the number of those important professionals who can make a huge difference to people affected by this condition.

[Lord Maginnis of Drumglass]

I cannot help the noble Lord with figures, but we are certainly able to concentrate the demand for those interventions. They may relate to sensory issues, speech or all sorts of things. Those interventions can often be carried out in the home or school environment; they do not always require a medical practitioner—although, on occasions, they do.

[Lord Hunt of Kings Heath]

I am grateful to the noble Lord. One of the powerful points he is making is on the number of professions there are. It is also a question of organisation, and I should like to come back to that issue because I think he is suggesting that in Northern Ireland the stability of the organisation of health and social care enables a much more co-ordinated response to be given.

I want to come back to the English situation, which is worse than he stated because of the changes that are to take place from 1 April and are apposite to his comments. We have been given a very good research paper by the Library in anticipation of this debate. The briefing note refers to the report from Brian Lamb commissioned by the previous Government, the follow-on in this Government’s initiatives, and the identification in March 2011 of some of the problems—particularly of,

“parents having to battle to get the support their child needs … SEN statements not joining up education, health and care support … multiple layers of paperwork and bureaucracy”,

and,

“a confusing and adversarial assessment process”.

Clearly, it is very important that all these issues are tackled. We welcome the prospect of legislation and the publication of draft clauses, as well as the work done in Parliament to comment and reflect on those draft clauses.

I want to express some concerns, particularly in education. The Government have clearly identified gaps in services between different sectors, education, health and care support. My concern is with the demise of local education authorities as significant players in education in England. I remember when we debated the new Government’s first children Bill that there was particular concern about provision of SEN under the new structures. Does the Minister think—and how does she think—co-ordination of SEN in local authority areas is now happening with the reduction in authority of LEAs and the freedom of academies and free schools to plough their own furrow? I know that academies operate in accordance with the individual funding agreement and obligations are imposed on them, but it would help the Committee to know that the Government believe there is machinery at local level to ensure that there is proper co-ordination between schools, linking into the health service. I point out to the noble Baroness the recent Ofsted reports on the first tranche of free schools is not exactly encouraging about their performance. Could she help me in relation to whether Ofsted was able to comment on those schools’ responsibilities in relation to SEN?

It is clear, too, that the health service has much to do, and I fully accept that. Co-ordination between health, education and social care services is very important indeed. The noble Lord, Lord Maginnis, referred to the English situation as of now and to the 10 strategic health authorities and 190 or so primary care trusts. He referred to that as being a bit of a mess—but if we were coping only with the current structure. The fact is that from 1 April we are losing strategic health authorities and primary care trusts and replacing them with clinical commissioning groups, which are untried and untested. We are losing the essential leadership role of strategic health authorities, which are being replaced by local area offices of the NHS Commissioning Board. All the signs are that those local area offices neither want to nor have the capacity to give the kind of leadership that is required. So at the local level, within each local authority area, we have a worrying picture of, on the one hand, local education authorities losing a lot of the levers that they used to have, and, on the other, of a health service being broken up between lots of new and different organisations. It is very worrying in terms of the co-ordination required. Will the Minister reflect either now or in writing on how she thinks one can achieve a co-ordinated approach in relation to SEN, particularly in relation to the group that the noble Lord is mostly concerned with, in the new structures? That is the only way in which to get early intervention and the continuous assessments, which noble Lords believe should be produced.