EU: Budget
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Lord McConnell of Glenscorrodale
To ask Her Majesty’s Government what position they will take on the European Development Fund and other European Union aid budgets in the current negotiations on future European Union funding.
Baroness Northover
My Lords, the UK’s top priority in negotiations for the EU budget for 2014-20 is budgetary restraint. We oppose increases beyond inflation in any area of EU expenditure, including the European Development Fund. However, it is important at least to maintain or increase the proportion of official development assistance within restrained EDF and overall EU budgets.
Lord McConnell of Glenscorrodale
I thank the Minister for her Answer. It would be an absolute scandal if those who lived in the poorest countries in the world were made to pay for the deficits that exist in the richest part of the world. In addition, will the Government address this technical point? Any reductions in the EU aid budget will simply have to be made up again in the national aid budgets of the member states. In the United Kingdom, where we have agreed to meet the 0.7% international target, that will mean that any reduction in the EU aid budget is simply transferred to the DfID budget because the EU aid budget contributes to that 0.7% target. The only countries that will benefit from a reduction in the EU aid budget will be those that wish to reduce their aid contributions by the back door and do not replace that money in their national budgets. Will the Government look again at this issue and ensure that the EU aid budget is preserved so that those countries that wish to reduce their aid contributions by the back door are not allowed to do so, and ensure that we make a contribution to that multilateral development assistance?
Baroness Northover
I thank the noble Lord for his question. He is well aware that the United Kingdom is increasing its own spending because it recognises the importance of supporting the poorest in the world, even when we are in financial difficulties. As far as the EDF and the EU budget are concerned, we scrutinise them very carefully for their poverty focus. We are encouraged by the direction they are heading in, so perhaps I can reassure the noble Lord in that regard. However, we will continue to keep up the pressure, as it needs to be poverty-focused. I point out that we are fifth in the league, as it were, in terms of ODA in the EU, behind Sweden, Luxembourg, Denmark and the Netherlands, all of which have gone beyond the 0.7%. The evidence is not quite as he indicated in terms of other countries. For example, there are increases from Germany, Italy and Sweden, so the picture here is not quite as he portrays it.
Lord Chidgey
Is my noble friend aware that the European Court of Auditors has just reported on its study of 48 EDF schemes—road transport programmes totalling over something like 2,500 kilometres—in the Sahel? It shows that, while it is by far the European Commission’s financially most important sector, it has been only partially effective in promoting policy reform that would ensure the sustainability of this massive road infrastructure investment. What is the Government’s response to the court’s recommendations that the European Commission should better focus European Development Fund resources and make better use of the conditions that it attaches to the programmes?
Baroness Northover
This report was published a couple of days ago, on Tuesday. DfID will produce a considered response, which will be scrutinised by Parliament. It is worth flagging up that, as my noble friend rightly points out, this looks at aid since 1995 in terms of road building and at whether the balance between road maintenance and road building has been sustained as it should have been. In the United Kingdom we know that when you are in constrained financial circumstances a balance must be struck between those two areas. I am sure that we can learn many lessons; nevertheless, it is not as though the balance between those issues is not also felt in other countries.
Baroness Kinnock of Holyhead
My Lords, is the Minister aware that if current proposals made by the President of the European Council to freeze the levels of spending on EU development aid are implemented, aid will suffer a larger reduction than absolutely any other area of the EU budget and that the UK will see a decrease in its current contribution to the European Development Fund? These are two very important factors. Would it not be perverse if the effect of a commendably ring-fenced UK development budget was diminished by a huge 11% cut in the EU development budget?
Baroness Northover
As I said to the noble Baroness’s noble friend, the noble Lord, Lord McConnell, the EDF has clearly been a very effective measure in this regard. DfID is extremely keen to make sure that that is protected and that the EU’s aid contributions are poverty-focused. Within the EU budget there is clearly also a focus on near neighbours. We need only look at what has happened across the Middle East and north Africa to see how the security, stability and economic progress of those near neighbours are important. The new accession countries are also important. However, we are keenly aware of the importance of the EDF and its poverty focus, and we are seeking to increase its focus on the poorest.
Lord Pearson of Rannoch
My Lords, I am grateful to the noble Lord. Do the Government agree with the think tank, Open Europe, that only 46% of EU aid reaches really poor countries compared with 74% of our own aid? Have the Government worked out the cost of churning our aid through Brussels? Are we really incapable of controlling it all ourselves?
Baroness Northover
I have just given an answer saying that the EDF is very poverty-focused. What the EU is doing is looking somewhat wider, but that is a worthwhile project as well.
Lord Collins of Highbury
My Lords, DfID’s own multilateral aid review published in March last year rated the European Development Fund and ECHO among the top performers. It also identified clear reform priorities in order to demonstrate results and deliver greater value for money from the UK aid that is channelled through the EU. Can the Minister provide an update of the department’s assessment of the EU’s progress on achieving those reforms?
Baroness Northover
DfID is closely engaged in this area and I have met Commissioner Piebalgs a number of times. We are sure that they are heading in the right direction.
Legislative Reform (Constitution of Veterinary Surgeons Preliminary Investigation and Disciplinary Committees) Order 2013
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Earl Attlee
That the draft order laid before the House on 5 November 2012 be approved.
Relevant document: 9th Report from the Delegated Powers and Regulatory Reform Committee, considered in Grand Committee on 10 January.
World Food Supplies
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Baroness Northover
My Lords, the UK Government are committed to improving food security and nutrition in the developing world. We believe that private sector investment in agriculture is important in achieving that. We are clear that those investments, particularly any that involve commercial land acquisition, must be socially and environmentally responsible.
Lord Judd
Does the Minister agree with the estimate that, on average, every six days, investors buy an area of land the size of London in the poorest countries, which are often already facing acute food shortages? Do not those investors too frequently intend to export what is produced, although those countries are facing acute food shortages; and are not those exports often for biofuel, with all its questionable environmental dimensions? Do not such purchases tend to be made without proper community consent and, furthermore, without proper consideration of the economic and social consequences? What does the Prime Minister intend to propose to the G8 summit on land transparency and such purchases at the forthcoming meeting?
