Tobacco and Related Products Regulations 2016

Baroness Walmsley Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Hunt of Kings Heath]

No doubt we will of course be able to see in the future what a Government would do in the event of Brexit. However, to be fair, at the moment we are debating these regulations, which have come into force. I have attempted to signal some of my concerns that this would have a negative impact on the use of e-cigarettes without detracting from the overall regulations. I beg to move.

[Baroness Walmsley (LD)]

My Lords, I was most interested in the speech made by the noble Lord, Lord Callanan, and in particular his gallant admiration of his colleague the Public Health Minister, who in my experience has usually been quite on top of her brief. I venture to warn the noble Lord never to make a mistake in your Lordships’ House, because I suspect that Facebook might be watching. I was also very moved by his defence—in fact it was quite tear-jerking—of the discrimination against the multi billion pound tobacco companies compared with the multi billion pound pharmaceutical companies.

I agree with much of what was said by the noble Lords, Lord Callanan and Lord Hunt of Kings Heath, about the desirability of encouraging smokers to give up smoking. There is no doubt that vaping devices have an enormous role to play in this campaign, as many former smokers have managed to give up through using them. However, the regulations are not just about vaping devices but include, as the noble Lord, Lord Hunt, pointed out, standardised packaging regulations, which are essential for ensuring the effectiveness of the health information and warnings on cigarette packs. They also help to enable the UK to meet its obligations as a party to the World Health Organization’s Framework Convention on Tobacco Control with respect to tobacco packaging and labelling, and product regulation.

There is no doubt that vaping devices have already been an enormous benefit to public health—although I fail to see why we need 25,000 different kinds of them—and have saved the NHS a great deal of money. When the directive to which these regulations give effect was first discussed in the European Parliament, as has been said, the Liberal group, which contained at that time several Liberal Democrat MEPs, worked hard to ensure that while the regulation of tobacco packaging continued to be robust, the regulations about vaping devices would be proportionate. Given that the original proposals followed the World Health Organization’s recommendation that these products should be licensed as medicines and would therefore be extremely tightly regulated, the Liberal group had some considerable success in making them a bit more proportionate, resulting in the directive as it is now. However, one of the things on which the group was not successful was the prohibition of commercial advertising of vaping products. This is the major item contained in my regret Motion.

According to the Royal College of Physicians, vaping is 95% less harmful than smoking and half of all smokers die from diseases that result from smoking. That is why it is vital that smokers can get information about these products and their benefits, and I regret very much that publicity about them is to be restricted. However, I support the noble Lord, Lord Hunt, in his call for a new public information programme to inform smokers of the benefits of switching to e-cigarettes. It may surprise your Lordships to know that half of smokers are not aware of how much safer for their health e-cigarettes are. I also agree with the noble Lord, Lord Hunt, in regretting the cutting of smoking cessation services—one of the many results of the public health funding cuts which I have condemned many times in your Lordships’ House.

I suppose that one of the reasons for the advertising ban is the fear that advertising will attract young people to vaping even though they have never smoked. This is of course undesirable, because nicotine vapour is very addictive, and I would not want to see children being attracted to spending their money on something so addictive and with no known benefits to their health. Indeed, more research needs to be done on the effect of nicotine inhalation combined with the various flavouring chemicals used in e-cigarettes. Some evidence is emerging that if inhaled, some of the flavourings may be harmful to the delicate cells lining the lungs. But although e-cigarettes have been around for years, there is no significant evidence that they are attracting non-smokers to take them up. On the other hand, we now have a large and growing cohort of people who use vaping devices, which is why I call on the Government to fund research on the benefits and—if there are any—the dangers of vaping.

Everything should be done to encourage smokers to switch to vaping, which is why my Motion also regrets that little attention has been paid to those vapers who claim that they need the higher-end concentration of nicotine products, which would be banned by some of these regulations, to help them give up smoking. Only time will tell whether that is the case. That is why the Government need to monitor and report on the implementation of these regulations and their impact on public health. While the further regulations on cigarette packaging are likely to be good, those on vaping devices could turn out to be bad.

