(4 years, 1 month ago)
Grand CommitteeMy Lords, I shall address Amendments 9 and 10. I do not have anything as profound to say as my noble friend Lord Stevenson about Walter Bagehot, but I have something to say about the importance of our parliamentary democracy. There has been considerable recent debate, both publicly and in the House, about the role of Parliament, its input as well as its scrutiny, consideration and decision-making processes, and the importance that is attached to what the noble Lord, Lord Balfe, was saying on the previous group of amendments. In fact, I thought what the noble Lord said about taking back control was so obviously on point that I can make my observations extremely brief.
If Parliament is to work at all, it is not simply to give carte blanche to the Executive. My noble friend Lord Stevenson quite rightly made the point that, were amendments to be agreed and changes made that secured the framework on which trade agreements in future are ratified, Parliament would in part have done that job. If the amendments are not agreed, of course Parliament’s ultimate sanction is to consider and vote on the agreements themselves. Given the profound nature of our withdrawal from the European Union, the change in trade policy and the terms on which other subsequent trade agreements will be reached, it is absolutely critical that that is secured.
The reason that I intended to intervene this afternoon is purely on the basis that our Executive exist within Parliament. There is no presidency appointing an Executive, nor an assembly bringing forward its own separate policy requirements. Governments are embedded in Parliament, and as such Parliament has an obligation as well as a democratic duty to ensure that it does not give away those powers unless it has secured the requirements in the framework that avoid having to do it.
I thank noble Lords for my first opportunity to speak in Committee. Since Second Reading, an all-party parliamentary group has been established on the subject of trade and export promotion, of which I am vice-chair. I raise that in order to signal that I have that additional interest which has not yet been entered in the register.
On this group, I thoroughly agree with what I took to be the import of the remarks of the noble Lord, Lord Stevenson—that is, that he intends to have a substantive debate about the process for agreeing future trade agreements at a later stage. I agree with him about that; the group led by Amendment 35 seems to be more appropriate for that purpose, bringing, as it does, an amendment similar to that raised on Report in the other place by my former parliamentary neighbour, Jonathan Djanogly. So I will not go on at length about that.
At this stage we need to understand to what extent the Bill is purely for the purposes of securing continuity agreements following our exit from the European Union. Those who were with us on the debates on this subject on the Trade Bill in 2019 will recall that many amendments, just as they are this time, were put forward on the proposition that we are trying to establish what the future structure of trade agreements should look like, rather than seeking to establish what the continuity agreements after we leave the EU, carried forward, should look like.
Later amendments will look at how we might modify the constitutional reform and governance process. I think that is a better way of proceeding. I have my own amendment later for this purpose, and I think that CRaG is the basis for how we will look at future trade agreements. We can amend CRaG, and we will debate later how we might do that. I have my own proposal, but I will not go on about it now. I think it is important for us to distinguish between, on the one hand, the process of parliamentary approval of trade agreements and, on the other, separately from that, the implementation into domestic legislation of the obligations we enter into through international trade agreements and treaties.
A treaty entered into by the Government cannot itself change domestic law. Therefore, legislation is required to implement it, so will the Minister tell us two things in response to this early debate? First, will he repeat at this stage what our noble friend Lady Fairhead said on 21 January 2019 in the first day in Committee on the then Trade Bill? She said:
“We have already been clear that we will introduce bespoke legislation as necessary to implement those future free trade agreements. The Secretary of State for International Trade has already launched four consultations on prospective future trade agreements and announced that the Government will introduce bespoke primary legislation as necessary to implement these.”—[Official Report, 21/1/19; col. 613.]
I am hoping that my noble friend the Minister will say that, whether the number is four or more, the same process will apply in future. Of course, from my point of view that means that we do not need to specify what should be in future trade agreements and, by extension, change the law in this country, because, when the time comes, if the Government seek such a thing they would have to secure the consent of Parliament in primary legislation to do whatever they wish to do under those trade agreements. We do not need to have all those debates now.