Baroness Northover
The noble Lord, who has worked in this area for a very long time, is right to highlight this as a potential problem. However, I cannot agree with his first statement about its scale because there is insufficient evidence. One thing that is extremely important and that we are pursuing is supporting the evidence-gathering in this area to see what the scale of the problem might be so that we can better address it. Nevertheless, the noble Lord is right to say that transparency is the key here. If we can promote that, we can see whether the acquisitions that people may have made reference to are simply anecdotal or whether there is evidence of the nature that he is talking about. I assure the noble Lord that we are emphasising transparency and that at the G8 summit the Prime Minister will indeed focus on food security as one of the issues.
Lord Chidgey
What proportion of DfID’s aid budget has been allocated to the provision of more support for sustainable small-scale agriculture to help poor—mainly women—farmers feed their families? What measures are the Government taking to ensure that increased private investment in agriculture, as the Minister mentioned, is aimed at maximising poverty reduction and sustainable equitable growth, as highlighted by many NGOs, including Oxfam and ActionAid?
Baroness Northover
The noble Lord is right. DfID does support smallholder production, and one of the key issues here is trying to establish land rights. The United Kingdom is working in a number of countries to promote this and has increased the spending in this area. It is working in 13 countries to support smallholder farmers by supplying seeds, fertilisers and access to finance and by making sure that women, who are often the ones running these smallholdings, are particularly supported.
Lord McConnell of Glenscorrodale
Do the Government agree that the land reforms implemented in rural Scotland over the past decade have shown the benefit of involving those who live on the land in its future use? That benefits both the wider community and the individual families concerned, and may provide some lessons that could be used in our international development policy to assist those who are currently fighting against their movement from the land or the exploitation of their land in other parts of the world.
Baroness Northover
The noble Lord makes a good point. He will probably be aware that at the G8 last year the New Alliance for Food Security and Nutrition was set up specifically to take forward that approach of looking at the responsible development of agriculture, recognising its importance in sustaining the poorest communities and making sure that people are engaged in that positively. The UK is continuing to press forward that approach.
The Earl of Listowel
Will the Minister look particularly at any adverse impact on pregnant mothers and nursing mothers and their crucial role in the early development of children in terms of their being denied food because their area is being used to grow biofuels or for other uses?
Baroness Northover
The United Kingdom is extremely aware of the importance of supporting pregnant mothers and infants in their first days. The noble Earl will be aware that the first 1,000 days of gestation and a child’s life are so important to the future health of that child. The areas that I have just focused on support this, but I also flag up the fact that we have social safety nets. It is extremely important that financial support reaches pregnant women and those who are trying to support their families so that they have enough money to provide for those families.
Lord Bates
Is it not part of the evidence that could be considered the vast increase in local food prices in the poorest parts of this world? Is it not basically immoral to take food from countries in the developing world that cannot feed their own populations to feed biofuel incinerators here in the UK? We should be fuelling those biofuels from the massive food waste in developed countries, rather than have food scarcity in the poorest.
Baroness Northover
I was listening to the point on the “Today” programme about food wastage and it is extremely dramatic. Within DfID, we are working with other government departments to look at the impact of biofuels. It seems, although the evidence is disputed, that they have played a part in some of the food price spikes that we have seen. We are into the third one at the moment, which is largely because of the drought in the United States. However, the effect of using maize for biofuels is potentially significant and we are looking at this very closely.
Baroness Kinnock of Holyhead
My Lords, will the Minister confirm that discussions are taking place, or are planned to take place, with the World Bank about a public freeze by the bank of all agricultural investments that involve large-scale land acquisition? Does the Minister agree that such leadership from the World Bank would leverage responses from other investors and developing country Governments in a much needed initiative?
Baroness Northover
We do not agree that there should be a freeze in World Bank lending for agriculture, the reason being that to do so could disrupt valuable projects and because the World Bank itself has high standards in place to try to ensure that things are transparent. We are pushing for greater transparency than is already the case in what the World Bank does. However, it is probably missing the mark to aim at the World Bank rather than looking in other directions. It is extremely important that we take forward the World Bank’s engagement in advising Governments to try to make sure that any land acquisition is to the benefit of their communities.
Legislative Reform (Constitution of Veterinary Surgeons Preliminary Investigation and Disciplinary Committees) Order 2013
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Baroness Northover
That the Grand Committee do report to the House that it has considered the Legislative Reform (Constitution of Veterinary Surgeons Preliminary Investigation and Disciplinary Committees) Order 2013
Relevant documents: 9th Report from the Delegated Powers and Regulatory Reform Committee
Baroness Northover
My Lords, this draft legislative reform order seeks to make changes to the outdated constitution of the two committees that deal with disciplinary proceedings, the disciplinary committee and the preliminary investigation committee of the Royal College of Veterinary Surgeons. At the moment, the college is required to populate these two committees with members of its governing council. In effect, that means that the same body of people is responsible for both setting the standards for the profession and dealing with possible breaches of those standards. This is not in line with modern regulatory best practice as there is insufficient impartiality and independence and there is public pressure for reform. The RCVS needs to separate these functions to balance both professional and public interests. In addition, the current size of the disciplinary committee makes it difficult to manage the current and future case load in an efficient and timely manner. The college reports that RCVS council members who are elected to the disciplinary committee are now overstretched as they struggle to find time for the increasing number of sitting days.
The constitution of the DC and the PIC is prescribed in the Veterinary Surgeons Act 1966 and reflects the regulatory practices of that time. Replacing Part I of Schedule 2 to that Act allows the college to implement modern disciplinary practices in line with other comparable regulators such as the General Medical Council, the General Dental Council and the Nursing and Midwifery Council. In these organisations, there is a separation between those who advise on professional standards and those who implement the disciplinary process.
The proposed amendment to the Veterinary Surgeons Act is to change the constitution of the two disciplinary committees, in terms of both the eligibility for membership and their size. This will allow the royal college to make changes that comply better with the Better Regulation Commission’s principles. No longer will the membership and chairmanship of the PIC and DC be drawn from the council. They will in fact be ineligible for appointment. Instead, appointment to both committees will follow an open, transparent and independent recruitment process. For the first time there will be a statutory requirement that the committees must contain a proportion of lay people, to bring a fresh perspective to the work of the committees and to improve further their independence. There will an increase in the size of the committees. This should make it much easier, and possibly quicker, to assemble a panel for an individual case-hearing from the larger pool of people, thus removing a burden, specifically defined as “an obstacle to efficiency”, from the RCVS.
The amendments will also introduce more flexibility into the constitution of the committees as well as remove the most outdated restrictive provisions. Committee members will serve for a specific term of office and for no more than two terms on each committee. The new size of the committees allows for flexibility in case further increase is needed in the future, without the need for another legislative change.