Therefore, like the noble Lord, Lord Hunt, I do not support the Motion in the name of the noble Lord, Lord Callanan—that the Government should withdraw these regulations—because we need the ones that affect tobacco. However, although I sincerely regret the Government’s current intention to withdraw from the European Union in the fullness of time and hope very much that it never happens, the current situation does give us an opportunity. As things stand we are not able to keep the good tobacco regulations and ditch the undesirable ones, but the forthcoming negotiations do give us an opportunity to do a bit of cherry picking.

I therefore ask the Minister, what is the Government’s intention with regard to these and other EU regulations? Do they plan to adopt them all and then repeal the ones they do not like? If so, I call on the Government to consider carefully any deterrent to smokers switching that might result from these regulations, and to repeal the ones that deter them as soon as possible. Of course, that would require careful monitoring and publication of the results. On the other hand, in the unlikely event that the Government plan to repeal all EU regulations and then adopt new UK ones, I call on them to replace only the ones that affect tobacco packaging and marketing to further decrease the public health burden of tobacco and the terrible effects on the health of individuals and the NHS.

Given that all these regret Motions are non-fatal, I do not intend to vote on mine, although if the noble Lord, Lord Callanan, votes on his, my colleagues and I will vote against it. We are where we are. What matters now is what the Government do in future. Lives depend on it.

--- Later in debate ---

[Lord Forsyth of Drumlean]

My Lords, first I congratulate my noble friend Lord Callanan on the very excellent case that he put. I shall not proceed by repeating any of the arguments. I have looked at the regulations, but some people who have spoken in the debate clearly have not.

If someone wanted to sabotage a product, add to the costs of producing that product, limit the scope for competition with that product, and drive out of business small producers, it is hard to see how a more effective job could be done than in respect of the regulations that apply to electronic cigarettes. As far as noble Lords who argued that this is all a plot by the tobacco companies are concerned, one way of ensuring that all of this ends up in the hands of large businesses will be by pursuing exactly these regulations—by limiting choice and, of course, by creating a black market, which will be accessed through the internet, as we have seen occur over and over again in respect of medicinal products.

There seems to be no logic in the regulations. We have already touched on why some advertising is allowed but not others. I find it extraordinary that a Government should want to ban advertising when the evidence that we had from ASH—the noble Lord referred to that—states:

“Perceptions of harm from electronic cigarettes have grown with only 15% of the public accurately believing in 2016 that electronic cigarettes are a lot less harmful than smoking”.

If most people do not realise the benefits of it, what on earth is the logic of preventing people advertising it? How does the noble Baroness, Lady Walmsley, explain that she wants a public information campaign? How can we have a public information campaign without advertising the benefits of electronic cigarettes? Therefore, why is she against the advertising of electronic cigarettes? There is no logic in that.

I hope that noble Lords do not mind me mentioning the fact that my son is 37 years old. He has smoked cigarettes since he was 16, to the best of my knowledge, and probably earlier. He smoked very heavily, but three Christmases ago—I should declare an interest—I bought him an electronic cigarette. As a result, he has reduced the levels of nicotine and of all the things that we have tried—blackmail, bullying, nicotine patches, and everything under the sun—it has worked. The figures show that one-third of the 2.8 million adults who are vaping in this country are ex-smokers. The arguments being put for the public health benefits are overwhelming.

It pains me to say this, but this is a classic example of gold-plating of European regulations by the UK health department. The point is that, because the regulations are gold-plated, there is nothing we can do about them. They are EU regulations and we are required to implement them. I wonder what on earth was going on in the Department of Health that made it do this.

