HIV

Debate between Lord Collins of Highbury and Earl Howe

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

My noble friend is right. I think that we have come a long way since my noble friend Lord Fowler was Secretary of State, when stigma and discrimination were very apparent in virtually all sections of society. We do not see that so much now, I am glad to say, as evidenced by the fact that we are reporting a continuing reduction in late diagnosis. It was down to 42% last year from 47% in 2012, and that is a key indicator in this context.

[Lord Collins of Highbury (Lab)]

My Lords, the UK is a leading supporter of research and development into universal prevention methods, including HIV microbiocides and vaccines. With 19 million people globally remaining unaware of their HIV status today, will the noble Earl tell us how the Department of Health is working with the Department for International Development to support this research and development work?

[Earl Howe]

My Lords, in November 2013 DfID conducted a review of our 2011 HIV position paper. The review paper highlighted three areas of particular focus in the international context. They were to identify the key affected populations—girls and women—and the integration of HIV responses into the wider health system, as well as broader development priorities. That of course includes tackling stigma and the unacceptable things that we see in certain overseas countries, including discriminatory legislation.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 3rd July 2013 Lords Chamber

[Earl Howe]

My Lords, I am aware of the issue that the noble Lord raises. He will know that NHS commissioners are statutorily required to fund clinically appropriate drugs and treatments which have been recommended by NICE. The Centre for Workforce Intelligence has been commissioned to review the ophthalmology medical workforce after discussions were held between the royal college and Health Education England earlier this year. That review is due to report in the summer and the results of it should, I hope, point the way to a resolution of the issue that the noble Lord has raised.

[Lord Collins of Highbury]

My Lords, as a type 2 diabetic, I benefit from annual retinal check-ups at UCH; it is an excellent service. However, despite there being a national screening programme, there is a large variation in take-up, which in some areas is as low as 65%. What steps are the Government taking to ensure a higher and more consistent take-up?

[Earl Howe]

In the end, accepting the offer of screening is a matter for each individual. There are some people who, for personal reasons, will choose not to take up the offer. However, as part of the process of continuous improvement, we would expect the gap between the number of people offered and the number of people receiving screening to reduce, and for there to be greater consistency in numbers offered and received across local screening programmes.

Autism

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th June 2013 Lords Chamber

[Earl Howe]

My Lords, the Children and Families Bill, which was introduced into Parliament this month, will usher in from next year new joint arrangements for assessing and planning commissioning services for children and young people with special educational needs. We realise the difficulties that young people with autism can face in making that transition to adulthood. Under the autism strategy, my department and the Department for Education funded the social policy research unit at the University of York to examine how statutory services are currently supporting young people on the autistic spectrum. Its report, published in February, points the way to some important lessons that we should take on board during the review.

[Lord Collins of Highbury]

My Lords, despite the strategy, only 63 out of 152 local authorities have a pathway to diagnosis. Will the Minister give an assurance that the department will produce a clear guide for CCGs on how to commission the right diagnosis and support services?

[Earl Howe]

My Lords, we are indeed currently supporting, along with NHS England, a practical guide for CCGs to support health professionals and others in implementing the adult autism statutory guidance, as well as the NICE guidelines on recognition, referral and diagnosis, and the management of adults on the autism spectrum. This will be published later in the summer through the Joint Commissioning Panel for Mental Health.

Health: Tuberculosis

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 24th April 2013 Lords Chamber

[Earl Howe]

My Lords, we are now introducing a system of pre-entry screening. We recognise the contribution that latent TB makes to the overall TB disease burden and that is why we have commissioned NICE to produce a clinical guideline on this. In the countries where TB presents the most significant risk, we shall in future insist that people are screened before they enter the United Kingdom.

[Lord Collins of Highbury]

My Lords, drug-resistant TB will not subside until the problem is controlled globally. That requires not only intergovernmental co-operation but cross-departmental working. Will the Minister update the House on the Government’s position on the replenishment of the global fund, which will be useful in tackling this problem globally?

[Earl Howe]

My Lords, the Government fully support the need to scale up efforts to deliver universal access to TB prevention and treatment, and care and support services. Our target date for that is 2015. We have made a long-term commitment of £1 billion between 2007 and 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a 20-year commitment to the international drugs purchase facility, UNITAID, which is helping to increase access to and the affordability of TB drugs.

Food: Fast Food

Debate between Lord Collins of Highbury and Earl Howe

Thursday 21st March 2013 Lords Chamber

[Earl Howe]

In fact, my Lords, 32 businesses have signed up to the pledge to help people consume fewer calories, which is a responsibility deal priority. They include seven of our major retailers and some of the nation’s biggest food manufacturers, as well as Subway, which is a fast food company—so we do have one. It is a deliberately wide-ranging pledge, allowing companies and their customers to reduce calories through a broad range of actions. I say to my noble friend, however, that we will have fast food companies very much in our sights over the coming months.

[Lord Collins of Highbury]

My Lords, helping people to make informed choices on what they eat is really important. However, we have learnt in recent times that what is on the label is not always what is inside. I have stated previously that so-called healthy products such as low-fat yoghurts and cereals are jam-packed with sugar, which has huge implications for the threat of diabetes. Will the Minister consider statutory food labelling which is easy to understand?

[Earl Howe]

My Lords, we certainly have not ruled out regulation in this area, but we can be encouraged by the progress that we have made to date through the responsibility deal in terms of calorie labelling. Some 47 businesses signed up to labelling calories at the end of 2012, while 5,000 fast food and takeaway outlets and around 9,000 high street outlets, including pubs, restaurants and coffee shops, will display calories.

Health: Anorexia

Debate between Lord Collins of Highbury and Earl Howe

Monday 25th February 2013 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank my noble friend Lord Giddens for initiating this debate. As we have heard, the causes of eating disorders are both complex and multifaceted. At times of stress many of us resort to what is euphemistically called comfort eating, and the consequential results impact on self-esteem that can cause a very negative spiral.

Whatever the physical or psychological factors are it does not help that in our modern society we are constantly urged on the one hand to look sleek yet on the other to consume fattening foods. More often than not the food industry through its advertising campaigns manages both in one ad. Why is it that only on television does the person stuffing a bar of chocolate down their mouths appear to be so thin?

