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"( ) in paragraph (d), for "or a section 17C employee" substitute ", a section 17C employee or an Article 15B employee"

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Page 148, line 22, at end insert—


"(2A) In subsection (2), after the definition of "the 1978 Act" insert—
""Article 15B arrangements" means arrangements for the provision of services made under Article 15B of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No. 1256 (N.I.14));
"Article 15B employee" means an individual who, in connection with the provision of services in accordance with Article 15B arrangements, is employed by a person providing or performing those services"." Page 148, line 25, at end insert—


"15A In section 28EE(2), for "personal" substitute "primary"." Page 152, line 43, leave out "a list" and insert "all lists"


    Page 152, line 44, leave out "such a list" and insert "a list under that section"


    Page 154, line 15, leave out "28U" and insert "28TA"


    Page 154, line 24, at end insert—


"38A (1) In Schedule 7A, paragraph 3 is amended as follows.
(2) In sub-paragraph (1)—
(a) after paragraph (f) insert—
"(fa) persons providing primary medical services or primary dental services under Part 1 of this Act;";
(b) in paragraph (g), omit the words from "or under" to "this Act".
(3) In sub-paragraph (2), for "(1)(g)" substitute "(1)(fa), (g)"."

On Question, amendments agreed to.

Schedule 11, as amended, agreed to.

Clause 181 [Replacement of Welfare Food Schemes: Great Britain]:

Lord Clement-Jones moved Amendment No. 464A:


    Page 98, line 36, after "more" insert "pilot"

The noble Lord said: I hasten to reassure the Minister that this is a probing amendment. I was quite amused to read the Minister's response when he stated that, as drafted, the amendment would condemn the scheme to being run as a pilot for evermore. I had a vision of the scheme being held in purgatory. I wondered whether officials had recently been reading Dante's Inferno. I was not entirely sure, but a nice image was conjured up.

There is a great deal of support for the Healthy Start scheme, for the principle of reforming the welfare food scheme and for the broad principle of widening the nutritional bases. However, the devil lies in the detail. A great number of organisations have an interest in the scheme—the National Childbirth Trust, the CPHVA, the Infant and Dietetic Food Association, the Royal College of Midwives, the Royal College of Nursing, the Maternity Alliance, the British Retail Consortium, the Royal College of Paediatrics and Child Health and so on. So it is not surprising that there are a number of differing views and the Government and COMA have tried to pull together some of the voices on this issue.

But it is not all about differences; there is a great measure of agreement on the scheme and on some of the difficulties it faces. It is this area that I wish to explore and to put forward the thesis that it is extremely important to test out the way in which the scheme will work in practice. Therefore, whether it is called a pilot or a partial roll-out—whatever the

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language used—it is very important to try out different ways of making the scheme work. It is not entirely clear how it will operate and whether or not mothers will receive the right balance of nutrition from the scheme.

I shall not deal with registration. The amendment of the noble Earl, Lord Howe—which we support—in the next group of amendments deals with that aspect, on which many of the organisations have a common position.

I wish to deal with the value of the vouchers. There is a big issue in regard to their value, currently stated to be the equivalent of seven pints—about 2.20p. That would not be sufficient to pay for the cost of formula milk. For 900 grammes of formula milk, the voucher would need to be worth between 6 and 7. There is great concern that that could cause mothers to move to cows' milk too early, with all the attendant problems that that would involve.

The idea has been put forward, rather imaginatively, by organisations such as the Maternity Alliance and others that a differential could be established so that in the early months—the first six months or, indeed, the first year—the scheme would have a higher value and then in the last years—all within the same overall budget—it would have a lower value. It is very important that that aspect of formula milk provision is dealt with. It would not be cheap, but the scheme could discriminate against mothers who are not breast feeding. Committed organisations such as the National Childbirth Trust—of which I am a patron—and others are very worried about the infant formula aspect.

There is an issue about whether or not the voucher should have a cash value or a food value. Without a food value being attached to a voucher there could be potential discrimination in favour of those with good access to supermarkets. I remember that Tessa Jowell, when she was the public health Minister, carried out a fair amount of work on the aspect of food deserts. We do not all have good access to supermarkets, so that is a real live issue.

There is also the issue of the actual physical delivery of vouchers, which is a problem. In addition, the Maternity Alliance and Royal College of Paediatrics and Child Health are concerned about the introduction of the new tax credit scheme that comes into force this April. It will reduce the numbers of those eligible for the scheme.