When we see something absurd happening, we should ask, “Cui bono?”. Who benefits from this? Certainly the Government benefit from it because people who are continuing to smoke cigarettes will pay a very considerable amount in tax to the Exchequer. I do not know how much a packet of cigarettes costs, as I have never smoked my life, but I am told it is about £9 for 20 cigarettes. People who start vaping will not spend that in a week. Families on low incomes—and many of the people who smoke heavily are among the lowest- income families—will benefit from something which enables them to deal with the addiction that they have to nicotine and remove themselves from it. Who benefits from this? Certainly not the people who are among the poorest in our country who are smokers. The Exchequer benefits—the Treasury benefits—if people are still smoking cigarettes because it gets its tax on the cigarettes, which is very considerable. Of course, the pharmaceutical companies, which sell the nicotine patches, benefit. The tobacco companies benefit because people are not switching away.

So what on earth are the Government doing, promoting the interests of the tobacco companies and the large pharmaceuticals—because that is the effect of this? The detail in the regulations is unbelievable. They even spell out which typeface—Helvetica—appears on the warnings, and whether it should be bold or italic. That is North Korean stuff: it is utterly absurd regulation. We may laugh at it, but, as the noble Lord, Lord Campbell-Savours, pointed out, it means that small businesses up and down the country will have to comply with these regulations, work out what they mean, change all their literature and everything else, and, as a result, be driven out of business.

We are in a bit of a quandary here, because there is much in these regulations that is quite desirable. When we have left the European Union, we will be in a position where we can hold our Ministers to account, hold votes and actually make these things happen. I had not realised that this is a very clever operation by the Department of Health. This is what you do: you have some absurd regulations, which you know you are not going to get through the House of Commons. So you persuade Brussels to include them in an EU directive; and heigh-ho, they have to sail through both Houses, because there is nothing we can do. We all take part in this pantomime, where we explain all the reasons why they should be changed, knowing full well that there is very little we can do about it until we leave the European Union.

So I congratulate my noble friend on his efforts and hope that, when the Government are free to do so, they will rethink these absurd regulations, which will undoubtedly cost lives. They are a classic example of how big business is able to use Brussels, together with lobbying organisations, to the disadvantage—and, in this case, life-threatening disadvantage—of the citizens of this country.

[Baroness Walmsley]

May I correct something that the noble Lord, Lord Forsyth, said? He suggested that there was an inconsistency in my remarks. I point out to him that my regret Motion regrets the advertising ban. If there were no advertising ban, it would be perfectly possible to have a public information campaign.

[Baroness Young of Old Scone]

My Lords, after the excursion by the noble Lord, Lord Forsyth, into Europe bashing, may I bring the House back to the subject in hand, which is these regulations?

The noble Lord, Lord Rennard, hit the nail on the head. Why are the major tobacco companies all piling into these products and their manufacture, distribution and promotion globally? It is not because, in a spirit of public protection, they want to see smokers take up these products rather than the main part of their activities, which will continue to be the pushing of tobacco globally.

We have to ask ourselves why there is a need for regulation in this area. The reality is that electronic cigarettes are effective in reducing, in the case of smokers, their reliance on tobacco, but this needs to be associated with a wider tobacco control strategy and some good, targeted, mass promotion—not of individual products in the vaping field but with the concept that, if you are a smoker, vaping may be one of the things, among others, that can help you. That must include psychological support as well as simply a change of product. I hope, too, that the Government will ponder on further increases in the price of tobacco; at the end of the day, that is the most effective way of reducing demand. Perhaps we can hear from the Minister what the Government are planning to do to ensure that there is public promotion of vaping as an alternative for smokers, access to good-quality, evidence-based stop smoking services and changes in costs.

We should not delude ourselves that tobacco manufacturers are getting into vaping products simply to allow people who are smoking currently to reduce their risk. They are getting into it because that, in their view, is the double whammy: an alternative product that can run alongside their very damaging products, which will continue, and a little bit of what in the environment movement used to be called “greenwashing”—I do not know what one would call it in the public health movement—in order to make their image more acceptable publicly. Therefore, I would not support the amendment of the noble Lord, Lord Callanan.

