Health: Parity of Esteem
Lord Hunt of Kings Heath Excerpts(8 years ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure to wind up for the Opposition tonight and congratulate the noble Lord, Lord Alderdice, on what can be described only as a powerful tour de force. It was a fascinating insight into parity of esteem, as he saw it, in Northern Ireland more generally, which set the context for our debate. Almost all noble Lords have agreed with his proposition that, despite any number of pronouncements, policies and changes in the law, mental health continues to be a Cinderella service. Certainly, my impression of mental health services is that, although they came as part of the health service in 1948, although in the original structures they had their own hospital management committees, which were brought into area health authorities and then district health authorities—and then there was the development of NHS trusts and foundation trusts—and although they were in some cases integrated with those organisations and in some cases were not, they remained invisible throughout. It is a service that continues to be invisible when it comes to the key policy decisions that the Government, NHS England and the regulators make on the health service.
From a managerial point of view it is my impression that, once you become a manager in a mental health service, you stay a manager there—you do not move over. You are not perceived to have the qualities needed to become a leader in a more acute trust. If you look at the NHS people seconded into the department, NHS England or the regulators, you can see how few of them are experienced in mental health services. The noble Lord, Lord Lansley, suggested that this was rather underpinned by the financial system of mental health services whereby, because there is no tariff-based system, clinical commissioning groups tend to negotiate around the tariff and then what is left goes under block contracts to mental and community health services. This puts them at a disadvantage.
Although structures are not important, there is an issue in relation to both the culture and some of the structural issues which seems to account for the lack of focus on and priority for mental health services. Yet my experience when I chaired an acute NHS foundation trust was that many of the challenges we faced were because of the lack of proper support for patients with mental health problems. In any emergency department there will be a huge number of people with these issues. Unless there are properly based mental health services, working side by side with the acute trust, you end up with people inappropriately cared for in inappropriate places, with their outcomes often getting worse and worse.
The noble Baroness, Lady Hollins, asked the Minister a very good question about the sustainability and transformation plans. She thought that the department should not sign off STPs unless it was satisfied that the principles of parity of esteem were fully embraced within them. That is a very good suggestion which I hope the noble Baroness will agree to consider. I have looked at the names of the leaders of the 44 sustainability and transformation plans. They are clearly eminent people, many of whom I know, so there is no doubt that NHS England has appointed people of high calibre. However, they are mainly chief executives of acute trusts, clinical commissioning groups and, in one or two cases, local authorities—particularly Birmingham and Manchester. Why is this? Why have we not turned to mental health chief executives to lead some of these STPs? In my experience, mental health services often know a lot about the system because their clients impact on so many aspects of the service. If we want to make a real, visible indication that mental health services are important, we should look for leaders from mental health services to lead the sustainability and transformation plans. Even if that does not happen, I hope that both NHS England and the Department of Health will ensure that legal requirements for parity of esteem are applied before they are signed off. More than that I hope it is recognised that, unless you put mental health right at the heart of these plans, the ambitions in them are very unlikely to be realised.
I will briefly come to the question of finance. We know that the Government have ordered the NHS to put more money into mental health services. We have heard from noble Lords about the commitment for £1 billion more for mental health by 2020-21. We also heard from the noble Lord, Lord Prior, only last week, that the spend on mental health in 2015-16 is up by 8.4% on the previous year. He said that,
“there is clear evidence that the money that we have been talking about is getting through”.—[Official Report, 16/11/16; col. 1417.]
Yet most noble Lords who have spoken would say that they disagree that the money is getting through to the front line. I do not know whether the Minister has seen the recent work by the Royal College of Psychiatrists on mental health services for children and adolescents. It points out that 52 CCGs in England are allocating less than 5% of their total mental health budgets to services for children and young people. We know of the horrendous problem of young people having to be sent to places hundreds of miles away from their homes because of a lack of facilities. We have also heard, from other noble Lords, that the money simply does not seem to be getting through to other mental health services. Is the noble Baroness assured of the accuracy of the returns made by the NHS to her department on the sharing out of the mental health budget, because there is a suspicion that there has been a rebadging of existing programmes to massage the figures to make it look as though mental health spending is up when the clear experience on the front line is that services are being squeezed and squeezed?
I do not doubt Ministers’ good intents in regard to mental health and ensuring that parity of esteem is achieved. However, the reality is that on the front line mental health services continue to be discriminated against and services are under great threat. There is great concern that in the major changes we are going to see in the health service in the next two or three years as a result of the sustainability and transformation plans, mental health, far from being at the core of the changes, will once again be treated as the neglected hidden Cinderella service. I hope that the noble Baroness can prove us wrong.
NHS England: HIV Prevention
Lord Hunt of Kings Heath Excerpts(8 years, 2 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government whether NHS England is informing patients that lifesaving drugs will be denied them if funding has to be made available for pre-exposure prophylaxis (PrEP) for HIV prevention.
Baroness Chisholm of Owlpen (Con)
Clinicians can apply for funding for the drugs in question where there is a clinically exceptional or clinically critical need. Each year NHS England receives many proposals for investment in specialised services. Difficult decisions then have to be made on behalf of taxpayers about how to prioritise the funding available.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the noble Baroness. She will know that evidence from clinical trials shows that PrEP can be highly effective in reducing the spread of HIV when given to those who are at most risk. Quite disgracefully, NHS England has sought to avoid funding responsibilities by saying that it is the responsibility of local authorities, at a time when there have been big cuts in the public health budgets of those councils. Even more disgracefully, government sources appear to have briefed the media that if they were forced to fund PrEP, treatments for serious conditions would have to be stopped, including treatments for children with cystic fibrosis. This was deeply unpleasant, caused great offence and may well have added to the stigma faced by many living with HIV. Will the Government assure the House that this will not happen again, and instruct NHS England to fund the drug forthwith?
Baroness Chisholm of Owlpen
The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.
Disability: Premature Deaths
Lord Hunt of Kings Heath Excerpts(8 years, 2 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I warmly welcome this debate and thank the noble Baroness, Lady Hollins, for her excellent introduction. I also very much congratulate the noble Baroness, Lady Fall, on her maiden speech. I hope that she will make up for her earlier enforced silence by speaking more often in your Lordships’ House. Perhaps she will also look a little more kindly on noble Lords in her current position than she did in her previous post.