The excellent work of the All-Party Parliamentary Group on Body Image has shown that the constant portrayal of the man with the perfect six-pack or a young woman in a bikini does have an impact. It has highlighted the growing evidence that body image dissatisfaction is high, and on the increase. It is associated with a number of damaging consequences for health and well-being. We should contrast this with the way we are encouraged to eat foods packed with calories and made up of saturated fat and simple carbohydrates, the two food types most likely to make us put on weight. I remain concerned that so many so-called low-fat products are packed with sugar and calories.

Eating disorders can stem from a combination of issues, including distorted body image and low self-esteem. As I know from personal experience, someone with an eating disorder is very good at hiding the fact, often using a great deal of deception to fool the person or people to whom they are closest. This partly explains why there is a lack of data on the number of people who suffer from eating disorders. However, as we heard tonight, the numbers are great and the costs to the individual, their family and society can be devastating. Although eating disorders are considered to be a young girl’s disease, they can affect anyone at any stage in life, and up to 20% of sufferers are male.

It is clear that early intervention is vital. However, that relies on greater openness and understanding of the issues on the part of all of us. The excellent campaign launched by the eating disorder charity Beat just two weeks ago used as its theme, “Everybody Knows Somebody”, to flag up the fact that these illnesses are far more common than most people think. The Minister for Women and Equalities, Jo Swinson, in supporting the campaign, highlighted the fact that we are bombarded with all kinds of images, and that we need to equip young girls and boys to be more resilient to these pressures.

The Government’s Body Confidence campaign has worked for the past 18 months to identify non-legislative solutions to tackle the causes of low levels of body confidence. It is a great initiative that includes representatives from the health and fitness, fashion and retail, youth and education, media and advertising, and beauty sectors. That is to be welcomed, but we still have a fashion industry that portrays extremely thin women and girls, and we have also heard that we face a proliferation of websites promoting images of anorexic girls. What assessment has been made of the impact of the Body Confidence campaign? What action will the noble Earl’s Government take against these appalling websites? What action are they taking about the growing number of eating disorders among men?

The NICE guidelines on the treatment of eating disorders, published in 2004, are due for review in 2014. Many excellent services exist—we have heard about them tonight—but what impact will the new commissioning arrangements have on the fragmentation of these services? In my own area there is now a six-month waiting period for the first appointment for someone referred by a GP. Will the Minister ensure that best practice is maintained and that the gap between youth and adult services is addressed? Is it not time for a more coherent government strategy that encourages us all to understand better that what, when and how we eat really matters?

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, perhaps I may begin by thanking the noble Lord, Lord Giddens, for securing this short debate on eating disorders, not least because it affords us a twofold opportunity: first, to let sufferers and their families know that their voices and experience are influencing what we do at the highest levels of government; and, secondly but no less importantly, to give prominence to a range of disorders that so often are hidden.

The noble Baroness, Lady Crawley, described eating disorders as desperately sad. I agree with her. The statistics are grim. Anorexia nervosa has the highest mortality rate of all psychiatric conditions. It disrupts education and quality of life, and in 20% of cases continues to create difficulties in independent living for up to 10 to 20 years after the onset of illness, as a number of speakers said.

Although relatively little research has been done into long-term outcomes for bulimia nervosa, binge-eating disorders and other less well known conditions, anecdotal evidence suggests that these disorders can, for a significant cohort of patients, have equally life-limiting, long-term consequences. These disorders can affect anyone at any time, regardless of gender, but most cruelly the peak age at onset for the majority of sufferers is the mid-teens.

The noble Lord, Lord Giddens, asked what the Government’s policy is in this area. The answer to that has several strands to it. Early intervention is vital, and that is why it is a key national priority for the Government. Our cross-government mental health outcome strategy, No Health Without Mental Health, takes a life course approach, recognising that the foundations for lifelong well-being are already being laid down before birth and that there is much we can do to protect and promote well-being and resilience through the early years, into adulthood and on to a healthy old age.

The strategy’s implementation framework, published last July, sets out that public services intervening early is one of the 10 key changes that will be needed to turn the mental health strategy into reality and the specific actions which local organisations can take to achieve this, including: children and their parents receiving evidence-based health promotion from birth; public services, including GPs, recognising people at risk of mental health problems and taking appropriate timely action; and schools taking a whole school approach to supporting all pupils health and well-being, including both universal approaches and targeted services for those at risk of developing mental health problems.

We are investing £54 million over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme to drive service transformation, giving children and young people improved access to the best mental health care by embedding evidence-based practice and making sure that whole services use session-by-session outcome monitoring. In February 2012 the Government announced a further £22 million over three years to the CYP IAPT programme. Some of this money will be used to extend the training offered by CYP IAPT to two further therapies—systemic family therapy and interpersonal psycho therapy. These therapies are invaluable in addressing some of the major mental health problems of adolescence, including eating disorders, as well as providing much needed support for the families of those affected.

The noble Lord, Lord Giddens, mentioned the tragic case of Laura Willmott. I, too, saw that coverage. I know that transition can be a huge issue, often pitching sufferers and their families into crisis at a critical time. Sudden changes in treatment and services can be bewildering and dangerous for patients and their families, and parents can find themselves excluded from decisions about care. I was very struck by the powerful remarks of the noble Countess, Lady Mar, on this theme. Charities such as Beat and Anorexia & Bulimia Care, which do so much to raise awareness as well as provide support and advocacy in action, are working with experts in the field on the feasibility of improvements to the care system, with a specific focus on introducing the option for students to receive care wherever they are.

It is this kind of grass-roots action that will make the difference the Government envisage when we have freed up health and social care services from micromanagement, empowering localities to make vital decisions that are tailored to meet the needs of their communities.

My noble friend Lord Carlile referred to the variation in services. I recognise his concern. New arrangements for the commissioning of services for eating disorders should also result in better planning and co-ordination of specialised services, greater equity of access, care and outcomes for patients, and a more proactive and systemic approach to service development, research and innovation. The child and adult specialised eating disorder services will be commissioned by the NHS Commissioning Board from April this year.

Within the board there will be a central team that will have a clear focus on specialised services organised around programmes of care. The team will develop a national service specification for each service while at the same time ensuring that it is sensitive to local needs. Work on eating disorders services has been underpinned by expert clinical reference groups on eating disorders and child and adolescent mental health services. The groups have explicitly recognised that targeted work is needed on the issue of transition.