The second thing is that I am hoping, as my noble friend the Minister knows, that he will reiterate the Government’s commitments, given early in the passage of the previous Trade Bill, to the processes for the future scrutiny and parliamentary approval of free trade agreements, published in the early part of 2019. If he can do that, it would help a great deal from the point of view of simplifying scrutiny of these and future amendments.
As for this group, Amendment 7 is a matter, strictly speaking, of semantics. To Ministers, if certain regulations are necessary to implement an agreement, then, in their view, they would be appropriate. If Ministers think something is appropriate, they always think it is also necessary. That is why, although the dictionary may not regard these two terms as meaning the same, in the mind of a Minister, they are the same.
Amendment 9 deals with the question of ratification. It says that the agreements that have to be implemented should not simply have been signed but should be ratified. It relates this, of course, to exit day for these agreements. I remind the Committee that we have passed exit day. After exit day it was the case, for example—I do not know how many examples there are, but it is a rather compelling one—that all member states of the European Union that were required to ratify the comprehensive agreement with Canada, CETA, had not so ratified. So, for example, the Dutch parliament ratified that agreement in July of this year: it was after exit day. The example I would draw, which I think is a compelling reason not to accept Amendment 9, is that it would have the consequence that the Canada-EU agreement would not satisfy the requirements of the legislation.
(13 years, 4 months ago)
Commons ChamberThe House will know of my hon. Friend’s consistent support, through the all-party group, for patients with cancer. I entirely agree that a number of proxy measures and process measures will be relevant in the context of the commissioning outcomes framework. There may be measures that are attributable to CCGs individually in some respects. For example, the quality of life of people living with long-term conditions, to which I referred, would be relevant to a small population. For other measures, however, it may be appropriate for the CCGs to be held to account at the level of, for example, a cancer network, using cancer registry data.
The considerable improvement and focus on breast, lung and bowel cancer is very welcome, but groups campaigning on prostate and ovarian cancer are extremely worried about both the lack of update guidance and the failure to reverse premature death, especially in ovarian cancer, over the last 30 years. Has the Secretary of State anything new to tell us about the direction in these areas?
The right hon. Gentleman will doubtless be aware that we published a quality standard for ovarian cancer, and that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), published the outcomes strategy for cancer, which will have been relevant to many of the issues to which the right hon. Gentleman refers. I continue to look forward to the results of a major trial on screening for ovarian cancer, but I am afraid that I anticipate that we shall not be able to see the results and recommendations for nearly three years.
(13 years, 4 months ago)
Commons ChamberAs a vice-president of the Alzheimer’s Society, and like many hon. Members, I am aware that it is dementia awareness week. The most enormous resource is needed to help both individuals and their carers, particularly with residential support. Is not my hon. Friend the Member for Sheffield, Heeley (Meg Munn) entirely right to draw attention to the fact that even within Andrew Dilnot’s acknowledgement of the perverse incentives, there is still an emphasis on the care market and the drive to encourage people to take up, or to consider the option of, residential care? Do we not need to put the glue back by supporting families and neighbourliness, so that we can keep people independent in their own homes as long as is humanly possible?
I understand the point that the right hon. Gentleman makes and in the past some of the criticisms of previous proposals have been made because they would have led to a situation in which informal care and family care would not have been properly supported—indeed, there would have been perverse incentives for people not to have family carers. We need to support family carers rather than bypass them.
I am glad that the right hon. Gentleman raises the issue of dementia. It is tremendously important that we understand it is one of the principal reasons for such a rising burden of disability and requirement for care and support. It is why we are looking to the longer term, not least to improve research into dementia. I am grateful to the Minister of State, my hon. Friend the Member for Sutton and Cheam, who has chaired the work on research into dementia, and he was able to announce substantial additional funding to support dementia research just the week before last.
(13 years, 9 months ago)
Commons ChamberWill the Secretary of State give way?
In a moment. [Interruption.] The right hon. Gentleman’s Front Benchers have been asking me to explain what the Bill does, and I am doing that.
Thirdly, there will be relentless focus on quality, embedded within a new legal duty. Fourthly, there will be a diverse and vibrant social market for health care. We will encourage NHS staff to set up social enterprises and foundation trusts, and we will encourage new capacity in delivering services through social enterprises, charities, private companies, and, indeed, NHS providers.