Removal of the provision regarding veterinary practitioners supports better regulation principles by removing outdated and unnecessary provisions through simplification and streamlining, while removal of the prescriptive timing of committee elections removes another burden to the college’s operation of its disciplinary process. However, provisions that are seen as important in the current Act will be retained—these relate to the size of the quorum and the important judicial principal that no member may sit on both the preliminary investigation committee and the disciplinary committee in relation to the same case.
In conclusion, this replacement of the relevant schedule to the Veterinary Surgeons Act 1966 is necessary to allow the Royal College of Veterinary Surgeons to exercise its functions in relation to disciplinary cases brought against members of the veterinary profession. It will allow the disciplinary committees to work in a more efficient manner and in compliance with better regulation principles, and will provide flexibility to cope with future changes. I beg to move.
The Countess of Mar
My Lords, I declare my interest as an honorary associate of the Royal College of Veterinary Surgeons and the British Veterinary Association. This draft legislative reform order has been long in gestation and I know there will be relief all round to see it finally enacted. The order will bring the royal college in line with other professional health bodies, as the Minister said, such as the General Medical Council, which are responsible for setting standards as well as imposing discipline on those of their registrants who may be in breach. The importance of being fair as well as being seen to be fair has grown since the human rights legislation came into force. Ensuring that membership of both the preliminary investigation committee and the disciplinary committee is no longer elected by or from among the council of the royal college eliminates the possibility of accusations of bias. Increasing the size of both committees ensures that there will be a larger pool from which to draw members for hearings. The pressure on members to attend disciplinary committee hearings will be relieved and waiting times for hearings will be reduced. We should never forget that justice delayed is justice denied.
I have always believed that lay members add strength to committees of professionals because they are in a position to ask the important “how, what, when, why, where” questions that professionals tend not to ask each other. Changing the status of the current lay observers to full membership and enabling them to vote is laudable and will increase the transparency of the committee proceedings. I am also pleased to see the built-in flexibility with the size of committees for particular hearings as well as the definition of quorum membership and size that this order defines.
The open, transparent and independent recruitment process described by the Minister and in the impact assessment is a foil to anyone tempted to complain that the appointment of committee membership was opaque and partial. This problem had been of concern to the public, the veterinary profession and the Royal College of Veterinary Surgeons for more than a decade. The possibility of producing a new veterinary surgeons Act to replace the one that is now nearly 47 years old was considered. I recall the suggestions from the EFRA committee in the other place being given a very firm put-down by the noble Lord, Lord Rooker, when he was Defra Minister on the grounds of lack of time and finance. This order is the next best thing, and I commend it.
Lord Grantchester
I thank the Minister for her explanation of the order before the Committee, ably supported by the noble Countess, Lady Mar, and the noble Baroness, Lady Byford. I will not detain the Committee long as this is a non-contentious updating of regulation in line with modern practice. In the other place, it was taken without debate as there was no dissent following the excellent second report of the House of Commons Regulatory Reform Committee. The report explains with great clarity the problem with the constitution of the disciplinary committees of the Royal College of Veterinary Surgeons as defined by the Veterinary Surgeons Act 1966, and sets out the proposed solution made under the Legislative and Regulatory Reform Act 2006 by ensuring that the same group of people in the veterinary profession is not responsible for setting the rules as well as investigating complaints and adjudication. It also introduces formally lay persons on to both the preliminary investigation committee and the disciplinary committee. In your Lordships’ House, the ninth report of the Delegated Powers and Regulatory Reform Committee cleared the order, satisfied that it meets the tests set out in the 2006 Act. The committee was also content with Defra’s proposal that the affirmative procedure should apply. From these Benches, I am happy to add our agreement to the order.
In assessing the order, notwithstanding the necessary updating of compliance, I wonder if there is evidence of problems that have arisen from the existing procedures. In my conversations with the royal college, I am grateful to Anthony Roberts who sent me the details of an appeal to the Judicial Committee of the Privy Council against the judgment made exactly on the grounds that this order seeks to remedy; namely, that the profession’s disciplinary procedures were inherently unfair and against the Human Rights Act. This appeal in December 2011 was dismissed by the Privy Council, which noted that the royal college had gone to elaborate efforts to separate the membership and work of the committees that produce guidance, investigate complaints and pass judgment. It also noted that the RCVS had made strenuous efforts to ensure that its disciplinary procedures were fair and in accordance with human rights legislation. In addition, the Privy Council recognised that the veterinary profession’s regulatory framework was indeed constrained by the Veterinary Surgeons Act 1966, and the council therefore supported,
“statutory reform so as to enable members of the disciplinary committees to be chosen from outside the Council”.
This view from the Privy Council lends significant weight to the case for the legislative reform order before us.
I am also grateful to the noble Lord, Lord Trees, for his guidance on the situation. We look forward to his maiden speech tomorrow. He described this order as the most important reform of the profession since the 1966 Act. It is a discreet reform that is in the best interests of the public and the veterinary profession. It includes lay persons among the committee’s membership, thereby balancing public and professional interests.
I should like to tempt the Minister to comment further. The only sanction that the disciplinary committee has is to remove or suspend a veterinary surgeon from the register. This is a draconian power that disallows a vet from going about his or her business. When I commented on this to the noble Lord, Lord Trees, he said that the royal college has introduced further reforms to ensure that it remains at the forefront of regulatory best practice. The royal college has been able to widen its sanction measures by dealing compassionately with veterinary surgeons with health or mental health issues. I wonder whether further measures could be introduced, such as the power to fine or even to suspend penalties, although some may argue against this. Can the noble Baroness say whether other powers have been considered by her department, and what view she has in this regard? I know that the royal college has initiated a performance protocol which aims to allow the college to manage proportionately any justified concerns about professional performance and to launch a new code of professional conduct.
It is encouraging to see that the royal college is constantly seeking ways to improve and I commend it on its activities. Last November, it introduced its first-rate regulator initiative. Among the areas that the college has been reviewing is the regulation of veterinary nurses who are not subject to statutory regulation. Indeed, the title “veterinary nurse” is not protected. I understand that as long ago as 2007, the college introduced a non-statutory register for veterinary nurses under by-laws made under the royal charter. Mindful of the increasing role of veterinary nurses in practice teams and public expectations about professional accountability, what are the department’s views in this respect? In its discussion with the college, has the department come to a conclusion on how statutory regulations may be introduced, and to what timetable?