What can one say about the late Lord Rix? What an extraordinary man and humanitarian he was. Above all, his passionate advocacy on behalf of people with learning disabilities is surely a beacon to us all. I hope that tonight constitutes a small tribute to him for all that he did for so many.
The noble Baroness, Lady Hollins, was very telling when she talked about too many people in health and social care not listening to people with learning disabilities or those who know about people with learning disabilities. When one looks at the issues that have been raised—the statistics mentioned by the noble Baroness, Lady Rawlings, or the issue of the Southern Health NHS Foundation Trust, mentioned by the noble Baroness, Lady Tyler—what is most striking is the failure of so many health and social care bodies to treat people with learning disabilities with a sense of equality and respect.
The Mazars report is shocking in relation to the Southern Health Foundation Trust. It identified the lack of leadership, focus and sufficient time in the trust spent on carefully reporting and investigating unexpected deaths. That was followed up by the Care Quality Commission, which found that the trust failed to mitigate the significant risks posed by some of the physical environments in which it delivered mental health and learning disability services. It did not operate effective governance arrangements to ensure robust investigation of incidents, including deaths.
Following those two reports, we had the saga of the former chief executive being offered an opportunity to stay on the staff, on the same salary. She has now left. I cannot help wondering whether underlying this was a board that did not accept those reports. I do not know whether the Minister is able to say a little more about that, but it seemed to me that it encapsulated the problem that the noble Baroness, Lady Hollins, suggested. Although I am sure that many parts of health and social care do their very best by people with learning disabilities, the cold statistics would suggest that we have an awful long way to go before we can be satisfied that attitudes, policies and procedures are right for these vulnerable people.
In the time available, I do not want to say very much more, but I want to ask the Minister three questions. The first relates to the 18 key recommendations from the CIPOLD review of deaths. Of course she cannot go through all 18 recommendations tonight, but can the Minister write to noble Lords who have spoken in this debate to set out how the Government consider that the health and social care system—and the Government —are responding to those 18 recommendations? In particular, will she pick up the point raised by the noble Baroness, Lady Tyler, about whether the local action that NHS England has instituted, which is not mandatory, can be seen to be a response to the recommendation of a national learning disability mortality review body? I do not think that it can be unless there is a proper mandating of the NHS to take part in it.
The second question comes back to the point made by the noble Baroness, Lady Hollins, about a national strategy. Do we have a national strategy? If not, will the Minister say how the Government intend that there should be a proper national strategy, nationally led, that will ensure that the kind of changes that need to happen will take place?
Finally, I do not think that funding is the only problem: attitudes are much more important. But no one can deny the funding challenges in health and social care at the moment—nor that, despite the Government’s intention that more money should be spent on mental health, it is quite clear that clinical commissioning groups will not do that because they are under intense pressure to balance the books. It has become clear that balancing the books is trumping any other policy. So my final question for the Minister is, essentially, what will happen to protect the funding of those services, which impact directly on people with learning disabilities?
Clinical Pharmacologists
Lord Hunt of Kings Heath Excerpts(8 years, 3 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what assessment they have made of the impact of the decline in the numbers of clinical pharmacologists practising in the National Health Service and teaching in universities on treatment and research capacity.
Lord Hunt of Kings Heath (Lab)
My Lords, this debate was organised at a very late stage on Wednesday evening so I am most grateful to all noble Lords who are taking part in it, and indeed to the Minister who will respond.
Most of the major advances in medicine in the past 50 years are related to the better use of better medicines. That is what makes this debate so important. Clinical pharmacology is the study and use of drugs in men, women and children. Clinical pharmacologists are to be found in hospitals and teaching settings, employed by the NHS and the university sector, with many employed by both. Clinical pharmacologists teach clinical pharmacology at undergraduate and postgraduate level, and provide training and support for other healthcare professionals in hospital settings. They practise those branches of medicine where drug treatment and the safer medicines agenda are pre-eminent. They can help other doctors who practise in other branches of medicine to learn about dose response, inter-individual differences in drug response and drug-to-drug interactions in order to improve patient care and prescribing practice.
By working with and training healthcare professionals, clinical pharmacologists can save the NHS money by stopping unnecessary drugs and using cheaper, more appropriate and equally effective alternatives. This is particularly pertinent given recent discussions about the NHS drugs bill; medicines spending accounts for around 10% of the overall NHS budget and costs in the region of £16 billion.
In addition to playing a valuable role in the NHS and teaching in medical schools, clinical pharmacologists are researching pioneering medicine in British universities and the UK biopharmaceutical industry. They are experts in experimental medicine, designing early-phase clinical trials, establishing NHS clinical research facilities and providing overarching clinical support. The specialty provides leadership in the use of medicines, and the benefit is felt across the broader NHS—in primary and secondary care and in areas such as regulation and medicines assessment.
Clinical pharmacologists hold a number of strategic posts within the UK healthcare and regulatory environment, so they can make decisions with widespread impacts. The National Institute for Health and Care Excellence, the Scottish Medicines Consortium and the All Wales Medicines Strategy Group have all been led by clinical pharmacologists to ensure the best use of NHS resources. They hold and have held a number of key posts within the Medicines and Healthcare Products Regulatory Agency as well. The MHRA’s yellow card scheme, which collects information on side-effects, has centres led by clinical pharmacologists across the UK. Consultants in clinical pharmacology lead the National Poisons Information Service. They have jointly led the development of the prescribing safety assessment with the UK Medical Schools Council, an innovation in medical education that aims to increase prescribing competence among newly qualified doctors.
The past 50 years have seen a huge use of this highly specialised group of clinical doctors. Looking to the future, the question is: do we need them? Indeed we do. Thinking about personalised medicine as a new frontier, clinical pharmacologists can play a crucial role in refining the use of currently available medicines and developing and pioneering the medicines of tomorrow. With an ageing population and many people with multiple illnesses who use multiple medicines, the potential of the clinical specialty is very great.