Health: HIV

Baroness Walmsley Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the judicial review is being held next Wednesday, which is only 10 days from now, at which point we will know the exact legal position. I really cannot comment further on it today. As far as this drug being widely available as a prophylaxis, it is widely available only in some countries for very specific groups of people. If we commission it in the future, it is important that we are clear about where we can get the most benefit from it.

[Baroness Walmsley (LD)]

My Lords, the PROUD study reported in the Lancet last year showed that the PrEP use of Truvada in high-risk groups reached nearly 100%. Are there any other preventive treatments for life-threatening diseases which are 100% effective but for which NHS England is refusing to take responsibility?

[Lord Prior of Brampton]

It is true that in the control group used in the PROUD trial there was a very high level of success—85% or 87%, I think—but it is critical to identify the right group of people. That is why NHS England is providing £2 million to test Truvada as a prophylactic among a wider group of people to see whether it is equally efficient.

NHS: Unsafe Hospital Discharges

Baroness Walmsley Excerpts

Wednesday 15th June 2016 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government what action they are taking, in the light of the report of the Parliamentary and Health Service Ombudsman, to prevent unsafe discharges of frail and elderly people from hospital.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, unsafe discharge of frail elderly patients is unacceptable. Discharge can be very complex, and the integration of health and social care is vital for safe, joined-up care. We are using sustainability and transformation plans to promote integration, supported by the better care fund, creating a seven-day NHS and supporting local systems to develop integrated discharge systems and new models of care.

[Baroness Walmsley (LD)]

I thank the Minister for his reply, but is he aware that the ombudsman reports patients being discharged before they are clinically ready, without being assessed or consulted and without a care plan or their family being told that they are coming? Does he know why this is still happening 12 months after Healthwatch England’s report on the same issue? Does he agree that this not only puts an enormous financial burden on the NHS but is an appalling way to treat vulnerable people?

[Lord Prior of Brampton]

My Lords, there are millions of interactions between patients and consultants and doctors every day of the year, and there will be some mistakes. We cannot draw conclusions from one or two desperate situations. In so far as they reveal systemic problems, it is valid to draw attention to individual cases of this kind, and there are some systemic issues lying behind the PHSO’s report. In particular, it states:

“We are aware that structural and systemic barriers to effective discharge planning are long standing and cannot be fixed overnight … health and social care … have historically operated in silos”.

That is the issue on which we should be focusing.

National Clinical Director of Adult Neurology

Baroness Walmsley Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am of course very happy to meet the Neurological Alliance with the noble Baroness. I just say this: if the medical director and board of NHS England cannot make decisions about where they should get their clinical advice, one is bound to ask what on earth the point of them is. There are certain decisions that must be made by NHS England and Bruce Keogh, its medical director, came to this decision. I think it is a decision that he should make, not politicians.

[Baroness Walmsley (LD)]

If three years has been long enough for NHS England to decide that the national clinical director and the regional clinical networks are not working well enough for neurology, how long is it planning to give the new system to prove that it is better for patients?

[Lord Prior of Brampton]

I do not think that anyone is saying that the system was not working well enough. The argument that NHS England put was that it had to focus its resources on a smaller number of key national priorities—for example, mental health, cancer and learning disabilities—and that is what it is doing. It is poking the resource into a smaller number of well-focused and well-defined areas, but it can still get all the advice that it needs on neurology from the clinical reference groups and other sources.

