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Baroness Andrews: I shall respond to the point about moving quickly. I reiterate that we wish to get the matter right. I am serious when I say that we want a pilot scheme because that is extremely important. We would certainly not sacrifice getting the measure right for the sake of speed. We need to identify potential problems.

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The present scheme has been successful, but it was conceived at a time when the need for milk was overwhelming. While milk will not be dropped from the scheme and it will be a major part of it, we are now offering nutritional choices which match our knowledge of what children and mothers need and which can be provided as part of our general drive to try to raise health standards. As I have said, the affirmative regulations are important because they mean we can continue to build in flexibility as the scheme develops and as tax credits, social security schemes and health delivery schemes change. I hope that the noble Baroness will be able to reconsider her view.

Lord Clement-Jones: I thank the Minister for her reply to my Amendment No. 464A and I thank all noble Lords who took part in the debate. I was interested in the description of me given by the noble Baroness, Lady Howarth—going for an Olympian canter. I assume that that makes me Bucephalus for this purpose, but I am not sure.

All noble Lords said that it is vital to know how the scheme is working and to measure its impact. We all accept the point on strategic importance, made by the noble Baroness, Lady Howarth. It was interesting to hear the Minister unpick the strategy. We all accept the nutritional strategy, but the question which will arise under the next amendment is how far should the second limb of the strategy be pushed. It links disadvantaged families into the health service—the gatekeeper issue—and is an important aspect.

There has been a consultation exercise and the broad thrust of the reforms is generally welcome. However, the road map from here which relates to these proposals will be important. We want all the multifarious organisations to get behind the scheme. I welcome the Minister's comments that there is a commitment to a pilot scheme or phased roll-out, whatever it is called. However, the sooner the Government can set down a more detailed map of how that will work indicating what they have in mind, the better—and preferably before the Report stage.

There have been 63 years to work out alternatives, as the Minister made clear, but we have a shadowy outline of the way forward. I believe that it would be possible to say, "Right, this is the way we plan the roll-out and this is the way we plan the implementation. These are the ideas we have about actual measurement. This is the body which we think is the appropriate one. This is the kind of voucher and this is how they will be distributed". It is not beyond the wit of man or woman to get that right at this stage.

I hear what the Minister said about the value of the voucher, but she also talked about additional help with formula milk and so forth. I gained a vague impression that something is happening, but it is not entirely clear what that is.

The noble Baroness also mentioned a total cost of 142 million. That is interesting because it is the first time I have heard a concrete statement about the cost

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of the scheme. Some people would have put it rather higher than that. She also mentioned that 100,000 people will be eligible. I welcome the fact that in broad terms the Government expect the same numbers of people to be eligible.

However, many details—for instance, as regards the way in which implementation will take place and the basics of the scheme—have not been addressed. Have the Government addressed the issue of cash or food? There is a genuine point behind that question. Have they really considered whether different types of vouchers will be appropriate? That said, there is a big communications issue. It will be vital to communicate how the proposed scheme will work, starting at the beginning—which is now—saying, "Right, this is how we go forward". I therefore suggest that everyone gets their thinking cap on extremely early, starting this afternoon—

Baroness Andrews: I thank the noble Lord for saying that. We are very keen that the educational and information strategy is as good as it can be.

Lord Clement-Jones: That is great, but perhaps the communication of that to noble Lords at the Report stage would be a good way of demonstrating the Minister's commitment in that respect. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 465 not moved.]

Baroness Noakes moved Amendment No. 466:


    Page 99, leave out lines 13 to 27.

The noble Baroness said: The amendment seeks to delete subsection (4) of new Section 13 of the Social Security Act 1988. Put simply, subsection (4) reeks of the nanny state which we believe the Government would secretly like to create. They seem to crave interference in the private lives of the citizens, which is why, for example, there has been a massive creation of means-tested welfare dependency. For example, more than half the number of pensioners could, if the Government have their way, be subject to means testing. Of course that will not happen because elderly people value their dignity and privacy and will opt out of means testing, even if it costs them. And even the Government admit that because they anticipate that only two-thirds will receive their pension credit entitlement. Therefore, the Government know that schemes which undermine dignity and privacy will not work. But when we come to the new welfare food scheme, they have not learnt. We have another blatant attempt to interfere in people's private lives.