There can be no argument about either the past contribution of clinical pharmacologists or their potential contribution in future, but here is the rub. At a time when we need more of them, actual reductions in their numbers are taking place. This is affecting clinical posts as much as university teaching opportunities and it is producing a vicious circle. Changes in teaching at medical schools mean that many students pass through their training without ever hearing the term clinical pharmacology. In addition, the British Pharmacological Society has found that there is about one consultant in clinical pharmacology to 500 undergraduates, compared to one cardiology consultant to only 40 undergraduates. That means the specialty has low visibility among students and trainees, so there are few role models. Indeed, many medical students can go through the whole of medical school without even hearing of the specialty. Furthermore, the low number of consultant posts can be a deterrent in itself. Unsurprisingly, trainees are unwilling to start training in a specialty where local consultant jobs are at best uncertain, at worst unavailable. There is therefore compounded uncertainty, which makes it difficult to fill trainee posts.
We then come to the NHS and its employment of consultants. The problem is exacerbated by Health Education England’s workforce plan approach, which is an aggregate of local plans. Inevitably, those local plans are focused on immediate pressures related to targets and waiting times, so the decision-making of Health Education England operates on a demand and supply model. It asks NHS trusts what they need, collates those requirements and that essentially becomes the strategy. As most NHS trusts do not have a clinical pharmacologist consultant, they will never ask one. Hence, Health Education England states that there is no demand and therefore no need to increase supply. This is a problem for all small specialties. What we need, above all else, is strategic thinking at national level for these very important, small-number specialties. It needs to be multifaceted because we need to increase visibility to the next generation, supporting training and securing more consultant posts.
In many cases, even more worryingly, the problem has spread to industry. A shortage in clinical pharmacological skills in the UK biopharmacological industry was highlighted last year as part of a call for urgent development of a skilled workforce by the Association of the British Pharmaceutical Industry. We have traditionally enjoyed a very high reputation in this field: we can think of eminent people, such as Sir Michael Rawlins, now the chairman of the MHRA, previously the chairman of NICE, or Sir Alasdair Breckenridge, former chairman of the MHRA. Alongside these global leaders in thinking in this area is a pharmaceutical sector that is hugely important to Britain, given the scale of R&D investment and the consequent developments that take place in the UK. That is important not just to patients but to the UK economy.
Some of this is at risk because the people who make the key decisions are essentially NHS bodies and universities who do not have the strategic picture. Indeed, at the moment there are only 72 consultants in post in the NHS, despite a recommendation from the Royal College of Physicians that there should be about 440. Over the past 10 or 15 years we have seen a huge increase in the consultant workforce, but in terms of clinical pharmacologists there was a massive increase in the last 12 years from 72 to 77. These gains have not been protected and my understanding from the British Pharmacological Society is that the number has now gone to 72 consultants.
The case I want to put to the Minister is that we need some action. The British Pharmacological Society is calling for more investment by the organisations responsible for workforce management in the four UK nations—this is a UK issue as well as an issue for England—to provide a minimum increase of 78 consultant posts to bring the total up to 150 by 2025. It also wants to provide clear career pathways with associated career support and development.
How is this to be done? I hope that this afternoon the noble Baroness will signal her support for some action to be taken. I hope she will recognise the fundamental contribution of clinical pharmacology to the NHS and the safer medicines agenda and, as importantly, its potential pivotal role in maintaining the UK’s leading international academic and industrial position in the pharmaceutical sciences. I hope she will agree to meet the British Pharmacological Society with Health Education England, NHS England and the NIHR to agree workforce numbers, and to discuss what can be done in terms of a high-level strategy for clinical pharmacology. I also hope she will urge the British Pharmacological Society to work with the ABPI, the Medical Research Council and other employers and training providers on developing joined-up careers and training pathways as part of this strategy.
We are all aware of the financial pressure on the NHS at the moment, but I just point out that the clinical pharmacology specialty delivers essential cost savings. Indeed, work for the society to be published shortly by PWC estimates that for every pound invested in clinical pharmacologists, £5 can be saved through more efficient use of medicines and fewer adverse drug reactions.
This country has a pre-eminent role in the field of clinical pharmacology. It is very clearly at risk and I very much hope that the Minister will signal that the Government are prepared to take action to reverse the very worrying trend we are seeing at the moment.
Baroness Chisholm of Owlpen (Con)
My Lords, I begin by thanking the noble Lord, Lord Hunt, for securing a debate on this important subject. He has spoken today about the vital role fulfilled by clinical pharmacologists and the contribution they make to effective treatments for the population of this country.
As the noble Lord pointed out, pharmacology lies at the heart of biomedical science, linking together chemistry, physiology and pathology. Those that take up the speciality work closely with a wide variety of other disciplines, including neuroscience, molecular and cell biology, immunology and cancer biology, to name just a few. They improve the lives of millions of people globally by providing vital answers at every stage of the discovery, testing and clinical use of new medicines.
The ability to use medicines effectively, to optimise their benefit and minimise the risk of harm to people, relies on pharmacological knowledge and understanding. We hear much about new diseases such as Ebola and Zika and their emergence and also hear much about older medicines—most notably antibiotics—no longer working as well as they did, so the contribution of pharmacology to finding better and safer medicines continues to be vital.
While it is true that there has been a decline in the number of clinical pharmacologists practising in the UK, it is important that we recognise that the fall in numbers is relatively small. Data from the British Pharmacological Society and the Royal College of Physicians show that the number of CPT consultants in the UK fell from 74 in 2002 to 72 in 2013, and that 52 of the 72 consultants were based in England, but perhaps a drop of even that amount is important.
As regards the supply of the profession, as noble Lords will be aware, from being established in 2013, it has been Health Education England’s responsibility to ensure that there is sufficient future supply of staff, including those needed in specialist fields such as this, to meet the workforce requirements of the English health system. It is the responsibility of the devolved Governments to ensure their health systems have the staff they require. Each and every year, Health Education England produces a national workforce plan for England. This is built upon the needs of local employers, providers, commissioners and other stakeholders who, as members of the local education training boards, shape their local plans.
Health Education England therefore has a responsibility for ensuring an adequate supply of trainees to provide the consultant workforce of the future, but is not responsible for setting the number of consultant posts inside the NHS. As I have just set out, this is the role of trusts, commissioners and others. HEE annually reviews the number of training places in medical specialties in response to demand expressed by the NHS. It is therefore crucial that trusts have a clear view of how they wish to utilise and promote clinical pharmacology and therapeutics positions in their hospitals.