However good our intentions, beneficial change does not always keep pace with the urgent desire of patients and families to feel the impact of those changes, but there are areas where direct action can yield swift dividends. The Time to Change programme, England’s most ambitious programme to end mental health stigma and discrimination, now has the potential, with funding from the Department of Health and the Comic Relief fund, to reach 29 million members of the public with its vital messages on mental health. As is so often the case, it is the courage of individuals as evidenced recently in a debate in Westminster Hall in which Mr Brooks Newmark spoke. Events like that do much to challenge stigma and secrecy, and I think the honourable Member is to be commended for shining the light on an underreported aspect of eating disorders. The fact is that they are not simply the preserve of teenage girls. Male sufferers are growing in number, and I shall have something more to say about that in a moment.

The noble Baroness, Lady Gale, asked what we are doing to work with the fashion industry, a question echoed by the noble Lord, Lord Collins, and the noble Baroness, Lady Crawley. I commend the assiduous work of the All-Party Parliamentary Group on Body Image under the expert chairmanship of Caroline Nokes. The Government’s own Body Confidence campaign has made great strides over the past two years in encouraging a more open and public conversation about body image. Working with a range of representatives from health and fitness, fashion and retail, youth and education, media and advertising, and the beauty sectors, we have been active in a number of areas: research, parent education, resources for teachers, industry awards and promoting public debate.

The noble Lord, Lord Giddens, my noble friend Lord Carlile and the noble Baroness, Lady Gale, spoke powerfully on the theme of websites. I am aware of the growing evidence of pro-eating disorder websites. They attract impressionable young people and intensify weight/shape anxiety as well as, disturbingly, introducing users to new methods of losing weight, as the noble Baroness, Lady Gale, told us so graphically. What can the Government do about this? Legislation is not the answer. Many of these websites are set up by young people with an eating disorder and we would not want to criminalise an already vulnerable group, while other websites are hosted overseas. However, we are committed to joint working with charities and the internet industry to speed up the reporting of damaging web-based content and the blocking of harmful websites. In January, my honourable friend Norman Lamb hosted a round table with key stakeholders on this very issue where, encouragingly, the development of a concordat was discussed. The Government will support this joint endeavour in whatever way we can.

The noble Lord, Lord Giddens, asked whether we recognise the link between these disorders and obesity, while the noble Lord, Lord Brooke, also spoke on that theme. The answer is that we do recognise it and we are doing a whole host of things to combat obesity, some of which I have referred to in your Lordships’ House before. Weight management funding will in future be addressed through the new public health system, but most data on eating disorders come from charities such as Beat, particularly in its report on the costs of eating disorders in England, as well as surveys and reports from the royal colleges and other professional bodies. The Health and Social Care Information Centre published its annual mental health bulletin last Tuesday. It provides information on eating disorders for the first time, and I commend it to noble Lords as a reference point.

The mandate to the commissioning board makes it clear that the NHS should measure and publish outcome data for all major services by 2015, broken down by local clinical commissioning groups. To support that, the Government will strengthen quality accounts, which all providers are legally required to publish.

I have a great deal more material, but signals are being sent to me that my time is running out. I would like to address all these issues in letters to noble Lords, particularly those concerning men with eating disorders; my noble friend Lord Alderdice’s question on research that we are helping to fund; and the role of schools, which my noble friend Lord Carlile and the noble Baroness, Lady Gale, asked me about.

In my own researches in this area, I have been much struck how many of those affected talk about how worthless and disempowered they feel. I think it is appropriate for me to use this opportunity to send a clear message to them: you are valued, you are not invisible, and with the right, targeted support, recovery is not only possible but probable.

Children: Obesity

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, it is very much linked.

[Lord Collins of Highbury]

My Lords, I am going to take two bites of the cherry because I shall also briefly address the second Question. The noble Lord, Lord McColl, constantly reminds me that eating too many calories, not simply not exercising, is what causes me to be overweight, although I do exercise. However, when I pick up and eat a tub of low-fat yoghurt, which I have been doing for the past few years, thinking that I am eating healthily, I have not been able to read the very small print that states that this “low-fat, healthy” tub of yoghurt is packed full of sugars and calories. Actually, just before Christmas, I stopped eating low-fat yoghurts and I hope that noble Lords will appreciate the effect it has had on me. However, my specific question is: when will the noble Earl take the necessary statutory steps to ensure proper food labelling?

[Earl Howe]

My Lords, as the noble Lord will know, food labelling is largely governed by EU law and, at the moment, the EU directive is permissive about front-of-pack labelling. However, I take his point that it is very important that consumers are properly informed about what they are eating, and we are working with food manufacturers and retailers to ensure that there is much greater transparency in this area, across the piece, whether it relates to sugar, fats or salt.

NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 5th February 2013 Lords Chamber

[Earl Howe]

The noble Lord’s first point is a fair one. I was coming on to address it as it is quite clear that at least part of the wording of these regulations has seemed complicated and unfathomable to many noble Lords. I have to acknowledge that that is the case.

To address the noble Lord’s other point, we are talking about the difference between being a genuine voice for local people and simply being an adjunct of a political party. Local Healthwatch organisations should not be swayed or influenced by the activities of any political party. They must act independently. The only influence that matters to them is that of local patients and the public in seeking ways to improve the quality of care for people.

In that sense, the regulations tie down a local Healthwatch no more and no less than any other social enterprise. The wording of the regulations has been constructed in a very similar manner to the wording applied to other social enterprises in regulations. Regulations 36(1) and (2), against which so many missiles have been hurled this evening, are designed simply to reflect the standard community benefit test.

[Lord Collins of Highbury]

My Lords, if I have read Healthwatch England’s briefing correctly, it says that social enterprises are being treated differently in this statutory instrument, particularly as regards the 50% that could be retained. Perhaps the Minister could clarify that.

[Earl Howe]

I am surprised to hear that. My understanding is that that is not so and that local Healthwatch, as a social enterprise, is being treated on the same footing. My advice is as any other, but if I am wrong about that, naturally I will write to apologise to the noble Lord and copy all speakers into my letter. As I have said, I completely understand that the wording of parts of these regulations appears complicated. In answer to the noble Lord, Lord Collins, I should say that for that reason I can commit to my officials working with Healthwatch England and the Local Government Association to publish clarificatory material on this.