Dental Health: Children

Baroness Walmsley Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I agree with my noble friend. Fluoridisation has a huge and direct impact on oral hygiene. It will be up to Manchester to make that decision in due course. To pick up a point made by the noble Baroness, Lady Benjamin, social deprivation also plays a big part in the variation in the quality of people’s teeth. Interestingly, 75% of all children have no tooth decay now, but in some parts of the country—Blackburn, for example—the figure is as low as 40%.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that a healthy diet, including milk, fruit, vegetables and enough vitamin D, is as important to the development of children’s teeth as not eating too much sugar? The Healthy Start programme provides those eligible with free vitamins and vouchers to buy those healthy foods but I understand that the uptake is poor. What are the Government doing to improve the uptake of this programme and to ensure that the lessons learned by those authorities that choose universal distribution of vitamins are spread throughout the country?

[Lord Prior of Brampton]

My Lords, there is no question but that a low-sugar, healthy diet is good for people’s teeth. The noble Baroness will have to wait until we produce the children’s obesity strategy later in the summer, in which we will reveal the full strategy.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Baroness Walmsley Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not going to proffer the argument that it is too expensive, because that is not the issue today. The issue today is that NHS England feels that it does not have the power to commission this particular drug. Whether or not it has that power may well be judicially reviewed, so I cannot comment on the outcome of that judicial review.

The PROUD study produced strong evidence of the effectiveness of Truvada as a preventive drug. The work that NICE is going to do, and the pilot scheme to look at the effectiveness of this drug—it will cost £2 million and will be funded by NHS England and PHE—will ensure that when the question whether NHS England has the power to commission this drug is resolved, there will be the evidence on which to make that decision.

[Baroness Walmsley (LD)]

My Lords, are the Government simply delaying until Truvada comes out of patent and becomes cheaper? Can the Minister say whether NHS England has taken into account the protection from HIV infection of the whole community that would result from a reduction in infection of high-risk groups? Can he also explain why the Government see infection prevention as a local authority responsibility in this case, given that other forms of prevention, such as vaccination, are the responsibility of the NHS nationally? This is not consistent.

[Lord Prior of Brampton]

As I said in response to the earlier question, this is really not about the efficacy of the drug. There is evidence that it is very efficient; that will be confirmed or otherwise by the extra work done by PHE. It is purely a question of the independent legal advice given to NHS England that it does not have the power to commission this drug.

Obesity

Baroness Walmsley Excerpts

Thursday 26th May 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that some food manufacturers and supermarkets are delaying their reformulation programmes in anticipation of the strategy? Is he also aware that they would welcome mandatory industry standards for potentially harmful ingredients so that they do not lose competitiveness when they do the right thing?

[Lord Prior of Brampton]

My Lords, I think that the announcement of the sugar levy on sugary drinks has meant that that part of the industry has been forewarned of what is coming in the strategy. Already there are signs from some of the manufacturers that they are reformulating their products—which is the whole purpose of a levy rather than a tax.

NHS: Bursaries

Baroness Walmsley Excerpts

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, all the evidence is—not just from nursing but from other university courses—that loans have not reduced the numbers of people wishing to go to university: indeed, quite the contrary. The number of people going to university has gone up since student loans were introduced. The demand from young men and women who wish to go into nursing is very strong. The noble Lord will know that 57,000 people apply every year to become nurses and there are only 20,000 places, so we are confident that this will result in more, not fewer nurses.

[Baroness Walmsley (LD)]

My Lords, will the Minister say how much the Treasury will save by shifting this debt from the Government to low-paid nurses? Given the demographic of nurses, who are overwhelmingly female and, as I said, relatively low-paid, surely quite a lot of that student debt will never be repaid. Is this really such a good deal for the Government?

[Lord Prior of Brampton]

I think that it is a good deal for the Government—as the noble Baroness puts it like that—on a number of fronts. It is good for patients because there will be more nurses. It is good for the Government because there will be less need to recruit overseas nurses and agency nurses. Of course, the noble Baroness is right that for mature students coming in, the time to repay the student loan debt will be shorter than for younger people, but the Government will still make a return on that.