To its credit, HEE has increased the number of training posts available. However, not all of these have been filled. Clinical pharmacology and therapeutics has suffered in terms of its fill rates against other high-profile specialties. However, as my noble friend Lady Gardner of Parkes mentioned, there needs to be more recognition of the career, more involvement with related healthcare organisations and perhaps more understanding of how fascinating and interesting this career can be, as the noble Baroness, Lady Thornton, said. In an attempt to counter this, HEE has been working to make the profession more attractive to junior doctors as they begin to specialise, including making the role more flexible to trainees, offering joint training with other specialisms and actively promoting the role at careers fairs.
The noble Lord, Lord Hunt, mentioned people not coming forward because of the uncertainty of a job. That is why some clinical pharmacologists already train towards a dual CPT, which then broadens the scope of their practice, making them more desirable to employers due to increased flexibility. I am aware that HEE has also been undertaking a review of this area and will, in due course and upon completion, share these findings with stakeholders, including the British Pharmacological Society. Leading on from that, the role has also been promoted by the chair of the British Pharmacological Society and is supported by the four UK health systems.
It may be interesting to note that the supply of clinical pharmacologists is primarily domestic, with only a very small number coming from overseas. In the three years 2012 to 2015, only one of the newly appointed consultants was trained outside the UK. Both the Royal College of Physicians and the British Pharmacological Society feel that there is a need for growth in this area and assert that current and predicted supply is insufficient to support that growth, and as such are calling for more training posts. There is, though, a lack of consensus between the Royal College of Physicians and the British Pharmacological Society about the level of future demand and the numbers required. This is perhaps an indication that it is not easy to evaluate future demand or possibly indicates a lack of understanding of these roles out in the wider health system.
Given the need to spend taxpayers’ money responsibly —and the difficulty filling the existing training posts—HEE is not able to increase the number of training positions until the demand is signalled by the NHS. At this stage, no significant increase in demand has been signalled in HEE’s annual collection of forecast demand from providers, which forms the basis for the annual training commissions for medical specialties.
In summary, I strongly encourage professional bodies with an interest in this field of medicine to actively engage locally with NHS trusts to ensure that where there is a need for additional clinical pharmacologists, they feed this in to the HEE workforce planning process. This process is the fundamental bedrock for NHS workforce planning. HEE actively engages with its stakeholders in developing its annual workforce plan, and any change in workforce planning numbers needs to be debated and resolved through this process. It is interesting that this is obviously not only a problem in the United Kingdom, because several reports have come out of the United States which show that it is having similar difficulties.
I thank the noble Lord, Lord Hunt, for giving us the opportunity to discuss this important matter.
Lord Hunt of Kings Heath
I am most grateful to the Minister for giving way and for the eloquence of her response. From what she said, the Government’s view is that this is solely a matter for Health Education England, and I understand that. However, does she accept that because HEE is concerned only with the accumulation of the local plans, it is not able to take any account of the national significance of this clinical speciality, and that there is a risk here because local employers do not see this as particularly important, although nationally we can see that it is vitally important? Is there a case for asking HEE to look at the national strategic importance of the professions? That would be one way of looking at this from a rather different viewpoint.
Baroness Chisholm of Owlpen
The noble Lord stopped me just as I was about to say that very thing. This is one of the important problems. There is not joined-up thinking—certain bodies are not aware of the importance of this—so it becomes a kind of vicious circle. I was going to say that we need joined-up thinking, and I hope that debates such as this will increase awareness and get people to think further. I will be happy to meet those bodies involved; they might well prefer to meet my noble friend Lord Prior but I will be happy to accept on his behalf.
I thank all noble Lords who have taken part in this debate.
Record Copies of Acts of Parliament
Lord Hunt of Kings Heath Excerpts(8 years, 5 months ago)
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Lord Bridges of Headley
I am very delighted to be discussing this pressing issue today because there is not much else going on. I respect what my noble friend has to say but I gently repeat that the recording of Acts of Parliament is a matter for the two Houses. We very much hope that a way forward can be found to continue the use of vellum. If that is not the wish of this House, a way will have to be found, but, as I say, we await the outcome of the committee’s meeting this afternoon.
Lord Hunt of Kings Heath (Lab)
My Lords, I cannot really believe that that is the Government’s position. This House, through our committees, has decided to phase out the use of vellum. To reintroduce it would be hugely expensive and a complete waste of time. I hope the Government are not reversing their position on this.
Lord Bridges of Headley
I gently say again that this is a matter for both Houses. It is a matter for the committee of this House and the committee of the other House to come to some agreement on. I am delighted, though, that the Labour Party is now looking to save money; this is a great turn up for the books. As I say, this is not a matter for government. We have made an offer but it is up to the Houses to decide.
Security: State Procession
Lord Hunt of Kings Heath Excerpts(9 years, 5 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, will the noble Lord refer this matter to the appropriate Joint Select Committee of both Houses, which looks into these matters? I think that would give a great deal more confidence.
Lord Bridges of Headley
My Lords, let me take that concept away with me. I have looked into this matter over the last few days and I am assured that the relevant security matters have been addressed, and that we have balanced those matters with the need to deliver savings in government.
Constitution: Gracious Speech
Lord Hunt of Kings Heath Excerpts(9 years, 5 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I warmly welcome this debate and thank my noble friend Lord Wills for his opening remarks. I certainly agree with the noble Lord, Lord Norton, on the need for a coherent approach to constitutional change. He has made the point many times before. Any objective analysis of the Government’s proposals would show that they have produced anything but that coherence, and they certainly do not answer the questions raised by my noble friend Lord Soley when he asked what the nature of the UK itself is in the current context and about the need for a lasting settlement. Indeed, as my noble friend Lord Wills said, many of the proposals seem to be motivated by short-term political advantage rather than in order to provide any long-term national benefit. I certainly see nothing in them that would bring our nation together, nor do I see anything which would restore public confidence in the health of our political system. I shall take one example. As my noble friend Lady Taylor said, we have proposals to create two tiers of Members of Parliament on the basis of Commons Standing Orders. A change of such immense importance surely deserves the full scrutiny of both Houses of Parliament, looking not only just at the proposal, but at the impact on the rest of the constitution.