Having said that, I was slightly surprised that the noble Lord, Lord Warner, cast aspersions on Regulation 41. He asked how small organisations could understand the requirements set out in it. The matters set out in Regulation 41 are matters to be included in local authority contracts with local Healthwatch. In fact, these are based largely on the existing regulations on LINks. I have to say that it has not been previously suggested to us that these have been difficult to understand or are disproportionate.

The noble Lord, Lord Collins, asked me who was consulted before the draft regulations were published and whether Healthwatch England was consulted. We consulted a range of stakeholders, including LINks, local authorities, voluntary and community organisations, NALM, Social Enterprise UK, the Charity Commission and providers on the issues relating to the drafting of the local Healthwatch regulations. That included the Healthwatch England interim team.

--- Later in debate ---

[Earl Howe]

They are two different things, and I say to the noble Baroness that we are dealing here with a relationship that she may characterise as overly arm’s length. It is in the direct interests of a local authority to make sure that it has a good, thriving relationship with its local Healthwatch but that it is not tarnished by party political considerations that are irrelevant to the concerns of local people. The very fact that a local Healthwatch comes out with a political statement is not to damn its activity. What makes it vulnerable is if that local Healthwatch cannot show that it is truly representing local people as it speaks out. That is a matter of evidence and of fact.

The independent arbitration that the noble Baroness talks about should not be necessary. The matter could, in the final analysis, be decided in a court, although one hopes that that would never happen. However, in the end, the local authority has to exercise its judgment, and in doing so has to act reasonably and in good faith as a public authority. If it does not, it is acting unlawfully. I hope that that is of help to the noble Baroness.

I was asked a number of other questions by my noble friends Lady Jolly and Lady Cumberlege. My noble friend Lady Cumberlege asked me whether, if there were a controversial policy, say, to close an A&E department, a local Healthwatch would be permitted to provide evidence about patient experiences to campaigners on that issue. Yes. In that scenario, we would envisage a local Healthwatch taking those very views and evidence of good standards of service directly to the commissioners or decision-makers. A local Healthwatch can also make a referral to the health scrutiny function of the local authority, which would be required to keep a local Healthwatch informed of any action taken. If a local Healthwatch thought, as part of its Section 221 activities—patients’ public involvement activities—that local people need to know what their community’s experience of its A&E is, we would certainly expect the local Healthwatch to be transparent and make that evidence known.

My noble friend asked whether people who had been active in a national campaign could be decision-makers in local Healthwatch organisations. The regulations do not set out membership of a local Healthwatch, so it will be down to the local Healthwatch to decide whether such people can add value to the outcomes that it wishes to achieve for its local people. Local Healthwatch has to be different; it has to build up its reputation and credibility in order to secure the public’s confidence that it can have a mature relationship with local authorities, which was the point that I made just now. The regulations seek to ensure that local Healthwatch does not carry out the relevant political activities as its only or main activity. That would not meet the community benefit test.

Would local Healthwatch be subject to purdah? No, it would not. I repeat that it has been set up to be the local consumer champion, and as such its role becomes very important in getting people’s serious concerns listened to and acted upon.

My noble friend Lady Jolly asked me several questions. She expressed the fear that the regulations would render local Healthwatch a mere proxy voice. I emphasise to her in the strongest terms that that is not so. As I have explained, we have sought through the regulations to be as inclusive as possible of people who may wish to give up their time to do what they feel passionately about doing. To be frank, LINks, which is the arrangement that we have at the moment, have all too often been associated with white, middle-class men, and we need local Healthwatch to embrace diversity much better.

Could the manager of a care home sit on its local Healthwatch? Yes, he or she could get involved in their local Healthwatch, but it would be good practice for the Healthwatch in its governance arrangements to have procedures for a code of conduct, and, as set out in Regulation 40, it would be required to have and publish procedures before making any relevant decisions. That is essentially about transparency.

Could a local profit-making provider of primary care be a local Healthwatch contractor, and could its manager sit on the local Healthwatch decision-making group? Again, it would be up to the local Healthwatch whom it wishes to contract with for their expertise to help it deliver its statutory activities.

On the role of local Healthwatch to provide information and signpost people to choices, the decision rests with that individual seeking out the options available to them. We would expect local authorities’ arrangements with local Healthwatch to be robust so that it acts effectively. The local authority will be under a duty to seek to ensure that the arrangements are operating effectively and provide value for money.

My noble friend suggested that the department’s interpretation of lay involvement boils down simply to the foot soldier role. I do not agree. It would be a wrong picture to paint to the public about how a local Healthwatch discharged its obligations. The obligations are quite clear. Engagement, consultation and participation are all words that can be used to describe different types of involvement activity. Referring to “involvement” therefore provides for flexibility, as I indicated earlier.

Could the decisions listed in Regulation 40(2) be made by a decision-making body within a local Healthwatch composed of a majority of people who happen to be health or social care managers? No. Regulation 40(2) must be read with Regulations 40(3), 40(4) and 40(1)(a). The requirement to be imposed on local Healthwatch in the contracts is to have and publish a procedure for involving lay persons or volunteers in such decisions. As stated in the advice to the Secondary Legislation Scrutiny Committee, the plain provision of information would not in most cases comply with the obligation to involve; the involvement has to be in the making of the decisions.

I hope that I have covered satisfactorily all the questions put to me, and I hope that the noble Lord, Lord Collins, will be sufficiently reassured to withdraw his Motion.

[Lord Collins of Highbury]

I thank all noble Lords and particularly my noble friends for their comments. I also express my appreciation to the noble Baronesses, Lady Jolly and Lady Cumberlege, who drew attention to some fundamental issues here. They are fundamental in relation to the conflicts of interests, particularly in local authorities. The noble Baroness, Lady Cumberlege, referred to the draconian restrictions and reminded us that guidance does not have statutory force. Here I take the words of Healthwatch England: the Department of Health could and should have done better with these regulations. In my opinion, they have failed. I am afraid that the Minister has not given me satisfactory reassurances, certainly not in relation to the issues that the noble Baronesses, Lady Jolly and Lady Cumberlege, raised. In the light of that, and of the briefing we had from Healthwatch England itself, it is important that the department should think again. The only way I can do that is to ensure that we pass this Motion of Regret, and therefore I would like to test the opinion of the House.

