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Baroness Finlay of Llandaff: As my noble friend Lord Chan rightly pointed out, the very people who will be subject to this scheme will be those in areas of deprivation. I want to add a little detail to the debate for consideration by the Minister. I want to draw attention to the GP vacancies which exist, particularly in areas of deprivation. Anything that changes the role of the GP in those areas from being a person who works with his patients to being someone who is seen in an administrative role inevitably will drive young trainees further from such areas of deprivation.

In the past year, there has been an increased vacancy factor of 3.4 per cent in general practice. That is a very worrying trend. There are huge recruitment problems in areas of deprivation. One thing that may attract younger trainees to such areas is the possibility of working in a different way—that is, in not such an administrative way—with their patients in the future. Therefore, I am concerned that the scheme may be cumbersome and rebound on areas other than directly on the scheme itself.

Baroness Howarth of Breckland: I think I understand the aim of the clause, but I believe that the implementation of the scheme would be extraordinarily difficult and therefore I cannot support its inclusion. But I understand the need to get young mums in difficult areas to make a link with the health service. I would support that as part of the broader nutritional strategy, which we are all trying to move forward.

However, I believe that the communication/education phrase is probably a better one, and there are other ways in which the scheme can be carried out.

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To gain the vouchers at all, even under the present scheme, there will have to be a link with verification of pregnancy or of having children in the family. Surely we can develop that. But also, as changes in the type of credit available are introduced, surely we could include leaflets in that information. A wide range of alternatives is available which would not interfere with the relationships between the health professionals and the sometimes extraordinarily difficult to access families with whom they are trying to work.

Baroness Andrews: I am grateful to all those who have spoken in the debate. There has certainly been some very strong language, especially from the Opposition Front Benches. Nothing could be further from our intention than that we should exploit vulnerable people. The scheme is about creating better links in order to support vulnerable, disadvantaged people. The aim is that the health service should move nearer to their needs in more comfortable and more effective ways so that they have better lifelong relationships with the NHS and so that their children stand a better chance of receiving nutrition which helps them to grow healthily, avoid obesity and become healthy and active citizens. Therefore, I take issue with the language that has been used.

I understand that there are concerns about subsection (4) and I shall address the specific issues. However, first, perhaps I may answer a few of the questions raised. I turn to the matter referred to by the noble Lord, Lord Chan, who has enormous experience, which I respect a great deal. Our experience and evidence suggests that low-income families are less in touch with health professionals than middle-income families. To an extent, that explains their reluctance to go to the doctor or to make contact with a health visitor. That happens for all sorts of reasons—particularly in the case of young women. They attend later in pregnancy than higher-income women and they come with complications. They come not having had the proper nutrition that, thankfully, people such as us take for granted. We need to encourage and inform them.

I say to the noble Baroness, Lady Finlay, that the scheme is not about an administrative role for GPs. I hope very much that in the information that we distribute we make that clear. It is about bringing in low-income families on a confident, comfortable basis in the same way as we do with higher-income families and those who are more used to dealing with authoritative figures in society, of whom the doctor is certainly one.

We have also tested out the scheme with beneficiaries. Many beneficiaries welcomed the idea of receiving more support to help them to eat a more healthy diet and to navigate their way through the available information about what is and is not healthy. That information is often very confusing. They also welcomed the idea of being encouraged to obtain help with budgeting and to know that cooking is sometimes an easy alternative. I say that without being patronising. This is nothing to do with nannying; I

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believe that many people simply need to get their hands on the right information. We certainly welcome the schemes that exist. The Sure Start scheme has been a great success because it has made the link between low-income families and sources of support. I consider it to be a very good model for this scheme and we want to build on that.

We also know from the Acheson inquiry into health inequalities that breast-feeding confers short and long-term health benefits. However, the vast majority of mothers still choose to bottle-feed and we want to address some of those issues in relation to young mums, as mentioned by the noble Baroness, Lady Howarth.

As I said, we are talking about 800,000 eligible people. However, I reiterate that the current scheme is missing a major opportunity to bring the family within the framework of the National Health Service in more effective ways and to tackle health inequalities that start at birth. The aim of the reformed scheme is to make better use of that potential and, indeed, to offer the health professionals themselves a better way of becoming involved. The scheme provides the most significant opportunity that health professionals have had for a generation to achieve their aims of improving nutrition and health outcomes. That is why we want to implement a new system of support, advice and guidance and why information and help is so important. It is important to get the communication right.

It is not our aim to introduce a series of new contact points; nor is it our aim to place undue burdens on the NHS or the beneficiaries or to put at risk the important relationships that exist. That is precisely why we are consulting so widely. We are going to build on existing NHS practices and contact points for pregnant women and young mothers in a way which is proportionate—proportionate with human rights as well—and which complements the role of health professionals. We are going to use the existing network. We want to encourage a more effective take-up of ante-natal services. But I assure noble Lords that we would not expect to set up schemes outside the normal provision which is available to all. We shall not insist that low-income women be subject to any examination outside the normal procedures that take place at present when any woman confirms her pregnancy. To receive maternity benefits at the moment one has to provide proof of pregnancy and that is why people have to fill in forms.

These aims are wholly consistent with our wide objective to reduce child poverty and to reduce disease. As I have said, a similar model is set out in Sure Start, which has a 95 per cent take-up rate. We anticipate similar levels of take-up. If the amendment were to be accepted, this vital opportunity to tackle health inequalities would be severely threatened. We would lose that opportunity. We would lose the potential of a very important change in the way that we do things.

However, I have been listening very carefully to the points that have been made. I understand that people feel seriously about this issue, particularly about the

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requirements relating to physical examination. We know that that has caused some concern. Therefore, I am minded to take the amendment away for reconsideration. On that basis I hope that noble Lords will withdraw their amendment.

Baroness Noakes: I thank the Minister for that reply. If it had not been for her last comment, my response would have been framed in the strong language that she does not like. If she wants to hear strong language, perhaps she would come to my room later where she could find out what really is strong language.

I thank all other noble Lords who have taken part in this debate. Some important issues have been raised. We are not at odds with the Government in wanting to help young mothers do well for their children and for themselves. We want that as much as the Government do. The question is the means. We have been most concerned about the compulsion behind subsection (4). The noble Baroness, Lady Howarth, spoke of helping, encouraging and informing. That is what we should be doing, not prescribing that a woman has to have a physical examination or a lecture or has to allow someone into her home and so on. That is why we find subsection (4) so wrong—not because we disagree with the aims.

We believe that the scheme could perfectly well be carried out in a proper way—without subsection (4)—by encouragement, and not by compulsion. I am very glad that the noble Baroness will take the amendment away and reconsider it for Report stage. I encourage her to think very hard about it before then. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 181 agreed to.

Clause 182 agreed to.

[Amendment No. 467 not moved.]

Clause 183 [Appointments to certain health and social care bodies]:

[Amendment No. 468 not moved.]

Baroness Noakes moved Amendment No. 469:

    Page 102, line 24, at end insert—

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