We also see proposals for the repeal of the Human Rights Act which will reduce the ability of those who find themselves the victims of state abuse to defend themselves adequately, along with proposals which may involve the Human Rights Act continuing to apply in Scotland and Northern Ireland but not in England, thus driving a further wedge between England and Wales on the one hand and the rest of the United Kingdom on the other. My noble friend Lady Kennedy pointed out the risks of that.
There are proposals from the Justice Secretary to limit the public’s right to know by emasculating the Freedom of Information Act, and proposals to make it more difficult for unions to donate to political parties and ballot their members. These proposals do absolutely nothing to increase the transparency of donations made by private donors to political parties, particularly the Conservative Party. In the Bills that the Government intend to introduce, nowhere is there any sense of the public crisis in confidence in our constitutional arrangements. Where is the response to the work of my noble friend Lady Kennedy and the Power inquiry and the disengagement of so many people from those who wield power? Where are the proposals to deal with the imbalance in registration of voters? The young, the renters—those who do not own their own homes—the poor and those from minority ethnic groups have the highest levels of non-registration. What steps is the Minister taking to ensure that electoral registration does not leave millions of people unregistered? My noble friend suggested that the figure is 8 million.
What steps will the Minister take to stop new constituencies being created that fail to take account of the actual number of people who live there? What is his response to my noble friend Lord Lipsey, who pointed out that the bias in favour of Labour has now been reversed, which should give the Government a greater sense of interest in providing greater tolerance in the numbers that will be allowed for each constituency? I also want to ask about the recent report of the Electoral Commission of the 1.9 million people retained on the electoral register under transitional arrangements. The Electoral Commission wants to delay bringing forward the order to bring an end to the IER. Will the Minister say whether the Government agree?
On human rights, my noble friend Lord Judd spoke of the indispensability of international institutions. How right he is. My noble friend Lady Kennedy spoke of the tragedy of our potential withdrawal on human rights. We have a Government who say that they support human rights but that they should be British human rights. Of course, one has to go back to the October 2014 document which said that the Conservatives would reintroduce the rights in the same wording as the convention rights, but would make it clear that there are aspects of those rights that would be specifically excluded. For example—the noble and learned Lord, Lord Brown, has already pointed this out—on the prohibition of deportations if the deportee would be tortured or killed on return, such deportations could go ahead. Another example is the application of human rights law to the military.
We are very confused about what the Government intend partly because Ministers keep making remarks that seem to be in direct contradiction to each other. The Minister has a very good opportunity to spell out what are the Government’s intentions. Can he say whether they will withdraw from the convention? The Lord Chancellor made remarks on this yesterday that directly contradicted something one of his junior Ministers said very recently.
On devolution, I will simply say that in relation to Scotland we want the Smith commission to be implemented in a comprehensive way. We want to keep the Barnett formula alongside more powers to make the Scottish Parliament one of the most powerful devolved Parliaments in the world. We also want to put devolution on a stronger statutory basis. We agree with the proposals of the Silk commission but Wales should not be unfairly disadvantaged by the Barnett formula, and we support a fair funding system for Wales by introducing a funding floor. In Northern Ireland we welcome any aspects of the Stormont House agreement, but the current deferment of decisions on welfare mean that the agreement is in a precarious position. I should like to know what the Government are doing with the Northern Ireland Executive to deal with this issue.
On English devolution, I want to pick up the point made by the noble Lord, Lord Rennard. We certainly support the devolution of much greater powers and control of budgets to the city regions and counties, but surely it is for those cities and counties to decide on their own leadership arrangements. Why, when the people of Birmingham made it abundantly clear in a referendum that we did not want an elected mayor, are we now being effectively blackmailed into having one to get powers commensurate with the importance of the greater Birmingham region to the UK economy?
On Lords reform, my noble friend Lord Desai put forward a perfectly coherent set of proposals and the noble Lord, Lord Steel, mentioned the Bryce commission of 1918, which bears a rather uncanny resemblance to the Billy Bragg secondary mandate proposals. The Conservative manifesto states:
“While we still see a strong case for introducing an elected element into our second chamber, this is not a priority in the next Parliament … will ensure the House of Lords continues to work well by addressing issues such as the size of the chamber and the retirement of peers”.
I assume it means that the Government will do absolutely nothing except address the size of the Chamber by appointing even more Conservative life Peers.
I want to ask about the increasing practice, raised by my noble friend Lady Taylor, which we have noticed in the number of Bills coming forward. They seem to be skeleton Bills with lots of Henry VIII powers. My noble friend said that we should look at whether the House should respond in the way in which it deals with statutory instruments. If the Government are using Commons Standing Orders to introduce two tiers of MPs in the House of Commons they should not be surprised if we seek to use Standing Orders in this House to give greater scrutiny to secondary legislation. The precedent will have been set in the other place.
My noble friend is so right. This is a programme aimed at short-term advantage and promotes division. It threatens the union, the reach of our voting system, the rights of our citizens and the strength of our nation as a defender of human rights in the world. Our political system is in trouble. The union is fragile. Our place in Europe is uncertain. Politicians are held in low esteem. Only 43% of those registered aged 18 to 24 voted at the last election. What better illustration of the problems in our political system?
No one should be complacent about the state of the health of our constitution. We have to re-engage and strengthen our constitutional arrangements. If ever we needed to look at the constitution in the round, the time is now. That is why we support the establishment of a constitutional convention. Why will the Government not agree to that?
Deregulation Bill
Lord Hunt of Kings Heath Excerpts(9 years, 10 months ago)
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“( ) This section does not apply to the following—
(a) Care Quality Commission,(b) Human Tissue Authority,(c) Medicines and Healthcare Products Regulatory Agency,(d) Professional Standards Authority,(e) General Medical Council,(f) Nursing and Midwifery Council,(g) Health and Care Professions Council,(h) General Chiropractic Council,(i) General Dental Council,(j) General Pharmaceutical Council,(k) Human Fertilisation and Embryology Authority, and(l) any persons exercising a regulatory function with respect to health and care service that the Secretary of State specifies by order.( ) An order under this section must be made by statutory instrument.
