(4 years, 2 months ago)
Grand CommitteeMy Lords, I will intervene only briefly, initially to support my noble friend Lord Bassam in some of the examples he gave. Dispute settlement in trade deals is pretty important as is what is put into the deal. I am not clear about—but I hope I am—whether “public services” includes critical infrastructure. As far as I am concerned, the two go together. I would cite energy, for a start, because one can see the problems we are going to have with energy in this country with the collapse of the nuclear deal. We must have a mix. There is a good chance that the lights and the gas may go out and the Government may want to move at some point to take monopoly control of the service. They ought to be able to do that, but there are too many sticky fingers for my liking in the issues involved and therefore I think the idea behind the amendment by my noble friend Lord Bassam is very good.
I want to make a brief point about Amendment 51 on the health service. I thought the speech by the noble Lord, Lord Patel, was devastating with its list of companies. Do not get me wrong, I have no objection to the NHS or other public services using the best available management tools, techniques and individuals to provide services but making use of them is not the same as handing over ownership. That is where one has to draw the line. The noble Lord, Lord Patel, made a very fair point. The public do not care who is providing the service as long as it is there when they need it, free at the point of use. He went on to say that they will care when their taxes go up. That point is when someone, such as the Prime Minister, will say, “You can avoid that by buying some insurance.” It is the slippery road to push us down the insurance route. I know we are all nice people in the Lords but frankly I do not trust the Prime Minister.
My Lords, many of the debates here take me back to 2012, and I look forward to the contribution from my former boss, the noble Lord, Lord Lansley. I want to speak in support of Amendment 75 in the name of my noble friend Lady Sheehan. She has laid the amendment out effectively and comprehensively. There has long been tension between those marketing and those purchasing proprietary medicines and generics. Clearly, where pharmaceutical companies invest in research and development they should be rewarded for that, but we also know how expert the industry is at claiming R&D when that is beyond what they have actually done.
This issue plays out in the NHS but also internationally, particularly in developing countries where basic medicines may not be affordable and dependence on generics is vital. As the noble Baroness, Lady Finlay, said, the pandemic has shown how important this is. It reinforces that we are all interlinked. An infection that affects the community in one part of the world is within days potentially spread worldwide. It is in all our interests that disease is countered everywhere, as well as that being the right thing to do.
As my noble friend Lady Sheehan said, Amendment 75 affirms the Government’s right to use internationally agreed safeguards to protect public health, including securing access to more affordable generic medicines. As she said, earlier FTAs often focused on tariffs and trade in goods, while in the past couple of decades FTAs have become more comprehensive. Of course, many such developments are welcome in terms of ensuring standards, as we have been discussing, but provisions can also inappropriately protect monopolistic business. As I have said, genuinely innovative companies have a case, but their role can be exploited. In recognition of this, the WTO’s TRIPS agreement included public health safeguards. These were reaffirmed in the 2001 Doha declaration. Protecting genuine innovation has therefore already been addressed by the WTO, and it is important that these proposals are taken forward. I look forward to hearing the Minister’s response.
(4 years, 3 months ago)
Lords ChamberMy Lords, I avoided devolved issues in Committee and was seeking to avoid them on Report, but I want to come in to support the noble Lord, Lord Wigley.
I have a couple of points to make. One is a general one, and it is no reflection whatever on the Ministers on the Front Bench: the Government do not do devolution. My experience of that comes from 2010 to 2013, some years ago now, when I was chair of the Food Standards Agency and the coalition Government came in. It was quite clear that there was a major problem with their attitude towards devolution, and I think that has carried on. I realise that there are relations between Ministers and they talk to each other, but the government machine does not do devolution.
My more specific point is that I plead guilty on two issues, really. The Agriculture and Horticulture Development Board was one of my babies when I went back to MAFF, or Defra, in 2006. The merger of the six levy boards was done under my watch. Of course, I realised at the time that I was the English farming Minister, not the Great Britain farming Minister, and the issue applied only to England. Furthermore, before that—this shows, I freely admit, that as the years go by I get a bit out of date, and I have had a year when I have not been on the ball, as it were—the cattle tracing service for passports and birth information, located in Workington at the time, was a UK-wide body; indeed, we recruited Welsh speakers. It could be that that has been taken apart and is no longer there, but the fundamental issue behind all this is traceability.