Health: Alcohol

Baroness Walmsley Excerpts

Thursday 12th May 2016 Lords Chamber

[Lord Prior of Brampton]

Public Health England is conducting an evidence review of the harm done by alcohol, and minimum unit pricing will be an aspect that is addressed. To express a personal view, if we are going to address alcohol consumption by increasing the price, is it best that the benefit of that should go to the drinks companies through charging higher prices, or is it better that it should go to the Government through taxation? That is a question that the House might want to ponder.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that compelling public information is key? Does he recall that the last time we talked about the sugar tax I recommended that manufacturers of sugary products should label them showing how much exercise would be required to burn off the contents? Is he aware that that is exactly what the Drinkaware website does? Would it not deter noble Lords, when considering ordering a glass of wine in the Bishops’ Bar, if they knew that they would have to run up and down Whitehall for 16 minutes in order to burn it off?

[Lord Prior of Brampton]

I am sure we will all be following in the noble Baroness’s wake when we do that. It is worth making the point that one of the benefits that came out of the responsibility deal, which I know not everyone in this House thinks was successful, is that the labelling on alcoholic products has got much better.

Care Quality Commission (Fees) (Reviews and Performance Assessments) Regulations 2016

Baroness Walmsley Excerpts

Tuesday 10th May 2016 Grand Committee

[Baroness Walmsley (LD)]

My Lords, it strikes me that this situation is rather like sending out the lifeboat to a swimmer in trouble in the sea and, instead of pulling him on board, pushing him further under the waves.

The issue raises a number of questions in my mind. First, is it right that providers should be expected to pay fully for the regulator, resulting in a dramatic increase of 75% in a single year and, I have been told, of 176% over the very short period of two years? If the Government believe that the CQC inspection is the “single definition of success”, they should be expected to pay for some of that quality assurance on behalf of the taxpayer, at least in the short term, in order to achieve the sustainability that we need not just for the CQC but for individual providers.

Over what time period should this new demand on the finances of providers be implemented? How much notice is being given? There were two days for implementation. That does not strike me as sensible, because it allows absolutely no time for proper budget planning.

The other question is whether providers can afford it. In particular, small GP practices in rural areas, I have been told, will be paying 1.75% of their turnover for the CQC. No wonder GPs are charging care homes for attending their residents, even though they already receive a per capita payment for them. What about the care homes, many of which are unprofitable even now? Let us face it: they are businesses—60% of patients are in private care—and we are heading for mass closure, which will be a disaster for all the old and vulnerable who need care.

As the noble Lord, Lord Hunt, said, what else will have to be cut from the front line in order for providers to pay for this at a time of unprecedented financial pressure? It will cost £28.7 million over four years, which has to come from a sector which already has a projected deficit of £2.8 billion. It seems that the Government are simply moving around the deficit deck-chairs on the “Titanic”. This is being done while the demand for efficiencies on the part of the CQC are marginal. It therefore follows that we should ask whether the regulator is giving good value for money and whether it is moving fast enough.

I wonder why the Government have chosen to ignore the overwhelming view of providers in the consultation, as the noble Lord, Lord Hunt, mentioned—the so-called consultation, perhaps I should say—given that the consultation on the proposed action was done before the CQC had completed and published its five-year strategy. As the strategy is expected to include significant changes to the inspection model, and therefore the costs, surely it should have been done the other way round.

Has any consideration been given to the idea of a risk-based approach to regulation, such as the one used by Ofsted, where schools that are consistently showing excellent results have a more light-touch inspection regime? Obviously, there would have to be safeguards and triggers for snap inspections, but it seems to work reasonably well in education so why not in health? It saves a lot of time and money.

There are a lot of questions there for the Minister.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I first acknowledge the fact that any increase in fees, at a time when providers of adult social care, the NHS and elsewhere are going through a very tough time, is clearly very unwelcome. So perhaps it was not surprising, in a sense, that in the consultation when given the choice of spreading the increase over four years or two years, everyone voted for four years rather than two. I think everyone knows that, over time, it was the intention of the previous Government, as well as this one, to have full cost recovery. In the end, that must be right, but it is a question of how long it takes to get from where we are to where we need to be.