( ) A statutory instrument containing an order under this section may not be made unless a draft has been laid before, and approved by a resolution of, each House of Parliament.”
Lord Hunt of Kings Heath (Lab)
My Lords, I am concerned about the unintended consequences of the economic growth clauses on a number of health regulatory bodies. The clauses on the impact of economic growth specify that regulators must consider the promotion of economic growth in exercising their regulatory functions. The Government have said that the health regulators likely to fall under Clauses 88 to 90 are as follows: the Human Fertilisation and Embryology Authority, the Human Tissue Authority, the Medicines and Healthcare Products Regulatory Agency, the Professional Standards Authority and the Care Quality Commission.
The noble Lord, Lord Wallace of Saltaire, has said that the economic growth duty will complement existing duties and will not override or reduce the protection of the public. However, I put the question to him: if the economic growth duty does not impinge on the prime responsibility of the regulator, why bring in the clause at all?
The Minister then said that the economic growth duty sits alongside any other factor that a regulator must consider. However, “sitting alongside” suggests that it has some weighting and cannot simply be ignored. Indeed, the noble Lord has also pointed out that regulators must understand and consider the impact of their policies on individual businesses. That is of course reinforced by the provisions in the Bill.
Clause 88(2) states that “the person”—that is, the regulator—must,
“consider the importance for the promotion of economic growth of exercising the regulatory function in a way which ensures that … regulatory action is taken only when it is needed, and … any action taken is proportionate”.
In Committee my noble friend Lord Tunnicliffe specifically asked about the position of the Care Quality Commission —the principal health quality regulator, to which the noble Earl, Lord Howe, has just been referring—as regards whistleblowing. My noble friend asked,
“do we want a situation where, when the CQC is contemplating putting a requirement on a failing nursing home that may close it down to protect the residents of that home, the operator of the home can say, ‘Closing me down is against growth. Please prove that this regulation, which you may have used elsewhere, is both needed and proportionate’?”.—[Official Report, 20/11/14; col. GC 206.]
I have to say to the noble Lord that I do not detect any enthusiasm from the health regulators themselves about the economic growth duty. The CQC’s briefing to me can hardly bring itself to mention the duty.
The Professional Standards Authority, in line 1, says that it supports the intention behind Clause 88, and then spends the rest of its briefing critically examining the clause. It concludes that Clause 88 ought to be restricted by excluding from the duty any regulatory function the prime purpose of which is to protect the public. I must say that I am surprised to see the Professional Standards Authority included. It is not a regulator. Its job is to oversee the nine statutory regulators, including the General Medical Council, and I do not understand why the GMC and the NMC are not on the Government’s list of organisations to be included within this clause.
Can we come to the Human Fertilisation and Embryology Authority? The noble Lord will know that that body has a crucial and difficult task, and this responsibility could make that duty even more difficult. On 24 February we will have a debate about regulations on mitochondrial donation. Currently, the law only allows these techniques to be used in research. For the IVF techniques to be used in patients, Parliament must pass new regulations.
Both the Nuffield Council on Bioethics and the HFEA held extensive public consultations in 2012. They identified broad public support for the use of these techniques with a “robust regulatory framework”. I stress those words. As the noble Earl’s honourable friend the Minister Jane Ellison told the other place when it debated the regulations:
“The HFEA is highly respected across the globe as a model for the regulation of fertility and embryology treatments and research. Many other countries do not have such a framework”.—[Official Report, Commons, 3/2/15; col. 163.]
Indeed, if the regulations are passed by Parliament on 24 February, the HFEA will be expected to introduce a robust regulatory process, as it has in other areas of fertility treatment. I know that not all noble Lords think that it is as robust as they would wish it to be. None the less, many of us would say that it is a robust process.
The question that I put to the noble Lord is about where the economic growth considerations come in. There is no provision in the Human Fertilisation and Embryology Act for the HFEA to have regard to the imperative to promote economic growth when making its decisions. If a clinic does not meet statutory requirements, it cannot grant a licence or allow a certain activity to take place, regardless of how economically desirable it might be thought to be. Similarly, if there had been gross failings at a clinic, regardless of the economic impact of closing it down the HFEA would be bound to say so in the interests of ensuring patient safety and maintaining public confidence in it as a regulator. Surely the economic growth duty is inconsistent with those requirements. The HFEA’s own website has often acknowledged that it is not an economic regulator. This has been confirmed by Ministers in Written Answers. Peter Thompson, the chief executive officer of HFEA, has recently been quoted as recognising a responsibility by that authority to take action against what he described as rampant commercialisation of IVF in the UK.
The Minister has prayed in aid the draft guidance during the passage of this Bill, but it only adds to concern. The guidance summary states:
“The growth duty does not automatically take precedence over or supplant existing duties held by regulators”.
The term “not automatically” must by implication mean that it is entirely possible for it to take precedence.
The decision about mitochondrial donation is of huge importance. It must be made in the absolute certainty of the regulatory process. There is no time for ambiguity. Will the Minister agree to give this further consideration? I find it very difficult to understand why any of these bodies are going to be included in the list for which regulations will be brought forward. Why on earth has the Human Tissue Authority been brought in scope of this provision, or the Care Quality Commission? I certainly do not understand why the PSA is included. I hope that the Minister will bring some words of comfort that the Government have reconsidered this issue, and I beg to move.
Lord Hunt of Kings Heath
My Lords, I am very grateful to all noble Lords who have spoken. However, I am disappointed with the Minister’s response because I thought that at the least he would have been prepared to give this matter further consideration between now and Third Reading. With my noble friend Lord Winston here to talk about the Human Fertilisation and Embryology Authority and the noble Lord, Lord Alton, also present, I knew that we would have an interesting debate.
The point is that, however effective or not the HFEA is at the moment, the one thing that unites us all is that we do not want to see its regulatory function weakened. My noble friend Lord Winston spoke about London becoming the centre of a healthcare market, and the Minister welcomed that. When I took through the 2001 regulations that extended the purposes of research in the original 1990 Act, which was based very much on the extraordinary work of the noble Baroness, Lady Warnock, we clearly had in mind that there was research potential for the UK. That was one of the factors behind taking through those original regulations. The argument that we put forward then was that the UK would be able to attract research investment because, despite some of the doubts that noble Lords have expressed today, we were considered to have a first-rate regulatory function. I put it to the noble Lord that he is putting that reputation at risk by allowing ambiguity in the nature of the regulatory process.