We want clinicians and their patients to lead the NHS, but they cannot do this while they sit under a vast hierarchy of regional and local organisations, all reporting to Whitehall. Everyone agrees that top-down command and control gets in the way of clinicians doing their job, so we need to dismantle the structures that sustain that interference; that is why we will abolish primary care trusts and strategic health authorities. There are many excellent people working in those organisations. Many will move to be with the new general practice-led commissioning consortia, to local authorities and to the NHS commissioning board. Some will want to set up their own new social enterprises. But even the best people cannot deliver the NHS that patients need if things stay as they are, so we will also introduce direct local democratic accountability. Councillor-led health and wellbeing boards will oversee and work with local NHS consortia, working to bring together the NHS, social care and public health services, and bringing a strategic coherence to the health and well-being of local communities.
On bottom-up decision making at a local level, will the Secretary of State give a guarantee to the House that if the GPs now coming together in consortia decide that they wish to employ the expertise residing in the current primary care trust, he and the future health board will not intervene to stop them doing that? Will he also guarantee that he will not insist on redundancies that cost a fortune and preclude that expertise being available to the existing local consortia, with private enterprises then employing them to do the job that they were doing in the first place?
Let me make two points to the right hon. Gentleman. First, in the impact assessment that we published with the Bill on 19 January, we set out very clearly our estimates—they are no more than estimates since they will have to be decided by the general practice commissioning consortia and local authorities—that between 50% and 70% of the staff in primary care trusts would be employed in the successor organisations.
Secondly, the idea that somehow general practice-led commissioning consortia would engage the private sector where that has not happened up until now is, I am afraid, completely contradicted by the facts. Under the Labour Government, in the two years leading up to the election, there was an 80% increase in the use of management consultants, while at the same time the number of administrators and managers in those same organisations was rising dramatically. We arrived at the point where there were 50,000 administrators in primary care trusts, and they were still spending nearly £300 million a year on top for management consultancy. That all has to change.
One thing that Labour abjectly failed to do was to empower patients with a real voice in the health service. Through this Bill we will establish local healthwatch organisations that will represent the patient’s voice in the design of local services and help individual patients, especially the most vulnerable, to make the most of the choices available to them and to help them when things go wrong. Sitting within the Care Quality Commission, the national healthwatch organisation, too, will act as the eyes and ears of the quality regulator, and work to give the local organisations real teeth in their dealings with their local NHS—something that was completely, abjectly destroyed by the Labour Government when they abolished community health councils. Indeed, I know that families of those treated at the Mid Staffordshire hospitals welcome the additional powers for patients to have a voice.
(13 years, 11 months ago)
Commons Chamber10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.
Following a very constructive meeting with the specialist children’s hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children’s hospitals will find that entirely acceptable.
I would like—uniquely—to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children’s hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children’s hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children’s hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?
Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.
(13 years, 11 months ago)
Commons ChamberI am grateful to my hon. Friend for his comments. As in a number of other areas I have mentioned, we will publish a strategy in due course, and a tobacco control strategy will be published in the new year. Parliament voted for the display regulations and we are looking into that, but we have to balance the evidence on health improvements with the impact of such a measure, particularly the burdens on small retailers. We are also currently examining the option of plain packaging of cigarettes, which the last Government did not do. That might in itself be an important measure to reduce both the visibility of cigarettes and the initiation into smoking of young people in particular.
Not so much nudge as fudge on this issue. Why will the Secretary of State not accept that giving those displaying tobacco and cigarettes time to adjust by allowing them to implement the regulation this time next year is good common sense? Is it not the case that the Government’s refusal to acknowledge the implementation of this regulation passed by Parliament can only be explained by there being an ideological objection to protecting young people in particular from the incitement to buy?
I am afraid the right hon. Gentleman is simply wrong about that: we have made no announcement, and I have said we are considering it. More to the point, I have said we are also considering the question of plain packaging of cigarettes, which is being pursued by a Labour Administration in Australia, and which his Administration did not pursue.