Most people will understand why the scope of the CQC’s work has developed over the past three or four years. The origins of the new CQC lay in what happened in Mid Staffordshire, Morecambe Bay and Winterbourne View, and a feeling that those tragedies could not be allowed to happen again. A much more comprehensive, expert-led inspection regime was the right way to try to unearth those awful things.

I totally understand what has been said by my noble friend Lord Lindsay and the noble Baroness, Lady Walmsley, about moving towards a more risk-based form of inspection. In the CQC’s strategy, which will be announced in a week or so, I hope there will be some reference to it having a more risk-based inspection regime. Of course, that has to be based, as my noble friend Lord Lindsay mentioned, on good intelligence. Over the past three years, the CQC has been able to collect intelligence, particularly on NHS trusts, where there are much better data—we are also using soft data as well as hard data—and that does enable one to put in place a more risk-based system of inspection. It has already said that it will re-inspect institutions that have a “Good” or “Outstanding” rating after a longer period of time than the ones with “Requires improvement” or “Inadequate”. But we will see when it produces its strategy next week exactly what it is planning to do.

On the comments of my noble friend Lord Lindsay, we did have some discussions when I was at the CQC, but I have to accept that they did not get very far. However, I would encourage him to meet the new chairman of the CQC, Peter Wyman, as well as David Behan, whom he already knows, to see whether or not there is any way that UKAS accreditation can help not just in adult social care but in aspects of clinical care as well.

On the points made by the noble Lord, Lord Hunt, about the consultation, the consultation period did go from 21 December 2015 to 1 February 2016. There was a reasonable period of consultation, but I accept that the implementation of the increase was much quicker. I also know that, although it did not sound very much in the context of the whole, for individual trusts this was just another cost increase that they had to bear. It is worth noting that the total cost of the CQC as a proportion of the whole that is expected for adult social care and the NHS is around 0.19%—very similar to the cost of Ofsted in education. So it is not as though it is expensive; it is just that the level of cost recovery has been ordained to be over a shorter time.

It is also worth noting that, for domiciliary care, the period of time is over four years and not two years. For GPs, where it was felt that the cost increase was the straw that might break the camel’s back, the baseline funding has been increased to allow for the extra increase.

[Baroness Walmsley]

My Lords, am I right in thinking that the help for GPs will be over just one year?

[Lord Prior of Brampton]

I believe that it has gone into the baseline funding of the GP contract, but if I am wrong about that I shall write to the noble Baroness.

More generally, the CQC’s scope and the way that it does its inspections is just much broader than it used to be. They are done in more depth and detail. This statutory instrument was introduced to Parliament so that it would reflect what the CQC is now doing and recognise its enlarged scope. The regulations do not extend the remit of the CQC’s activity or the scope of reviews or performance assessments to additional providers or services; neither does it change the fees actually charged.

The CQC, like every other aspect of the NHS, is going to have to save a considerable amount of money over the next five years, which the noble Lord, Lord Hunt, referred to in his speech. This means that the kind of inspections which we have seen in some NHS trusts, where a large number of very expensive people descend upon a trust, will have to be scaled back to some extent. As the noble Baroness intimated, I think that we will see a more risk-based inspection model—a bit more like the Ofsted model. I suspect that we will see more unannounced inspections as well, because a large part of the cost of the CQC is not just its direct cost but the indirect costs on the trusts preparing for the inspections. Sometimes the degree of preparation undermines the validity and insightfulness of the actual inspection.

I take on board entirely the strictures of the noble Lord, Lord Hunt. This is another expense when times are extremely hard, but it reflects the fact that the scope of the CQC is now broader than it was three years ago, and the need to have full cost recovery over a fairly limited time.