My noble friend talked about the dangers of commercialisation in this field and he is surely right. It is interesting that the chief executive of the HFEA has recently been quoted as recognising the responsibility to take action against rampant commercialisation of IVF in the UK. That statement is very welcome. My noble friend has argued that at the moment it does not have the powers to do anything about it, but the noble Lord comes here with a proposal to weaken its already inadequate powers. That is quite remarkable.
The Government are very keen for the mitochondrial donation regulations to be approved on 24 February. I support them, but has the noble Lord considered the risk to that decision from the impact of this Bill? This will be a big issue when we debate those regulations. When the noble Earl, Lord Howe, comes to make proposals for the regulations, he will say that your Lordships can have confidence in passing the legislation because of the robustness of the HFEA. However, I, who support those regulations, will have to get up and say that actually the noble Earl is incorrect because of what the noble Lord here is proposing to do.
Lord Alton of Liverpool
I entirely agree with what the noble Lord is saying, but does it not also undermine the noble Earl, Lord Howe, who has consistently said that the HFEA is not an economic regulator, to now put him in that invidious position?
Lord Hunt of Kings Heath
That is absolutely right. The noble Lord then went on to say that we should be fine because the provisions in the Bill say that all the regulator has to do is to “have regard to” the desirability of promoting economic growth. However, the moment you include those words, the regulator becomes liable if it can be shown that he does not have regard to that, even though the noble Lord recognises that in many cases he ought not to have regard to it.
It is quite inadequate to say that we are consulting on this. This is absolutely wrong. We need to know by Third Reading whether the Government are going to keep in the HFEA and the PSA. I think that the noble Lord ought to allow further discussions to take place between now and Third Reading, and he ought to discuss this with his colleague—particularly the impact on the new regulations on mitochondrial donations that will be coming forward. As for his assurance that any of these bodies will be included by an affirmative resolution, how many times has an SI been defeated in Parliament? It is fewer than 10 times, so it is a meaningless safeguard in effect. I invite the Minister to say that he will at least give this further consideration before Third Reading before I make my decision.
Lord Wallace of Saltaire
I will be glad to take this back and confer with others, but I cannot give any assurances that the Government will come back with anything different on Third Reading. However, I am always open to conversations off the Floor.
Lord Hunt of Kings Heath
My Lords, that is very handsome of the Minister and I beg leave to withdraw the amendment.
House of Lords (Expulsion and Suspension) Bill [HL]
Lord Hunt of Kings Heath Excerpts(10 years ago)
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Lord Brown of Eaton-under-Heywood (CB)
My Lords, I should like to put on record my support. I had the honour to serve as the chairman of the Conduct Sub-Committee of the Privileges and Conduct Committee. At Second Reading, I gave strong and firm support to, and welcomed, the Bill. As the noble and learned Lord, Lord Mackay, has made plain, it would fill the present, most concerning lacuna in our sanctioning powers. Again, I echo the hope that it will never be necessary to exercise these increased powers.
I welcome all the amendments. The first meets the concern expressed by the noble Lord, Lord Finkelstein, in Committee. In its original form, this provision was too narrow and confined only to what is now in proposed paragraph (a) of the amendment. As the noble Lord pointed out, it would fail, for example, to deal with someone who committed perjury in a libel case and it took four years for that perjury to be revealed. That problem is now cured by the amendment. I strongly welcome it and the other two amendments, too.
Lord Hunt of Kings Heath (Lab)
My Lords, on behalf of the Opposition, I agree with the noble Baroness, Lady Flather, that this is timely and long overdue. We support all three amendments. How good it is to know that something survives from the 2012 House of Lords Reform Bill and goes forward in this Bill. We support it.
Lord Wallace of Saltaire (LD)
My Lords, the important thing is to get all stages of the Bill through the House in good order. We entirely accept that the Bill is about Lords’ conduct and therefore their reputation. As such, it is a useful addition to the procedures available to the House, although—to repeat what has been said—we all hope that the powers will rarely, if ever, be needed.
The question of what happens in another place will, of course, have to be discussed. I have assurances that the Leader will be discussing that matter with others but, meanwhile, we welcome the clarity of these amendments. The Bill is now in good order and we should accept this as the Report stage.
House of Lords (Expulsion and Suspension) Bill [HL]
Lord Hunt of Kings Heath Excerpts(10 years, 1 month ago)
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Lord Finkelstein (Con)
My Lords, the last thing I would want to do is delay the Bill in any way. I was shocked recently to discover that this proposal has been debated since the 19th century without being passed. Of course the principle is absolutely right, but I just question whether Amendment 1 is really a very good idea. We talked just now about expenses. Obviously, if we pass the amendment, that conduct, which would have taken place before the Bill came into force, may only be exposed after it came into force. The amendment would make it impossible to deal with that conduct. In other words, the amendment makes it difficult to deal with some of the worst conduct. To use an entirely hypothetical example, if someone committed perjury in a libel case and it took four years for that perjury to be revealed, in the course of which the Bill was passed, the conduct would no longer fall under the Bill. I wonder whether the amendment is quite what we want.
Lord Hunt of Kings Heath (Lab)
My Lords, the Opposition fully support the noble Baroness in her endeavours. The noble Lord, Lord Finkelstein, raised an interesting point to which the noble Baroness will no doubt respond. There is time between now and Report if clarification is required. I take his point.
The Bill can be fairly assured of passage through your Lordships’ House. The question is, when it gets to the Commons, what help will the Government give it? Without government help, I suspect that it will be very difficult for the Bill to pass, so it is right for me to press the Minister on what the Government’s attitude will be. At Second Reading, the noble Lord, Lord Wallace, helpfully said, as the noble Baroness reminded the House, that the Government have no settled view on the Bill at present. He kindly said that he would take back the speeches and consider with colleagues what response the Government could make. I hope that today he will be able to tell us that the Government are prepared to give this a fair wind in the other place. The other place does not have much work to do; the Government have sent MPs home. They now do Mondays to Wednesdays, so there is plenty of time for the Commons to consider this if the Government so wish.