These further questions must not allow us to refrain from making progress today. I agree that the order before us must be passed to bring forward the necessary reforms, and I look forward to their implementation.
Baroness Northover
My Lords, I thank my noble friends Lady Mar and Lady Byford, and the noble Lord, Lord Grantchester, for their fulsome support for this measure, and I wish that that was the case for all the departments that I cover. This is really refreshing, especially for my first SI for Defra.
The noble Lord, Lord Grantchester, flagged up a couple of areas which I shall seek to address. As he will know, the Veterinary Surgeons Act 1966 regulates the profession of veterinary surgeons. We are aware that the college has been working to develop proposals for a framework for the statutory regulation of veterinary nurses, but these have not yet been presented to Defra for consideration.
In October last year, a project was launched that will see joint input from Defra officials and representatives from the veterinary profession and other para-professional industries to review how “minor acts of veterinary surgery” undertaken by non-veterinarians should be controlled in the future. Our general approach is that we would like to see a more effective but proportionate—echoing the word used by the noble Lord, Lord Grantchester—risk-based approach to this. We will look for a non-regulatory solution wherever possible and look forward to further discussions on this.
I was also asked about the fact that the only sanctions available to the college are those of removal or suspension and whether other powers are being considered. These could not be brought in using a legislative reform order, but we welcome what the college has done in terms of the health protocol. I have taken note of what the noble Lord, Lord Grantchester, said, and given that I have been given various other pieces of information on this, I shall be happy to discuss the detail with him later. As he has said, we do not want to slow down the passing of this order.
I want also to echo what the noble Lord, Lord Grantchester, said about the noble Lord, Lord Trees. I enormously appreciate the fact that he came to see me to express his support for this order, pointing out that he would have liked to have spoken in the debate but could not do so because he will be making his maiden speech in the debate tomorrow, which we look forward to hearing.
I thank all noble Lords for their support for this order and I will follow up on anything that has not been dealt with. In the mean time, I commend the order to the Committee.
Rape in Armed Conflict
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Baroness Northover
My Lords, I thank my noble friend Lord Lester for securing this debate and for all his work in this area. I also thank noble Lords for their contributions.
The Government have put women and girls at the heart of their international development work. Our Strategic Vision for Girls and Women sets out our strategy on delaying first pregnancy, support for safe childbirth and the prevention of violence against women and girls. We recognise that violence against women and girls is widespread, with high prevalence and devastating consequences. It has often been hidden and accepted for far too long. The noble Baroness, Lady Kinnock, is right to quote Hillary Clinton: rape is not cultural; it is criminal. It is brutal, as she and the noble Baronesses, Lady Flather and Lady Uddin, and others, have said.
My right honourable friend the Secretary of State for International Development has made it clear that tackling violence against women and girls is a central part of the UK’s development policy. My honourable friend Lynne Featherstone continues her very active efforts in this area as champion of combating violence against women and girls. My right honourable friend the Foreign Secretary has made the prevention of sexual violence in conflict countries a key priority for the UK’s G8 presidency this year.
The noble Lord, Lord Collins, is right to highlight the causes of the abuse of women and the assumption of the inequality of women. Millions of women and girls have no control over the circumstances in which they become pregnant. Every year 47,000 die as a result of unsafe abortion; millions more are permanently injured. I assure the noble Baroness, Lady Flather, that the UK is one of only a handful of donors willing to tackle this contentious issue, and we will continue to do so. I assure the noble Baroness, Lady Kinnock, that we are taking a lead here and will continue to do so.
This year we have major opportunities to secure greater international commitment to eliminating violence against women and girls. Key here are the Commission on the Status of Women, and our presidency of the G8, where for the first time the Foreign Secretary’s preventing sexual violence initiative will put this issue before G8 Foreign Ministers. Sexual violence causes physical and psychological damage to millions of women and girls and in the worst cases results in loss of life, as we have just seen in the terrible cases in India referred to by the noble Baroness, Lady Flather. A number of women and girls who are victims will be faced with an unwanted pregnancy. They may seek abortion, even when these services are not safely or legally available. In these situations the UK policy is clear: UK aid can be used, without exception, to provide safe abortion care where necessary and to the extent allowed by national laws. I can assure noble Lords that UK aid is not in any way influenced by the restrictions in place on US funding. Women and girls who are survivors of rape should have access to sensitive and high quality care that includes counselling and emotional support. I can assure my noble friend Lady Tonge that this includes access to emergency contraception—we recognise the importance of that—and presumptive treatment against sexually transmitted infections including post-exposure prophylaxis for HIV prevention.
My noble friend Lord Lester is flagging here the particular circumstances of sexual violence in armed conflict. Rape being recognised as a war crime was a landmark achievement. It has long been held that women are entitled to equal protection under international humanitarian law to that received by men. As we know, and as the noble Baronesses, Lady Kennedy and Lady Kinnock, and others said, rape is used as an extremely effective weapon of war. Let me address the central question of UK-funded medical care for women and girls raped in conflict. Parties to an armed conflict are obliged to provide all wounded and sick victims of armed conflict with humane treatment. To the extent practicable and with the least possible delay, they are obliged to provide the medical care and attention required by the given condition without discrimination except on medical grounds. This includes appropriate life-saving medical care which, in our view, may include the provision of abortion to women raped in conflict if it is deemed medically necessary.
The UK military manual sets out the UK’s interpretation of international humanitarian law applicable to the operation of our Armed Forces. While it does not itself apply to aid funding, it is a useful interpretation of the international humanitarian law context in conflict zones. As the manual notes, and as my noble friend Lord Lester pointed out, where there is a direct conflict between national law and the fundamental obligation on parties to a conflict under Common Article 3 of the Geneva Conventions, the obligation is to comply with Common Article 3. That article provides that those not participating in hostilities should be treated humanely. It prohibits murder, torture, humiliating and degrading treatment and, of course, rape, and requires that the wounded and sick are collected and cared for. The denial of abortion in a situation that is life threatening or causing unbearable suffering to a victim of armed conflict may therefore contravene Common Article 3. Therefore, an abortion may be offered despite being in breach of national law by parties to the conflict or humanitarian organisations providing medical care and assistance. Clearly, this service provision very much depends on the facts of each situation but I state clearly that it is our view that there is no blanket ban on such medical help when covered by international humanitarian law even if national laws might be at variance with that.