One reason we do it is self-interest, but the reason we were forced to do it by the European Union, as it does elsewhere, is so that we know what animal has been where if a disease breaks out. The issue should not be one of a dispute between devolved Administrations not being able to access the information; it is absolutely fundamental that the traceability of animals, their movements, the feed they have had and other matters is available if an animal disease breaks out—I hope that it does not happen but we have to prepare for the worst—particularly where there is a transfer to humans, or indeed if it is widely spread to other animals because they move around the country, as has just been said, east, west, north and south, and that leads to real problems.
So, first, I fundamentally doubt that the Government really do devolution. Secondly, in an area like this, Clause 32 is quite specific that the Government are in fact taking on board UK-wide information; indeed, relating to Scotland as well. The Minister is going to have to explain exactly what the detail is in terms of the devolved Administrations and how traceability—and the way we need it to operate in an emergency, because it is always an emergency when you actually need it—will actually function.
My Lords, we are, again, addressing how matters might be properly devolved. The noble Lord, Lord Wigley, has identified some key challenges in his amendment, and the amendment in the name of the noble Duke, the Duke of Montrose, is complementary to it. It seems to me that these amendments need to be taken very seriously by the Government, who need to assess the implications laid out by noble Lords.
(13 years, 1 month ago)
Lords ChamberMy Lords, I thank the noble Lord, Lord Rooker, for giving me the opportunity to highlight the outstanding work that environmental health officers carry out in district councils as well as in the private and voluntary sectors. The Chartered Institute of Environmental Health, to which he referred, also does an excellent job in presenting the issues nationally and in liaising with central government. They will all continue to play a crucial and developing role in public health.
The noble Lord has long been a doughty fighter on environmental issues. I remember my astonishment when, as a Minister, he granted an amendment which I had tabled that he had been refused permission to grant. I therefore feel very mean in suggesting that I will not be reciprocating today. However, when the noble Baroness, Lady Finlay, raised her points, I was rather glad that, when acting on the Energy Bill in relation to the point for which she fought on preventing carbon monoxide poisoning, I was at least able to grant something there, although I know that that was more limited than what is being sought now.
I should stress that environmental health officers, along with other local authority staff, will be very much inside the group of professionals and practitioners in local government who will form part of the wider public health workforce. Consequently, we expect many opportunities for them in the future to contribute to and to shape local plans and priorities. Surely that will help transform this area, because public health, as I indicated, needs to be defined widely. In its new location it will change in order to have the effects that we wish to see. The noble Lords, Lord Beecham and Lord Rea, are right to urge working together, especially given the history of these officers.
At the national level, the Chief Medical Officer will have a central role in providing impartial and objective advice on public health to the Secretary of State for Health and to the Government as a whole. She will be the leading advocate for public health within, across and beyond the Government, advocating the design of policies that improve health and well-being. We are clear that this role includes advising on environmental health issues as well, and that the Chief Medical Officer will in turn continue to be able to seek such advice on environmental health and other issues whenever necessary just as she can do now. The Government believe that, as valuable as environmental health expertise is, this makes the post of chief environmental health officer unnecessary.
The noble Lord is of course right to urge discussion across devolved areas in all fields, as we can learn from each other. He might be reassured that the Chief Medical Officers of the various Administrations meet regularly, and that Public Health England, like the Health Protection Agency, will in some ways have a remit that extends beyond England and thus offer the chance to learn from the experience of others. We remain confident that Ministers will receive high-quality advice from the CMO on environmental health. I stress that we also need to look internationally and draw on research and experience very widely in this field. We can learn a lot from that.
The noble Lord’s amendment calls for the Secretary of State to,
“report to Parliament annually on the work of the Chief Environmental Health Officer”.
We agree on the need for transparency and believe that the Secretary of State’s accountability for public health at the national level is a major strength of the new system. This is why Clause 50 of this Bill requires the Secretary of State to publish an annual report to Parliament on the working of the comprehensive health service as a whole, which will include his and local authorities’ new public health functions.
The noble Lord, Lord Whitty, asked what the Government are going to do about ring-fencing the budget. Some of the issues that he raised were discussed in the first grouping on public health. I do not know whether he was in his place at the time. If he was not, he should be reassured that his noble friend Lord Warner intends to flag up some of the concerns that he raised in a later grouping, and we have various other groupings in which his concerns will no doubt be flagged up. I point out in relation to our discussion on the previous group that we will be using regulations to set out what essential services local authorities have to provide. Noble Lords can also see what is in the White Paper.