Health: HIV Strategy for England

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to publish a cross-departmental HIV Strategy for England, in line with the Political Declaration made at the United Nations General Assembly in 2011.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, tackling HIV remains a priority for the Government. We believe the way forward is to develop a framework that covers both HIV and broader sexual health issues. We therefore plan to publish a policy document on sexual health and HIV shortly.

[Lord Collins of Highbury]

I thank the Minister for that response. One issue that is obviously of big concern is testing. Half of the people diagnosed with HIV are diagnosed late. With the commissioning of HIV testing being highly fragmented under the new NHS arrangements in England, how will the Government ensure that HIV testing recommendations from NICE and the British HIV Association are implemented consistently across the country?

Health: Hearing Loss

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend for raising a very important issue about war veterans. My department is doing a lot of work in this area. I will write to him if I have anything more specific.

[Lord Collins of Highbury]

My Lords, I note what the Minister said in terms of the previous review but we now have an increase in retirement age and people are working longer. Hearing loss is not simply a personal health issue; it also becomes a bigger public health issue and a health and safety issue. Can the Minister therefore better understand the importance of national screening?

[Earl Howe]

My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.

Health: HIV

Debate between Lord Collins of Highbury and Earl Howe

Thursday 29th November 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government whether they intend to endorse the standards of care for people living with HIV published by the British HIV Association on 29 November.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Department of Health commends the British HIV Association for these important standards, which we welcome. The NHS provides excellent care for people living with HIV. These standards are important in setting out best practice to support continuing high-quality HIV care services for all HIV patients. They will provide a valuable resource and inform the commissioning of comprehensive HIV care services.

[Lord Collins of Highbury]

I thank the Minister for that response. One recommendation made by BHIVA related to self-management. As with many other long-term conditions, this approach can help people with HIV to gain confidence, skills and knowledge to manage their own health, with resulting improvements in the quality of life and independence. In the light of changes in the commissioning process, who will now have responsibility for funding the excellent self-management services currently provided by organisations such as the Terrence Higgins Trust and Positive East?

[Earl Howe]

My Lords, the noble Lord is quite correct. Self-management is one of the BHIVA standards. I agree that self-management and supporting patients to manage their own care, both for HIV and, for that matter, any other long-term condition, are very important for promoting the best treatment outcomes for individuals. A variety of approaches will be needed to support individuals to self-manage their HIV. There are already some innovative programmes, such as the online resource, My HIV, for people living with HIV, delivered by the Terrence Higgins Trust. The key to this is for commissioners of services to work together in future to ensure that self-care is part of the HIV care pathway, and GPs will have a role to play in that.

NHS: Walk-in Centres

Debate between Lord Collins of Highbury and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government how many NHS walk-in centres have been closed or had their opening hours restricted since May 2010, and how many are scheduled to close or have their opening hours restricted.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, since 2007, the local NHS has been responsible for NHS walk-in centres. It is for primary care trusts to decide locally on the availability of these services. No information on walk-in centre closures or opening hours is held centrally.

[Lord Collins of Highbury]

My Lords, I was expecting that response. Will the Minister acknowledge that these closures will channel, unnecessarily, patients towards accident and emergency departments at times when GP surgeries are also closed? This will almost invariably increase NHS costs in the medium term. Or is the Government’s strategy to blame local clinicians for cuts in NHS services?

[Earl Howe]

My Lords, the Government’s clear policy is that people should be able to rely on high-quality, 24/7 urgent and emergency care that is right for them, when they need it. That is our starting point.

I say to the noble Lord that since walk-in centres were invented the array of services available to patients has been considerably enhanced. It is not just a case of going to an A and E department as an alternative. There are now many GP health centres, minor injuries units, urgent care centres and, in the extreme case, ambulance services, so I do not necessarily accept the premise of the noble Lord’s question.

Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My noble friend draws attention to an area of concern. Cereals of that kind are particularly attractive to children, although I would say that the good news here is that added sugar consumption among children has fallen during the past few years, which is perhaps a sign that the messages on the levels of sugar that children can safely consume is getting through to parents.

[Lord Collins of Highbury]

My Lords, I am grateful to the noble Earl for reminding us that a small reduction in weight maintained over time can reduce the risk of developing type 2 diabetes. I must admit that I wish that I knew that when I stopped smoking and piled on the weight. As a consequence, I am type 2 diabetic. It is true that small improvements in eating and drinking habits can reduce the risk. I ask the noble Earl, as I asked him last November, whether the Government will take this threat seriously and undertake to lead a major awareness programme about what to do to avoid type 2 diabetes.

[Earl Howe]

My Lords, there is a great deal going on in this extremely important area. I am grateful to the noble Lord for emphasising its importance. There is a ring-fenced budget for public health, and weight gain is one of the key indicators in the public health outcomes framework. There is the Change for Life campaign, which has, I think, gained enormous credibility among the public and professionals. We are engaging with the food industry through the public health responsibility deal to take forward the calorie reduction pledge. There are NHS health check programmes, which are being rolled out throughout the country, and at GP level there are the nine tests which GPs are advised to undertake with diabetic patients. The rate at which those tests are being done has gone up very encouragingly over the past few years.

NHS: Definition of Exceptional Case

Debate between Lord Collins of Highbury and Earl Howe

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.

[Lord Collins of Highbury]

My Lords, the Minister said that this treatment is not routinely carried out. The doctor concerned, who works in the NHS, is aware that pancreatectomy is carried out in other PCTs. Can the noble Earl explain where it is being carried out so that we can understand what is routine and what is not?

[Earl Howe]

My Lords, I hope that my earlier answers gave a clear indication of the definition of exceptionality, which should demonstrate to the House that something that is exceptional is not routine. Our advice is that that treatment is not routinely available in the NHS. There is a handful of centres in England with doctors who are trained to carry out the operation, but although the technique has been in use since 1977, it is available only in a few centres worldwide, which does not suggest to me that other countries are ahead of us in this area.

Health: Local Healthwatch Organisations

Debate between Lord Collins of Highbury and Earl Howe

Monday 11th June 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what progress is being made on establishing local Healthwatch organisations and what steps they will take to ensure that their commissioning and administrative costs are kept to a minimum.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, 75 local Healthwatch pathfinders have generated learning for all local authorities to use. The Local Government Association is working with all local authorities, including holding a series of master classes, and the Government are undertaking targeted engagement on local Healthwatch regulations until mid-June. The Government have made £3.2 million available for start-up costs and information is being made available on commissioning and procurement options.