I also assure my noble friend Lord Lester that DfID requires that all UK-funded humanitarian partners abide by humanitarian principles, including non-discriminatory provision of assistance. In conflict situations, DfID expects all medical humanitarian agencies to observe and abide by international law, including international humanitarian law, in the activities that they provide. DfID’s monitoring of projects focuses on how the agency has contributed to saving lives and alleviating suffering, and these findings inform our funding decisions. To be clear, in all funded humanitarian activities, the UK requires all its humanitarian partners to adhere to widely agreed international principles of humanitarian action: those of humanity, impartiality, independence and neutrality. All humanitarian assistance is provided on the basis of need and without discrimination on any grounds.
My noble friend Lord Lester also asked whether DfID has asked the ICRC to segregate its US funding from that of the UK. DfID respects the mandates and independence of its humanitarian partners and we do not ask the ICRC to segregate funds as it is fully aware of its obligations to different donors. We have flagged and will continue to flag the UK’s position to the ICRC.
My noble friend asked about the engagement with the United States on this matter, as did other noble Lords. DfID officials are in regular dialogue with both USAID and US-based international NGOs with regard to improving access to sexual and reproductive health services and rights. This includes reducing recourse to unsafe abortion. We recognise the challenges faced by the US Administration in reopening the interpretation of the Helms amendment, but I am happy to assure my noble friend and other noble Lords that we will flag this debate, with its forceful concerns expressed about the reproductive rights of women raped in armed conflict, to US colleagues. I can tell the noble Baroness, Lady Kinnock, that we are exploring further the Norwegian position with our counterparts there. I can also assure the noble Lord, Lord Collins, of our commitment to UN Women. We recognise the importance of that, and DfID has been a strong supporter since the very beginning.
I was asked by the noble Baroness, Lady Tonge, about research. There is a fund of up to £25 million for research and innovation, which will focus on the prevention response to violence against women and girls in conflict and humanitarian situations. However, I think that the noble Baroness was asking whether research was needed in order to produce clarification. I trust that I have produced the clarification that noble Lords were seeking.
This debate goes to the heart of our responsibility to protect women and girls around the world, and especially when they are at their most vulnerable in places and times of conflict. As we have heard, rape is so terribly often used as a weapon of war. I assure noble Lords that the UK will continue to work to prevent violence against women and girls and to improve access to appropriate non-discriminatory medical care including services for abortion care in situations of armed conflict.
Syria: Humanitarian Aid
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Lord Selkirk of Douglas
To ask Her Majesty’s Government whether they have plans to reorder priorities in the humanitarian aid programmes of the United Kingdom and the European Union, in view of the number of refugees in Turkey, Jordan and other countries bordering Syria, and displaced persons within Syria.
Baroness Northover
My Lords, the UK is a leading donor to the humanitarian response for Syria. We have provided £53.5 million in support, and we continue to consider what more we can do. UK aid is prioritised to ensure that help reaches those who need it most. We are working closely with our humanitarian partners to provide a flexible, co-ordinated relief effort.
Lord Selkirk of Douglas
I thank the Minister for her reply. Will she promise to keep in mind the more than 525,000 refugees, whose number increases daily by 3,000, more than three-quarters of whom are children and women, and who are suffering from freezing winter weather, inadequate clothing, some of them on near-starvation rations, and most of them facing the constant threat of sickness and disease? Can she definitely confirm that every effort will be made to increase humanitarian aid through the UN and relief agencies in the face of this escalating crisis and the urgent needs of the refugees?
Baroness Northover
My Lords, I can assure my noble friend that the dire situation in Syria is very much in our minds. The United Kingdom is a major donor in this situation. I imagine that he is aware that the United Nations will issue a revised appeal tomorrow for further support. One of the problems here is that the UN appeals so far are severely underfunded. However, the United Kingdom is well aware of the significance of this crisis and, as I say, is a major contributor.
Lord Wright of Richmond
My Lords, is the Minister aware of recent press reports that armed gangs have been thieving aid and donations from displaced Syrians in Syria and Turkey? Does she agree that this makes it all the more important that all our aid, from HMG and the European Union, should be channelled through the international agencies? Does she accept that there is a potential contradiction between exploring all options to help the Syrian Opposition and—to quote from the Prime Minister’s Statement yesterday—giving further,
“support for the protection of civilians”,
many of whom are subject to discrimination and worse from elements within the Opposition and at least two of whom are now officially classified as terrorists by the United States Government?
Baroness Northover
The noble Lord will be well aware from experience how difficult it is to work in Syria at the moment. We pay tribute to those who are doing so. We note, for example, that the UN has had to pull back a number of its workers from Damascus. We are aware of challenges and, as he says, it is extremely important to work through the international organisations which are best placed to get in the aid that is required. We are assisting, in terms of peace-building, training and so on, the National Coalition for the Syrian Revolution and Opposition Forces but we are aware of how diverse the members of that group are. We are emphasising that they should work together inclusively for the benefit of all the people of Syria but we are aware of the challenges there too.
Baroness Uddin
My Lords, is the noble Baroness aware that recently His Majesty the King Abdullah was in Parliament and that he briefed a number of Members across both Houses? He echoed much of what the noble Lord, Lord Selkirk, has said about the need for emergency relief and support to continue. Will the Minister assure the House that a quick response will be made to aid particularly the Jordanians? What timeframe is she looking at to ensure that refugees receive the maximum amount of support? Furthermore—
Baroness Uddin
Will she also say what support is being provided by the other Arab Governments in partnership with our Government?
Baroness Northover
The noble Baroness is right about the contribution by Jordan and the other neighbours. The other day I met King Abdullah’s uncle, Prince Hassan, who made the same point. Jordan is receiving £11 million from us to support the refugees. We pay tribute to the countries around in that regard. In terms of the other donors, the Arab League is the fourth-largest donor in the region; the United Kingdom is the sixth.
The Lord Bishop of Exeter
My Lords, the latest UNHCR refugee figures, as quoted by the noble Lord, Lord Selkirk, truly are shocking. They reflect the protracted brutality of the ongoing conflict. Will the Minister give an assurance that within the generous and strategic response to the humanitarian situation on Syria’s borders, adequate provision is being given to those refugees who are survivors of sexual and gender-based violence? Will she also say what is being done to document these abuses in order that in due course the perpetrators are brought to justice?