On food choice, there is some divergence of view about whether a unified voucher ought to be given, but that is precisely where a pilot scheme would be beneficial. I sympathise with the idea that we should not be a nanny state, that we should allow mothers the choice and enable them to go to supermarkets with a voucher and, within the overall value of the voucher, choose the foods that they think are appropriate. We should also pilot the scheme to see whether that is the best way, or whether it is better to specify that an element of the voucher goes towards fruit and an

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element towards milk. That is quite important. The British Retail Consortium has qualms about that issue.

It is vital that different options should be piloted and evaluated before the national scheme becomes operational. There are quite a number of questions in that context that need to be raised. Is the value of the scheme going to be roughly the same as it was previously? It has been estimated variously at between 147 million and 167 million. Is there going to be a further cash injection? How many mothers and children do the Government estimate will be eligible for the scheme? On the value of the vouchers, have the Government considered whether there should be a differential between the early and later years?

How will the success of the scheme be actually measured? After all, this is an area in which evidence will be absolutely vital. This is a new scheme, and we do not want to be in a situation in which we take a leap of faith and the scheme is not reviewed or evaluated in a proper fashion, but goes on for as long as the original welfare food scheme.

What "healthy foods" will actually be included in the scheme? Who decides? Will it be COMA or an expert committee involving dieticians and paediatricians? What is the process for that? How will the cash value, if it continues to be the value of the voucher, be protected in future?

A great number of questions hang over the scheme. It has a fair wind in terms of general support, but the reason for wanting it to be piloted is the large number of question marks hanging over it. A large number of organisations want to see the answers to those questions. I beg to move.

Baroness Noakes: We support the noble Lord, Lord Clement-Jones, in his desire for more pilots. He has raised a number of practical issues about how the new welfare food scheme will develop. I shall raise a few concerns now that we would otherwise have raised in the stand part debate. It is probably better to wrap all the concerns up at this point rather than have a separate stand part debate.

We are concerned that, if milk is dropped from the scheme as an essential component, we move from having something of known nutritional value to a scheme in which it may be much less clear whether the equivalent nutritional value will be achieved. We know that the vitamin and mineral intakes for children under five can be, and are, improved by intakes of milk, with some rare exceptions. We do not know how the welfare food scheme might develop in other directions. Dropping milk is a potential problem, because we are moving from something certain to something far less certain.

The noble Lord, Lord Clement-Jones, did not mention the impact on the dairy industry and, through it, on consumers. I am aware that the Government are aware of that aspect, but they seem to be unconcerned about it. Welfare milk is said to account for around 5 per cent of doorstep milk sales, and not all suppliers could cope with the loss of that business. Of more

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concern is the impact on the loss of milk rounds, because the people who will be affected by them are the more vulnerable people in society, who depend on those deliveries. The Government's response seems to be, "Let the milkmen sell fruit and vegetables", but that is not an easy proposition and it is by no means clear whether it is viable.

My last area of practical difficulty relates to the abuse of the scheme. If we have value-attached vouchers, we must have real concerns about whether those vouchers will be used for nutritious food or for junk food, or worse. I take Members of the Committee back to the days of luncheon vouchers, which I recall from the early part of my employed life. I soon found suppliers who would give cigarettes for luncheon vouchers. I have no doubt that something similar would happen if a monetary value were attached to vouchers. That is why we are concerned about rushing into a new scheme without greater knowledge of what we are doing, because we are potentially throwing away something that has been of undoubted value to young children.

Amendment No. 465 relates to the requirement for the affirmative resolution procedure. We believe that there should be proper parliamentary scrutiny when a new welfare food scheme is introduced. The Department of Health, in its submission to the Delegated Powers and Regulatory Reform Committee, said that it may need to adapt the range of foods regularly. Paragraph 303 of the submission said:


    "This flexibility would be lost if the range of food were . . . required to undergo a separate and more demanding legislative procedure than the affirmative resolution procedure that applies currently".

We are not asking for a more demanding procedure than currently applies, because the current procedure under the welfare food scheme requires the affirmative procedure. We are, in fact, sticking with the affirmative procedure. I would take a lot of persuading that that flexibility means that we have to move away from the affirmative procedure. I accept that scientists' advice, over time, may change the approach to nutrition and, therefore, the composition of the scheme. However, I entirely reject the notion that the affirmative procedure would act as a serious brake on our ability to flex the welfare food scheme over time.

I hope that the Minister considers seriously the points encompassed in the thrust of the amendment introduced by the noble Lord, Lord Clement-Jones, if not its exact wording, and the parliamentary procedures applied to any new scheme.


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