[Lord Collins of Highbury]

I thank the Minister for that response. Only one local Healthwatch organisation will be contracted in an individual local authority, but the body itself will be permitted to subcontract most if not all of its activities. What are the department’s estimates for the overall cost of multiple contracts, solicitors’ fees and all the other on-costs of commissioning? Can the Minister also explain how fragmenting local Healthwatch organisations in this way will provide the strong and co-ordinated voice for patients and their carers that we need for real local scrutiny and accountability?

[Earl Howe]

My Lords, the noble Lord is absolutely right to raise the question of the cost-effective commissioning of Healthwatch and I have no doubt, from the Local Government Association, that both the efficient and effective functioning of Healthwatch is something that is well within its sights. The noble Lord has raised a series of hypotheses which I think are somewhat extreme, of local Healthwatch organisations parcelling out their functions all over the place. Our aim is to have as locally inclusive a body as possible in each local Healthwatch area to enable Healthwatch to perform its functions as much by itself as with the aid of others. Indeed, the pathfinder events to which I have referred have been clear that there is a local appetite to do that.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 1st February 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the National Diabetes Audit Mortality Analysis 2007–08, published by the NHS Information Centre, which estimated that up to 24,000 deaths from diabetes per year could be avoided by the condition being better managed.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we are working with the National Diabetes Information Service and National Health Service organisations to ensure that local services have the audit data for their own areas to show how they compare with others and where improvements can be made. NHS Diabetes has a suite of tools that can be used to help drive improvements and reduce avoidable deaths.

[Lord Collins of Highbury]

I thank the Minister for his response. Diabetes UK estimates that about 26 per cent of the 450,000 residents in nursing and care homes in England have diabetes. Care home residents are a highly vulnerable group of people and, without regular screening for diabetes, they are at an increased risk of complications such as heart disease, stroke, kidney failure, blindness and amputation. What are the Government doing to ensure that residents in care homes receive the appropriate screening that they need for diabetes?

[Earl Howe]

My Lords, much will depend on the way in which primary care engages with those in social care to ensure that the residents of care homes, who need diabetes care management, receive it properly. We very much want to see that joined-up commissioning arise from the reforms that we are currently in the process of debating in your Lordships' House. The noble Lord makes a very good point. We have many tools at our disposal. There is no shortage of guidelines in this area. Much will depend on the training of care home staff and a lot of work is going on under the aegis of the National Clinical Director for Diabetes in this area.

Health: Early Diagnosis

Debate between Lord Collins of Highbury and Earl Howe

Monday 21st November 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes an extremely good point. The answer to his question is, yes, I believe that it will have the capacity to do that. He rightly mentions advances in genomic science, which of course will have a major part to play in the field of diagnostics. As regards rarer diseases, as he will know, we are placing responsibility with the national Commissioning Board for the commissioning of specialised services for rarer conditions.

[Lord Collins of Highbury]

My Lords, as the Minister is aware, the reduction of 10 per cent in weight maintained over a period can reduce the risk of developing type 2 diabetes by 50 per cent. Small improvements in eating and drinking are needed. Will the Minister accept that the country needs a major awareness programme, led by the Government, on what to do to avoid developing type 2 diabetes; and, under the new legislation, will he continue to use his powers?

[Earl Howe]

My Lords, the Government have no current plans for a specific national campaign to raise awareness of diabetes. On the other hand, as part of Change4Life, which we are continuing with, we aim to raise awareness about diet and physical activity, and to create what we hope will be a mass movement to help to reduce obesity and related conditions, including diabetes. The campaign encourages everyone to,

“eat well, move more and live longer”.

There is also the very important ingredient of the NHS Health Check in this area, which the noble Lord is familiar with, for people in England aged 40 to 74. We think that this has the potential to prevent over 4,000 people a year from developing diabetes.

EU: Economy

Debate between Lord Collins of Highbury and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

[Lord Collins of Highbury]

NHS: Private HealthcareQuestion3.22 pmAsked By To ask Her Majesty’s Government whether general practitioner practices are permitted to advertise their own private healthcare services using the NHS logo.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Department of Health does not permit organisations, including general practitioner practices, to use the NHS logo to promote their non-NHS services, including private healthcare services.

[Lord Collins of Highbury]

I thank the noble Earl for his response, but of course most of us in the Chamber have read in the newspapers recently about the case of a GP practice writing to its patients. I believe that what happened there goes straight to the heart of general practice; that is, the relationship between the doctor and the patient. It is a relationship that I fear the Government show no sign of understanding. Will he give an assurance that the proposed form of commissioning in the health Bill will not result in the nightmare possibility of the doctor changing from the person who decides the best medical treatment for the patient to the person who decides what can be afforded?

[Earl Howe]

My Lords, I can give that broad assurance, but the noble Lord will know that it is already within the GMC code that doctors have to consider the totality of the resources available to them and take account of the needs of all their patients. With that qualification, of course our reforms are designed to ensure that the highest-quality care is delivered to every patient according to his or her needs.

Health: Diabetes

Debate between Lord Collins of Highbury and Earl Howe

Tuesday 1st November 2011 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the nearly 50 per cent rise, since 2005, in the number of people diagnosed with diabetes in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the increasing prevalence of diabetes is one of the reasons we remain committed to the NHS health check programme. The programme has the potential to prevent over 4,000 people a year developing type 2 diabetes. We are also continuing to improve treatment and support for diabetes. Earlier this year, NICE published a diabetes quality standard, which provides an authoritative definition of good quality care for use by clinicians and commissioners.

[Lord Collins of Highbury]

I thank the Minister for his response. I agree that the biggest benefit of the NHS programme is the prevention of diabetes. However, despite its being in place for two years, very few people have heard of it or used it. Will the Minister explain what action he will take to ensure that the scheme is properly provided and promoted? Can he guarantee that such schemes will not be the first casualty of the proposed NHS reforms?