Baroness Northover
The right reverend Prelate makes an important point. One of the striking things about this conflict, as in other cases, is the large amount of sexual violence, which is widespread and systematic. We hear reports of sexual abuse and domestic violence, and also of young girls being forced into early marriage among the refugees. Therefore we are extremely concerned.
We are providing clinical care and counselling for 12,000 Syrian refugees in Jordan who have experienced such trauma and sexual assault. I note the point about making sure that this is documented. It has struck me that this is better documented than may have been the case in the past but we still have a long way to go in terms of recognising the significance of this.
Baroness Hussein-Ece
My Lords, my noble friend will be aware that Turkey is shouldering the cost of the humanitarian aid for people from Syria crossing over its borders. They are currently accommodating 138,000 refugees in 14 camps at a cost so far of $500 million and rising. So, in the absence of any peace deal, what steps is the United Kingdom taking to lead international efforts to increase aid and support to Turkey, and what proportion of the figure she quoted earlier is going to Turkey?
Baroness Northover
We certainly commend Turkey’s extraordinary hospitality in looking after the Syrian refugees who are crossing their border. As I mentioned, the UK is providing £24 million in humanitarian aid. Overall, we are providing £53.5 million in response to the crisis; £29.5 million is going to those inside Syria; £24 million is going to the refugees outside, of which £3 million is supporting refugees in Turkey.
We are working with the international community, which is focused on supporting the neighbouring countries, and we will keep this under constant review.
Baroness Symons of Vernham Dean
My Lords, may I press the noble Baroness further about the situation in Jordan? When he was in this country last week, the King of Jordan stressed the urgency of the situation in a very small country which has few natural resources of its own. It also has a further refugee problem with the Palestinians.
To echo the question specifically in relation to Jordan, what proportion of the money we are giving is going to Jordan, and is the Minister satisfied that that money is getting there fast enough to help an urgent position on the ground?
Baroness Northover
The noble Baroness is right about the significance of Jordan. Jordan has hosted many Palestinian refugees and they are supported by UNRRA. The United Kingdom has increased their contribution to support those Palestinian refugees.
Of the £24 million from the United Kingdom that I mentioned, which is supporting refugees generally, £11 million is going to Jordan. The international community and the noble Baroness, Lady Amos, who is UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, are constantly monitoring where the need is greatest. The problem is not so much what the United Kingdom is doing, but making sure that other countries step up to the mark and contribute as well.
Care Services: Abuse of Learning Disabled
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Baroness Northover
My Lords, I, too, congratulate the noble Lord, Lord Rix, on securing this debate. I am glad to see him back in his place and wish him and his wife well. He has a formidable record in this area and we are pleased to see him back here. He has been fighting for a long time for the rights of people like Simon, whom he mentioned.
There can be no more important issue for us as a society than how we treat our most vulnerable people, as my noble friend Lady Jolly and others emphasised. I, too, was impressed by the maiden speech of the noble Baroness, Lady Kidron. It was very moving and she absolutely rightly emphasised that this debate is about cases like that of Louise. If we cannot get things right for people like Louise and her family, we are not getting anything right.
I thank the noble Baroness, Lady Hollins, for her praise for the report issued this week. I assure the noble Lord, Lord Maginnis, of the huge commitment of my honourable friend Norman Lamb in this area. That commitment shines through in this uncompromising report. Stimulated by this terrible case, it does not just deal with Winterbourne View but looks at the whole sector with its radical proposals—which I am glad so many noble Lords welcomed. Noble Lords have, if anything, asked if those can be done and delivered, rather than questioning whether this is the right route to take. There is a firm and detailed timetable of action. I hope that noble Lords have marked that, including the noble Lord, Lord Hunt. I am sure that noble Lords will hold us to account. My honourable friend Norman Lamb will oversee this. He will leave organisations in no doubt of his commitment in this area.
The scandal that unfolded at Winterbourne View was devastating but it has spurred us into action. Straight after the abuse was exposed, the Government commissioned an in-depth review. Noble Lords have referred to the report published earlier this week. As we said then, the Winterbourne View abuse was criminal. Staff whose job was to care for people instead routinely mistreated and abused them—as my noble friend Lady Jolly, the noble Lord, Lord Maginnis, and others said. Management allowed a culture of abuse to flourish. Warning signs were not picked up, and the concerns of residents’ families, and of a whistleblower, went unheeded.
As I have said, this case made us look again at how we care for one of society’s most vulnerable groups of people. Winterbourne View provided care for people with either learning disabilities or autism, together with mental health problems or challenging behaviour. Around the country some 15,000 people have similar needs, of whom some 3,400 are in in-patient settings. Many people receive good care in these settings but—as my honourable friend Norman Lamb, the noble Lord, Lord Touhig, and others have said—hospitals are not where people should live. Across the country, far too many people with learning disabilities or autism are in hospital and staying there too long. As the noble Lord, Lord Rix, and others emphasised, we have known for a long time that with the right support the vast majority of people with challenging behaviour who also have autism or a learning disability can live happy, fulfilled lives, close to their families and in their own communities—as Simon now is. When someone needs to be in hospital, it should be for a short period, in a small unit as close to their home as possible. I, too, pay tribute to Jim Mansell for all the work that he did on this.
We know what change is needed. It is now time to make sure it happens. First, owners, boards and senior managers must take responsibility for their services. I assure the noble Lord, Lord Rix, that we will examine how corporate bodies and their boards can be held to account for the provision of poor care and for harm experienced by people using their services. We will consider both regulatory and criminal sanctions, and will set out proposals in this area in spring 2013. I look forward to the noble Lord’s comments on those proposals. Of course, the noble Lord, Lord Hunt, is right to focus on the corporate responsibility of Castlebeck and other companies. I am sure that he will also scrutinise with great care the proposals that we bring forward. In addition, we will explore whether we can introduce a test to ensure that directors are fit and proper persons to oversee care. The CQC will consider a best practice model of care as part of its regulation of services from 2013. It will also check whether all providers are following national guidance or similar good practice. Where standards are not met, it will take enforcement action.
We will also stop people being placed in hospital—unless hospital is actually the best place to be. All current hospital placements, as noble Lords have referred to, will be reviewed by June 2013. Everyone who is there inappropriately will move to community-based support as quickly as possible—and no later than June 2014.