Subsection (4) can make a condition of receiving welfare foods attendance at a hospital, clinic or doctor's surgery; an examination; home visits by state busy-bodies; or being on the receiving end of lectures. Those lectures are not just about nutrition and diet; they can extend to any other health matter. So the state will exploit the vulnerable to keep its vice-like grip on those people's lives.

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Subsection (4) is offensive, which is why we oppose it in principle. We also believe that it is likely to be counter-productive in practice. It will, like the means testing of benefits, drive many away. Others may subject themselves to the indignity, but to what effect? I do not believe that the Government have produced any evidence that their forced intrusions into private lives will have any beneficial effect. Will the Minister say on what evidence this particular part of the scheme is based? Have the Government measured the effectiveness of forced clinical and other interventions?

This subsection is bad law. It is opposed by the Royal College of Nursing and the Maternity Alliance, among others. It should not be allowed to remain in the Bill. I beg to move.

Lord Clement-Jones: The noble Baroness, Lady Noakes, has typically been extremely cogent in introducing the amendment. We on these Benches support her. Philosophically and nutritionally speaking, we are happy with the overall concept of the new "healthy start" scheme, but the subsection is one of the major stumbling-blocks.

I sense from the Minister's letter that as regards the clause the dish has run away with the spoon. Someone who had clearly been working in the Soviet health system decided that it would be nice to insert subsection (4) and no one spotted it until it was too late. It is now in the Bill and the Government are having to decide whether it is a good idea.

There has been a universal ruffling of feathers from many organisations which are intimately bound up with child health, primary care and general practice. The noble Baroness, Lady Noakes, mentioned the Maternity Alliance. It states:


    "Opposition to the proposal to make midwives and health visitors gatekeepers of Health Start is both philosophical and practical . . . penalising a child for the non-compliance of an adult could never be justified . . . far from improving contacts with health professionals, it may simply decrease uptake of Health Start".

The CPHVA states:


    "We object strongly that professionals, in particular health visitors, become gatekeepers to benefits in this way".

The RCPCH states:


    "Insistence on early registration might exclude. The system should be flexible so that mothers can register at any point during their pregnancy or their child's first five years".

That is a slightly different view.

The RCN has been particularly strong. It states:


    "The RCN is opposed to compelling beneficiaries to register for the scheme and believes that it would detrimentally affect the nurse/client relationship and may also deter mothers from low-income families seeking assistance".

Its concerns are highly specific. It is philosophical. It believes—we on these Benches strongly agree, as do, clearly, the Conservative Benches—that the principle of conditionality in respect of this type of welfare is wrong. There is a human rights issue; there are practical objections to the measure; and, as is clear from my earlier quotation, the RCN believes that the nurse/client relationship could be affected by the

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measure. Of course, that applies to the other health professionals who are potentially involved in administering subsection (4).

I suggest that the Government take away this subsection, burn it and think of something entirely different and far more appropriate and acceptable in the circumstances. They will find a great deal more buy-in to the scheme as a result.

12.30 p.m.

Lord Chan: Having listened to noble Lords who have spoken about this subsection, I begin to wonder whether the Minister has a special reason for inserting it. I should have thought that the 800,000 people who will come under the scheme would be those living in areas of deprivation. They would also have health inequalities and would, in any case, require help from the NHS—particularly at primary care level. Therefore, they would be in touch with local health professionals, who would assist them and, it is hoped, would also encourage them to make good use of the scheme.

The subsection reads as a rather heavy-handed way of requiring people who use the vouchers to attend hospital and so on. Therefore, I am not clear why this provision is included as part of the scheme. I should like the Minister to help me with an explanation.


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