There is an appetite in this House for sensible change. Discussions are taking place about the noble Baroness’s Bill and other noble Lords are discussing the issue of retirements, which we are going to have to face up to. Yet more noble Lords are discussing improving the governance of the House. I hope that the Government will allow for these discussions to take place and that we can have some more general debates about the issue of retirement. I think that we could reach a consensus on retirements in your Lordships’ House. The Minister is looking at me but there is an overwhelming appetite among noble Lords all around the House to sort this out. We have had the remarkable example of the Lord Speaker making a statement some months ago, giving notice of her intent to leave the House at a certain time. That was a marvellous example. Why are the Government not allowing the House to come to a sensible view on these matters?
The Minister may say that it is because substantive reform is just around the corner, and he may quote me as having said that in the past. It is difficult to assume who is going to win the next election, but let us assume that we have a Government after the next election, after some time and of some sort. Let us assume that they set up some kind of review—a convention or whatever—to come forward with proposals on substantive reform. I would say that the first opportunity of that coming into practice would not be before 2020, if we are realistic.
Lord Cormack
I am grateful to the noble Lord, whom I am tempted to call my noble friend on this occasion, as on others, for giving way. Does he not agree that it would be entirely feasible for the Government to set up a Select Committee of this House, with a strict timetable to report back by the end of January or in early February on the issues to which he was referring? I am quite confident, from my experience in the Campaign for an Effective Second Chamber, that consensus could be reached, and reached amicably.
Lord Hunt of Kings Heath
I very much agree with that. That is a very sensible approach and I am sure that consensus could be reached. The point I was making is on the argument that we should not do this because substantive reform is just around the corner. As I said, even if we agreed and a Bill went through and was approved by both Houses, it would be very unlikely to be implemented before 2020. So for at least five years ahead, we will be working under the current arrangements. The argument for sensible change—
Lord Hughes of Woodside (Lab)
I am slightly confused. I thought that this Bill was about dealing with people who transgressed the behaviour expected in this House. I appreciate that my noble friend is anxious to pursue his agenda but he knows perfectly well that consensus on reform of this House can proceed only on the basis of its powers compared to the House of Commons. Until that is satisfied, all the discussion in the world will get nowhere and he should not waste his time on it.
Lord Hunt of Kings Heath
With the greatest of respect—and I have great respect for my noble friend—I think that he has missed the point. I agree that substantive reform of the Lords will not take place until the relationship between this House and the other place is fully resolved. I believe that conventions will need to be codified in an Act of Parliament to have any chance whatever of there being a relationship between two elected Houses, if we are to have two elected Houses. Other noble Lords will disagree but I say to my noble friend that the argument that the Government have deployed on a number of occasions is that we cannot agree to sensible, incremental measures because we are committed to a fully elected second Chamber. That seems to be the argument that essentially comes out, certainly from the Minister and his party. My point is that even if we were to reach consensus and a reform Bill went through both Houses, it would be some years before it could actually be put into practice.
In the mean time, we still want a second Chamber to be as effective as possible. The way we are going, the issue about numbers is becoming so serious that we are running into a real problem of credibility. That is why I hope that the Minister will be very positive on this Bill but that he will also reflect on what his noble friend has said about allowing the House to discuss these other matters and come to a view very quickly, which I believe could be done.
Lord Wallace of Saltaire (LD)
My Lords, I hesitate to open up a wider debate about long-term Lords reform. We all know that we are already into substantial discussions about constitutional reform of this multinational state. I suspect that after the next election and, as the noble Lord, Lord Hunt, just said, with whatever shape of government should emerge from it, the future of this House will be caught up in those discussions. Two of the three parties are already committed to a constitutional convention, so there are a range of things—
Lord Hunt of Kings Heath
I am grateful to the noble Lord for giving way. I am sure he is right but does he also accept that it will be some years before any change can take place? Therefore, the argument that the House should be given a fair wind by the Government to make some incremental, sensible change is overwhelming.
Lord Wallace of Saltaire
The noble Lord and I will discuss, off the Floor, the question of how easy it will be to get consensus on the principle of retirement. I will tell him about some of the conversations I have had with Members of his own Benches about this over the past two years, some of which have been extremely vigorous.
Meanwhile, we are dealing with the Committee stage of today’s Bill, which, as the noble Baroness, Lady Hayman, rightly pointed out, is concerned with the conduct of the House. It has a limited and specific purpose and is concerned with the reputation of Parliament as a whole. We welcome that. The Bill is also concerned with rebuilding public trust in our political institutions and, as she made clear, is intended to give the House precautionary powers—powers which are intended to be available but to be rarely, and, one hopes, never, used. We recognise that and the Government also recognise the sentiment around the House on the Bill. We are very happy to work with the noble Baroness to ensure that the amendments are tweaked into a form that would suit.
We understand the spirit of the amendments but there are some issues about the exact definition, which we need to clarify. The noble Lord, Lord Finkelstein, raised one example: what do we do if we become aware of past conduct which was egregious but was not previously known? What do we do about past conduct, the effects of which are continuing? The issues of retrospectivity are complicated in this regard and the House will also need to be concerned that we currently have an inherent power of suspension, which may or may not be used with retrospective regard to past conduct. If we were to pass this, we would be limiting the power of suspension that the House currently has. What I can do on behalf of the Government is to say that we would be very happy for Cabinet Office officials and lawyers to discuss between this stage of the Bill and the next, with the noble Baroness and others, how we might reshape these amendments to put them into a reasonable form.
The Government are giving the Bill a fair wind in this House. How far we will be able to assist it in the other place is a matter which the Government do not yet need to address and have not yet fully addressed. All Members of this Chamber will know of the complicated internal procedures that the Government need to go through. It will be tight to get the Bill through the other House, given the queue of Private Members’ Bills before the next election—although I take the comment from the noble Lord, Lord Hunt, that some of them are not entirely overworked at the moment—but we need not address that issue definitively at present.
For the moment, I am very happy to say that the Government will work with the noble Baroness to revise the amendment into a form that would suit the purposes that are intended, and that we have thought through some of the complications about the principle of retrospection, which is a very delicate and important one in the issue of conduct.