[Earl Howe]

My Lords, we are completely committed to the NHS health check programme, so I can reassure the noble Lord that we are clear that it has a major part to play. It is a very cost-effective way of both preventing and detecting early those who are at risk of diabetes or who may have recently contracted it. Health checks are part of the current operating framework. It is true that the figures for the first quarter of this year were a little disappointing, but PCTs are fully engaged in the process.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011

Debate between Lord Collins of Highbury and Earl Howe

Monday 31st October 2011 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the regulations before the Committee today relate to the registration of providers of NHS primary medical services with the Care Quality Commission. The effect of the regulations is straightforward. It defers the registration of most providers of NHS primary medical services by 12 months, until April 2013. The registration of a small number of out-of-hours providers of such services will still go ahead in April next year, and the commission has started the process of registering these providers.

As the independent regulator, the Care Quality Commission has a key role in assuring the public and people who use services that health and social care providers of “regulated activities” meet certain requirements. In order to be registered, providers must meet a series of essential safety and quality requirements on an ongoing basis. Where a registered provider fails to meet these requirements, the CQC has a range of enforcement powers that it can use to bring a provider back into compliance. In the case of the most serious failings, the CQC is able to cancel a provider's registration, which would result in the provider's closure.

The Committee will be familiar with some of the criticisms that have been levelled recently at the CQC, in particular that the number of inspections of providers that it carries out has fallen to unacceptably low levels and that it failed to respond appropriately to serious service failings, most notably in the case of the appalling abuse of residents at Winterbourne View, a hospital for people with learning disabilities.

The Government attach the highest importance to the role of the regulator in carrying out its statutory functions in an efficient and effective manner. The regulations before us are part of the process of how we and the CQC respond to these issues. Deferring the registration of around 9,000 providers of NHS primary medical services will give CQC additional time both to improve the registration process for this tranche of registrants and to increase the compliance activity of providers that are already registered with it.

Implementing the new registration system has required the Care Quality Commission to register around 21,000 providers already, bringing in, first, NHS providers; then independent sector healthcare providers and adult social care providers; and then independent ambulance and primary dental care providers. This has been a major programme of work for the CQC, which it has carried out well. However, given the scale of the task, it is perhaps not surprising that the number of compliance inspections carried out by the regulator fell. The current timetable set in regulations brings providers of NHS primary medical services into the registration system in April 2012. This would bring in around 9,000 additional providers and includes GP practices, out-of-hours primary medical care providers and some NHS walk-in centres.

Although we remain committed to the registration of providers with the CQC and are confident that this will provide effective levers to tackle providers who deliver sub-standard care to patients, we have reconsidered the timing of registering the majority of these providers in the light of the challenges that the CQC has faced. Following a consultation that came to an end in July, and engagement with key stakeholder representatives, we have decided that providers of NHS primary medical services who provide out-of-hours care to patients who are not registered at their practice will be required to register with the CQC as planned from April 2012.

Out-of-hours services tend to treat unfamiliar patients in unfamiliar surroundings and see a higher proportion of vulnerable patients with urgent care needs that are often more complex than those generally found in daytime general practice. As such, there is a more pressing need to register these services than other NHS primary medical services, which is why we are forging ahead with the registration of this group of providers. All other providers of NHS primary medical services will now be required to register in April 2013. The regulations before us amend the regulated activities regulations in order to achieve this delay.

In parallel with our consultation on the proposed changes, the CQC has reviewed its registration process, looked at streamlining its registration systems, and is increasing its scrutiny of providers that it already registers. Consultation responses made clear that a streamlined process would be welcomed. I am pleased to assure the Committee that the commission is taking steps in this direction. On the registration process for primary medical services, I am informed that the CQC is overhauling its online application process so that providers will be able to start completing the application sooner than in previous application rounds. The website will contain full information on the registration process and will provide updates on the progress of an application and how long it is anticipated that it will take for key decisions to be made. The CQC will also put in place a central team to handle applications, avoiding the risk of the registration of NHS primary medical care providers impacting on the CQC’s ability to monitor the compliance of other registered providers. Noble Lords may recall that there were delays in registering dental practices earlier this year due to the volume of Criminal Records Bureau checks required. The CQC is considering a different approach, which I am assured will go a long way to resolving these problems.

The CQC will engage with providers of medical services over the coming months to ensure that they have a clear understanding of what registration will entail and how compliance with the registration requirements will be assessed. The CQC’s compliance inspections have been increasing steadily since the spring. and I am confident that the delays proposed and the arrangements the commission is putting in to handle registration in April 2013 will allow this to continue and be sustained.

Looking beyond initial registration, the CQC is also proposing changes to strengthen and simplify its regulatory model. Importantly, the commission is planning to increase the number of inspections that it carries out. These proposals would see all registered providers of hospitals, social care providers and independent healthcare providers being inspected at least once a year, with primary dental care providers inspected at least once every two years.

I hope that the Committee will be reassured by the progress that the CQC is already making to improve its registration processes and to increase its focus on compliance and inspection. The delay to the registration of providers of NHS primary medical services that we are considering today will allow the commission the space and time that it needs to move further in this direction more quickly. I commend the regulations to the Committee.

[Lord Collins of Highbury]

I thank the Minister for his remarks about the regulations. I must admit that when I read the words:

“These Regulations may be cited as the … Regulated Activities … Regulations”,

I felt as if I was participating in a Marx brothers’ movie, as you wonder which part relates to which. However, behind the regulations lies a very important human story. I want to focus my comments and questions on some of those issues. The Minister referred to the fact that in respect of NHS primary care services there is clearly a risk that the problems which the Care Quality Commission faces now could still apply in 2013. Apart from simply delaying the requirement to register again, has the Minister any other contingency plans to deal with the capacity problems in the CQC?

A human-issue story concerning out-of-hours services relates to the report that the CQC wrote arising out of the Daniel Ubani case, where the real risk posed to patient care from out-of-hours services was apparent. I would like the Minister to spell out how the small number of—

Medicines Act 1968 (Pharmacy) Order 2011

Debate between Lord Collins of Highbury and Earl Howe

Monday 17th October 2011 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Medicines Act 1968 (Pharmacy) Order, being debated today, will remove the restriction placed upon pharmacists registered in Britain by virtue of a pharmacy qualification awarded by a relevant European state that prevents them being in charge of a newly established pharmacy. This refers to any pharmacy that has been registered for less than three years and is commonly known as “the three-year rule”.

The relevant European states referred to are Iceland, Norway, Liechtenstein, Switzerland and the European Union (EU) member states. It is not relevant to pharmacists who qualified in the United Kingdom.