Foreign Affairs: Global Role, Emerging Powers and New Markets
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Lord Williams of Baglan
My Lords, like others, I thank the noble Lord, Lord Howell, for his initiative in calling this debate. I also pay tribute to his contribution to discussions on international affairs in this House, in the House of Commons and in other institutions over many years. Just over a month ago, we were together at one such institution—Wilton Park, in Sussex—for a conference looking at the enormous changes now taking place in Burma. One thing that we discussed, and that I hope we can see in the future, was that Burma might take its place in the Commonwealth. After all, it is one of only two former British colonies—I think the other is South Yemen or Aden—which did not join the Commonwealth on its independence.
The noble Lord, Lord Howell, spoke of the reform of the EU. I think we all wish to see a more efficient and modernised EU, but I caution that we need to take care. Many foreign companies from the United States, Japan, China, Korea and India have invested in the United Kingdom because they see the UK as one of the most liberal countries in Europe and as a gateway to Europe. We can ill afford to lose their investments, economically and politically. We also need to take care in talking about reform of the EU in the wider sense of reform of international institutions. This country has a great stake in the United Nations, in the IMF and in the World Bank. After all, we are one of only five countries in the world with a permanent seat on the Security Council, despite the fact that we are a nation of 60 million souls, whereas India is a country of more than 1 billion. Talk of reform needs to be taken forward with great caution as regards discussion of international institutions.
To my mind, the heart of change with regard to global affairs lies very much with the rise of Asia, China, Japan, Korea, India and Indonesia, whose president, Bambang Susilo Yudhoyono, was here as a state guest only a month ago. We have to recognise these realities and think whether we would do better to deal with them in the EU or decoupled from the EU. President Obama has made it clear where he thinks the United States’ future direction should be. Just over a year ago, he spoke of the US’s pivot towards Asia and we need to be mindful of endeavouring to intensify further our relations with such an important part of the globe. If the US saw a UK decoupled from the EU, and France and Germany more dominant in the EU, I believe that that would accelerate US involvement and commitment to Asia at the expense of its longstanding commitment towards Europe.
In the debate, much talk has been made of soft and moral power, concepts with which I always feel a little uncomfortable. However, there is no doubt that such things have been critical over the years, over the decades and perhaps over the centuries to Britain's international role. Here I declare an interest as a trustee of the BBC and as a trustee responsible for the World Service. I appreciate the concerns expressed in the debate about the World Service. Like the rest of the BBC and like all British institutions, the World Service has suffered from diminished budgets in recent years but I can assure noble Lords—
Baroness Northover
I apologise for interrupting the noble Lord but I would like to remind him that those who are given permission to speak in the gap have, at most, four minutes, so he might wish to conclude his speech.
Lord Williams of Baglan
I can conclude by assuring noble Lords of the robust and rude health of the World Service. We broadcast in an array of languages, from Azeri and Burmese to Persian and Uzbek. In all those countries we still have an impact and a reach that is much greater than anyone else.
Arrangement of Business
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Baroness Northover
My Lords, as the Question for Short Debate proposed by the noble Baroness will now be taken as last business, the time limit for the debate becomes 90 minutes rather than 60 minutes. Speeches should therefore be limited to nine minutes, except for the speeches of the noble Baroness, Lady Greengross, and the Minister, which remain limited to 10 and 12 minutes respectively.
Health: Neurological Services
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Baroness Northover
My Lords, like other noble Lords, I pay tribute to the noble Baroness, Lady Ford, for tabling this Motion and for her very effective introduction. I know how important this subject is to her. I am also very well aware of her excellent work with the All-Party Parliamentary Group on Epilepsy and with Epilepsy Action to improve care and support for people living with this condition. Like others, I must declare an interest, as I did two years ago, that I have two close relatives living with epilepsy.
As ever, this has been an extremely well informed and wide-ranging debate, which has raised issues across a range of neurological conditions. In November 2010 I was in the fortunate position to be able to answer an equally illuminating debate put down by the noble Baroness, Lady Ford, to which she and the noble Lord, Lord Patel, referred. I know that she has been somewhat busy with one or two things since then, including the Olympics, but I am glad that we are returning to putting an emphasis on this issue.
I assure the noble Lord, Lord Patel, that, in being briefed on this subject, one of the first things that I did was to ask what I had promised two years ago and what had been delivered, and I hope that I can provide some reassurance. I cannot guarantee that I will not overrun, but if I do not answer all the questions asked by noble Lords—there have been a multitude of them—then I will write to them.
This evening, we have heard that the challenge posed by neurological conditions is huge. Taken together, they are common: more than 10 million people in the UK live with such a condition. As noble Lords have indicated, they can give rise to complex needs that require support from a wide range of professionals. They also can change people’s lives profoundly. We have heard that neurological conditions have not always been well served in recent years, which, once again, as it was two years ago, was reflected in many of the speeches tonight.
Since then, the Public Accounts Committee has reported on neurological services, and the noble Baroness, Lady Ford, and others made reference to that. That report, which was published earlier this year, clearly argued that we need to do more to improve the quality of services. We have already responded to that report and we take its recommendations very seriously. Some of the issues that were flagged up had been flagged up before, and work is already under way to improve neurology services.
As noble Lords well know, it has been argued for years that better integration between health and social care is vital in this area, as in so many others. That is something that we are working hard to achieve; my honourable friend Norman Lamb has it at the top of his agenda. Better integration of health and social care offers a real opportunity to improve care and support for people with complex needs.
The noble Baroness, Lady Ford, and others made reference to the current changes in the health service. Locally, joint health and well-being strategies will, as noble Lords know, set out how local commissioners will work together to deliver the best possible outcomes for their communities. Health and well-being boards will bring together local partners to address the wider determinants of health such as education, transport and housing. So there are new opportunities there.
The Health and Social Care Act 2012, the outcomes frameworks for the NHS, adult social care and public health, the NHS constitution, the mandate we have just heard about and the draft Care & Support Bill all emphasise how collaboration between local government and the NHS is crucial to the future success of health and care systems locally. We are working to identify barriers to integration—those who were at the King’s Fund breakfast the other day will have heard how people across the spectrum are seeking to do that—and the means to encourage integration, which will seek to ensure that the patient is the focus, whatever complex needs they have.
Integrated care will also be the key theme of the outcomes strategy for long-term conditions that we are developing. The strategy will take a life view of long-term conditions, looking at issues across the course of a person’s life, and will set out what local government, the NHS, communities and individuals themselves can do to improve outcomes. In addition to integrated care, the strategy will be structured around the goals of early diagnosis—again, noble Lords made reference to that—promoting independence and taking steps to support those with long-term conditions to live as well as possible.