I want to clarify what will be covered in regulations so that if I was not clear in the last grouping, I can be clear now. Essential services that we think need to be delivered consistently across the country—for example, dealing with local emergencies—will be included in regulations. We will use publications like the updated White Paper, which I quoted earlier, to set expectations about the totality of services to be covered by the public health ring-fence. I hope that that provides clarification.
My noble friend Lord Greaves talked about the co-operation between different councils—county councils, district councils and so on. District councils have local insight and expertise. In many cases they will have the lead on key services affecting health and well-being, such as housing and environmental health. Health and well-being boards will play a big part in local health improvement activity and must find themselves able to involve local councils so that they work most effectively.
The noble Lord, Lord Northbourne—sorry to startle the noble Lord—wondered what would happen if local authorities do not carry out their duties. The Secretary of State does not have a conventional performance management role with local government—I am sure that those in local government will be pleased to know. However, he does have the power to intervene and ensure that particular services are provided if a local authority fails to do so. Local authorities will also have to account for their use of their ring-fenced grants, and the power exists to recoup money if the conditions attached to the grant are not met. I hope that that reassures the noble Lord.
In summary, it is very clear that environmental health is and will continue to be a very important component of the public health system, which will be led locally by directors of public health. I hope that the noble Lord is prepared to withdraw his amendment.
My Lords, I am grateful to the Minister for her reply, and particularly for reminding me about the favour that I did her. It proves that Ministers can make policy at the Dispatch Box. I accepted her amendment against advice; I used the excuse that there would have been a government defeat if I had not. She cannot use that tonight because I shall not press the amendment anyway, but I am very grateful that she remembered that.
I do not want to make a long speech. The Minister said that the work of environmental health officers is absolutely fundamental. They are the unsung heroes of policing a system in this country for our citizens on a whole range of issues, whether food, air quality or other matters. The public are aware of them only when things go wrong. I am reluctant to go down this route, but I declare an interest of chairing the board of the Food Standards Agency, which is a government department, and that is why I do not speak on it in this House. Environmental officers are unsung heroes and they deserve our support. They provide a 24/7 operation and they go into areas where, by and large, police officers would go in only pairs. Late at night they visit takeaway enterprises and so on. They do an enormous amount of work.
I also hear what the Minister said in answer to the point about discussion between the four Governments in the UK. If the only link between the four UK Governments on the respect agenda is between the four Chief Medical Officers, we are in dead trouble. Although that is important, it is more important that Ministers in the four Governments who have similar responsibilities talk to each other. Devolution means that things will be done differently—we are not looking for a one-size-fits-all situation—but it is crucial that there is co-operation, consultation and information. Major changes take place without any contact whatever with other Governments and it is the same in this area. There is no doubt that that causes problems. I am sure that we will turn in more detail to the issues relating to local government in regard to other amendments and we may or may not come back to this on Report. In the mean time, I beg leave to withdraw the amendment.
I am reassured that she is slightly clarified. This has been yet another important exploration of how the new arrangements might work. I realise that there will no doubt be further discussion; nevertheless, I hope that in the light of what I have said the noble Lord will be prepared to withdraw his amendment.
My Lords, I am grateful to the Minister and for the support for the fact that we need to address this issue. I am not asking for any more reassurances but I should like to believe that between now and Report there will be deeper discussions with local government, probably even addressing the machinery of government.
I cannot believe that the existing silos of Whitehall will work when the Bill is implemented. There is now a cross-over between health and local government which has not existed in this country for many decades. Therefore, there is going to be a cross-over and a different kind of working relationship between the Department for Communities and Local Government and the Department of Health. That seems to me eminently sensible for reasons of both accountability and delivering a seamless service to the public. After all, that is what it is about. The public do not care where the service comes from; they want to know that the service is there.
I appreciate the constraints that the noble Baroness is under, but I think that it was well worth while giving this issue a run-out. I have no doubt that we will return to it on Report, but basically I hope that there is more of an impetus and that Ministers’ officials will say, “Well, we do need to have a little bit more discussion to lock this thing down”. The Government cannot afford to get this wrong with this legislation, as the Minister has realised. I think that, with a bit of extra thought, consultation and discussion within government and with local government, a satisfactory solution can probably be found. I beg leave to withdraw the amendment.