I should first give the Grand Committee some background. All pharmacists practising in Britain must be registered by the General Pharmaceutical Council, as must all pharmacy premises. Some pharmacists are registered to practise in Britain under arrangements for the mutual recognition of pharmacist qualifications awarded by EU member states or other relevant European states.

EU Directive 85/433—now 2005/36/EC—includes provision for member states to place restrictions on the recognition of the qualifications of such pharmacists in the case of pharmacy premises registered for a period of less than three years. In Britain, the restriction applies to the pharmacist in charge of such pharmacies, known as the “responsible pharmacist”. In other words, while all pharmacists registered in Britain under the mutual recognition arrangements may work in any British pharmacy, however long it has been registered, such pharmacists cannot hold the position of responsible pharmacist in a pharmacy that has been registered for less than three years. The current restrictions on visiting pharmacists owning pharmacy businesses or acting as superintendents are not affected by this order.

The derogation in the directive was originally put in place in the mid-1980s for economic reasons, following concerns by UK MEPs. They believed that, given the UK’s comparatively open arrangements in relation to pharmacy ownership, there was a risk that the mutual recognition arrangements would put existing UK pharmacies at a disadvantage. Since then, however, much has changed both in terms of pharmacy arrangements in other EU member states and the evolution of domestic policy in Britain.

We have conducted a full public consultation on removing the restriction, both for established pharmacists—those fully registered with the General Pharmaceutical Council in part 1 of the register—and for visiting pharmacists—those temporarily practising in the UK and registered in part 4 of the register. However, the restriction has not affected any visiting pharmacists as, to date, none has been registered.

The response to the public consultation has been very much in favour of removing the restriction. The proposal has support from the General Pharmaceutical Council, the pharmacy regulator, the Royal Pharmaceutical Society, the professional body for pharmacists, as well as all the main pharmacy representative organisations, including the Pharmaceutical Services Negotiating Committee, Community Pharmacy Scotland, the Company Chemists Association and the devolved Administrations.

The proposal will encourage flexibility, efficiency and continuity of care within pharmacy. It will end the situation where a responsible pharmacist, registered here by virtue of the mutual recognition arrangements, can no longer continue in that role if their pharmacy relocates, even if it only moves next door, and therefore becomes a newly registered pharmacy. Removing this restriction will mean that patients can enjoy greater continuity of care in such circumstances; that all registered pharmacists will be placed on a level footing in terms of their employment prospects; and that employers will have a deeper pool of potential employees to draw upon and less bureaucracy to deal with when filling vacancies.

I should now explain the revision of the draft Explanatory Memorandum laid before your Lordships today and the change required to the final version of the Explanatory Note on the order. In undertaking preparatory work for this debate on the draft order, officials in the Department of Health realised that, contrary to previous understanding, “visiting pharmacists”, a sub-category of registrants from relevant European states who do not go through the full registration procedure, are covered by the removal of restrictions that the draft order would achieve. It will not, therefore, require a separate legal instrument to remove the restriction upon their acting as “responsible pharmacist” at new pharmacies. Up to this point, it had been thought that a separate legislative instrument would be required to achieve this. The confusion appears to have arisen in the understanding of the differences between the restrictions applying to those who either may own, or carry on, a pharmacy business or act as superintendent, on the one hand, and the provisions relating to the responsible pharmacist on the other. A superintendent manages a pharmacy on behalf of a company. A responsible pharmacist is in charge of a pharmacy at a given time, and takes on responsibility for the effective management of pharmacy law and practice within a single branch at a particular time. If the draft order is approved, it will still not be possible for a visiting pharmacist to carry on—that is, to own a new pharmacy—or act as a superintendent in relation to a new pharmacy.

However, a visiting pharmacist, and any other pharmacist registered by virtue of the mutual recognition arrangements, would, upon the coming into force of the order, be entitled to be the responsible pharmacist in charge of a newly registered pharmacy in Britain. It is the similarity between the different concepts of control that appears to have led to the confusion. The intention has always been to remove the restriction on responsible pharmacists for all those registered to practise in Great Britain under the EU mutual recognition arrangements, whether visiting or not. The consultation reflected this and the order as currently drafted would achieve this.

Because of the misunderstanding, the earlier version of the accompanying draft Explanatory Memorandum, and the Explanatory Note on the order itself, suggested that the order did not remove the restriction in relation to visiting pharmacists. In fact, the substantive provisions of the order achieve the intention and a further instrument is not, therefore, required. However, the text in the Explanatory Note that refers to the register was incorrect, and the reference to part 1 of the register will not appear in the final version. I apologise for any confusion caused by this late change. I commend this order to the Committee.

[Lord Collins of Highbury]

As the noble Earl stated, a lot has changed since the derogation in the directive was put in place. Much has changed in pharmacy arrangements in other EU member states and in the evolution of domestic policy. The reasons, as the Minister stated, were commercial.

In England, for example, there has been a welcome change over the past few years making it easier for people to get to a chemist, given that there are new pharmacies with longer opening hours. Clearly, such market restrictions are not appropriate today, and their removal will assist by increasing the pool of available pharmacists and ensure improved continuity of service delivery. I note that the change has also been welcomed by the key representative bodies of pharmacies.

I of course recognise that the restriction affects a relatively small number of pharmacies—just over 10 per cent, and just over 5 per cent of all pharmacists registered to practise in Great Britain. I also understand and accept the reasons for the change in the Explanatory Memorandum. However, these changes in the legislation raise broader issues relating to the competencies of the pharmacist and the person’s ability to manage a pharmacy. For example, the report on the consultation noted that concerns were expressed by respondents on competency in English. The Department of Health in its response stated that in the UK a check on the language knowledge of a pharmacist from outside the UK who is seeking work within the NHS is applied by the prospective employer, but that there is no check made at the point of registration.

This leads to three specific questions to the Minister. First, are there plans to introduce a standardised competency test to ensure that any pharmacists from the countries mentioned in the order who are in charge of a new pharmacy have all the required skills and competences? Secondly, are there plans to ensure that those in charge of a pharmacy will have a sufficiently high standard of English to avoid all risk of a patient misunderstanding any advice given? Thirdly, how can an employer determine whether the pharmacist in question is qualified in their own country and has no pending fitness-to-practise cases to answer?