The PAC’s report in particular identified a lack of neurological expertise in developing services. In the current system, clinical networks have been responsible for sustained improvements to particular care pathways or for particular groups of patients. Noble Lords made reference to that too. They have raised standards, supported easier and faster access to services and encouraged the spread of best practice.
We are committed to ensuring that in the new system this way of working and delivering services is maintained, and that we build upon the progress that has been made. In July the NHS Commissioning Board Authority announced the establishment of four new strategic clinical networks, including one covering dementia, mental health and neurology. The network will help to improve outcomes for patients across England by ensuring that the NHS Commissioning Board and clinical commissioning groups have access to expert clinical opinion about the way that care should be planned and delivered.
Quality standards, to which noble Lords have also referred, published by the National Institute for Health and Clinical Excellence, will also play a central role in the new health and care system by providing patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality health and social care. We have asked NICE to develop a number of quality standards that are neurologically focused. Noble Lords also made reference to them, and I shall come back to them in a minute. These are already in development and, additionally, people with a neurological condition will benefit from cross-cutting quality standards.
I want to try to address a number of noble Lords’ questions at this point. The noble Baroness, Lady Ford, raised a number of specific questions. She asked about individual care plans. I assure her that personalised care planning is already being delivered. She also asked what was happening with regard to quality standards. A clinical guideline on assessment is to be developed, and from this we can develop a generic quality standard.
The noble Baroness asked about the continuation of the PAC recommendations on progress and wanted to know about driving up quality. The mandate to which people have referred emphasises what is important for people with long-term conditions. Irrespective of the nature of that condition, the focus is on how you try to ensure that people with long-term conditions are supported and how they would best manage their conditions. Taking it in a generic way, you try to ensure that you do not exclude other long-term conditions that we have not been talking about this evening, but obviously these ones would be included in that approach.
A number of noble Lords referred to data. The NHS Commissioning Board is working with the Neurological Alliance to develop a data set. It is extremely important that the information is there because, as noble Lords have said, unless you understand the nature of the problem—where you have patients, what treatment they are receiving, and so on—you cannot take forward what you wish to achieve. When I first became involved in this area, I was astonished at the lack of information on particular conditions around the country. That is something that the previous Government, and Governments before them, must take responsibility for. I am not at all surprised that the noble Lord, Lord Darzi, started to try to draw up atlases of diseases and outcomes and suchlike. To me as a former academic, it was astonishing that that kind of information was not there before. I assure noble Lords that this Government are taking that forward, but I would pose a criticism to previous Governments for not having done that basic work.
The noble Baroness, Lady Ford, asked about clinical commissioning groups taking specialised commissioning seriously, as did my noble friend Lady Jolly. It is extremely important. The neurological charities and organisations are providing support in this area, and I welcome that; they are supporting commissioners to understand the complexity of support and services needed, and the Department of Health has funded neurological commissioning support to work with the CCGs. I hope that that will pay dividends.
My noble friend Lady Jolly asked about the national strategy to help with the diagnosis of epilepsy. Quality standards are due for publication in February which will cover referrals to specialists and timely access to diagnostic tests, which we hope will improve things.
The noble Baroness, Lady Masham, asked about MMD guidance and various aspects to do with that, including the development of drugs. The UK rare diseases plan, which will be implemented before the end of 2013, will be looking at drugs for rare diseases and the research needed to bring them to market. She is quite right that, as in developing countries, rare diseases do not bring in the kind of investment that is needed in these areas. That is something that we are looking at.
We continue to review how NICE is taking things forward, and, of course, NICE itself reviews its workload and how it is managing it. Clearly, those who are concerned about other diseases are equally concerned that their NICE proposals are expedited. It is extremely important that NICE carries this forward as rapidly as it can, but it needs to balance that with its other workload. We recognise the importance of specialist nurses—a point made by the noble Baroness, Lady Masham. They help to achieve significant cost savings, and the Royal College of Nursing is at the moment looking at the value of specialist nurses and will help service commissioners in trying to understand what is required and what the workforce needs to be.
The noble Lord, Lord MacKenzie, asked a number of questions, some of which I have dealt with in my previous answers. He wondered whether the PAC recommendations would be revisited. No doubt the noble Baroness, Lady Ford, will have another debate, which I will no doubt answer, but I can say that the PAC has been asked by the National Audit Office to follow up on its report in 2014.
In terms of clinical leadership, the NHS Commissioning Board is determining how to structure national clinical leadership and advice within the board, and further announcements will be made shortly. I note that Dr Martin McShane, who has been appointed as the lead on long-term conditions, met the Neurological Alliance on 12 September, so I hope that that is encouraging to those who are concerned about leadership.
The noble Lord, Lord Patel, raised a number of questions that he had put to me previously. In terms of better services for children, subject to regulations being laid, children’s neuroscience services will be commissioned by the NHS Commissioning Board, which will promote greater consistency. The children’s health outcomes framework, which will be published by Christmas, will support the delivery of better children’s services and better outcomes. The noble Lord asked whether that would be carried over to adults, and I will get back to him about that. With regard to following the NICE guidelines, I remind him that they are advisory, not mandatory. Clinicians are free to adapt the guidelines. However, in a transparent system where those guidelines are known, that, too, puts pressure on the clinicians via the patients and certainly by the specialist organisations, which are clearly so well aware of what is required.
I have talked about the NHS Commissioning Board developing data sets and how astonished I was that they did not exist in a previous era.
The noble Baroness, Lady Gale, asked whether Parkinson’s and other diseases could be prioritised. All conditions will have equal priority under the new system. For those who are concerned about so-called Cinderella conditions, that should be an encouraging answer, although those who feel that the diseases that they are particularly concerned about get a lot of focus already might be a bit concerned. All conditions will have equal priority, so Cinderella conditions should be improved.
I conclude by assuring noble Lords that there is a real commitment within the Government to address the challenges identified this evening, with the support of the NHS Commissioning Board and generally within the health and social care sectors. We recognise that much still needs to be done, but our primary goal is the same: to improve the patient experience and outcomes, and to bring real benefits and real change to the lives of people living with neurological conditions. I am very sure that the NHS Commissioning Board will have heard what noble Lords have said in this debate.