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Lord Colwyn: My Lords, I declare an interest as president of the Parliamentary Group for Integrated and Complementary Healthcare and as patron of the Foundation into Research into Traditional Chinese Medicine. Is the Minister aware of the devastating effect on the herbal sector were statutory regulation not to occur by the time that the European directive on traditional herbal medicinal products becomes fully implemented in April 2011?
Baroness Thornton: My Lords, I specifically asked the department what will happen in April 2011. The public will still be able to access over-the-counter herbal medicine. Where herbal practitioners prepare unlicensed herbal remedies to meet individual patient needs, they will not be affected by the European herbals directive. The noble Lord rightly points out that where practitioners buy in manufactured herbal medicines and products, as with any other medicine they will require the appropriate product licence. Transitional protection afforded to such manufactured herbal medicines comes under the directive, which runs out in April 2011. After that, it would not be lawful for those practitioners to commission manufactured unlicensed herbal medicine. However-this is the point I made to the noble Lord, Lord Pearson of Rannoch-we are considering the possibility of creating a national scheme under a derogation in medicines legislation that could allow practitioners to continue to commission unlicensed manufactured herbal medicine.
Baroness Thornton: My Lords, I am afraid I do not have those figures. The number of manufacturers who are third-party practitioners is relatively small, but they would be severely affected were we not to solve this problem by April of next year.
Baroness Finlay of Llandaff: My Lords, I declare an interest as a member of the Foundation for Integrated Health. Do the Government recognise that accurate diagnosis is absolutely key to any kind of prescribing or intervention? They would do well to look at models of the practice of herbal medicine in other parts of Europe.
Baroness Thornton: My Lords, the noble Baroness raises an important point. The department is aware of what is happening in other parts of Europe. The UK has a well developed alternative medical sector. I understand that it is bigger than anywhere else in Europe. We have specific issues to resolve.
The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bach): My Lords, we are very grateful to Lord Justice Jackson for his remarkable report, which makes significant recommendations for reducing costs in the civil justice system. We are now actively assessing the implications of Sir Rupert's proposals and how they should be taken forward. We will work with the senior judiciary and others to consider the options for reform and we will set out a more detailed timetable once we have completed our initial analysis.
Lord Clinton-Davis: I thank my noble friend for that reply. I recognise that it is too early for the Government to make a definitive decision, but does he recognise that there are serious and fundamental flaws in the present situation, particularly with regard to costs,? Too often, costs are much too high and constitute a real deterrent to many, especially claimants. Does he recognise that?
Lord Bach: Indeed we do. There is a balance to be struck in ensuring both that appropriate claims can be brought to justice and that costs are proportionate. Sir Rupert's report suggests that those objectives have got rather out of balance, with some costs becoming disproportionate. We will seek to ensure a better balance as we consider how to take the recommendations forward. My noble friend is right to say that, in some cases, claimants might currently be deterred from bringing claims because of the level of the defendant's costs that they might have to pay if they lose the action. The Jackson report deals with this in a number of ways, such as through judicial cost management. We are considering how these should be taken forward.
Lord Goodhart: Does the Minister accept that the rule of law in any democracy is meaningless without access to justice and that the proposed cuts to civil litigation funding by the Government will deny many people access to justice?
Lord Bach: I do not recognise that at all as being the true position. If the noble Lord is referring to cuts in legal aid, let me say to him that there are some very marginal cuts in civil justice on the books, but we are determined to make sure that the vital part of legal aid, which is spent on social welfare law-giving legal advice on debt, housing and employment matters-is maintained, particularly at a time of recession.
Lord Borrie: My Lords, Lord Justice Jackson specifically indicated that claimants for personal injury incur undue deterrence when seeking to pursue their claims in the courts because of the rule that the loser pays the winner's costs, which may be considerable in those cases. Does my noble friend agree with the Jackson report that, if the loser is the claimant, that rule should no longer apply?
Lord Bach: My Lords, Sir Rupert has made various recommendations concerning costs, particularly about what is described as qualified one-way cost shifting in cases of this sort. That expression means that a defendant will always pay the costs of a successful claimant but a losing claimant will pay only such of the defendant's costs as is reasonable for him to pay in the circumstances
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Lord Woolf: My Lords, can the Minister say how long he anticipates that the initial consideration, which I fully accept is required, will take? Of course, how long it takes depends on what arrangements are being made to consider the extensive and generally welcome recommendations made by Lord Justice Jackson. I hope that sufficient resources will be allocated to this. I disclose my interest as the author of a report that bore the title Access to Justice. I recall that considerable resources were required before the noble and learned Lord, Lord Irvine, whom I see in his place, was prepared to give final clearance to my recommendations.
Lord Bach: My Lords, if I may say so, the two people who have been most involved in improving our civil justice system over the past 10 or 15 years are both in the Chamber-the noble and learned Lord, Lord Woolf, who has just spoken, and my noble and learned friend Lord Irvine of Lairg. Between them, they have succeeded in making our civil justice system infinitely better than it was. However, it is 10 years since the Access to Justice Act was passed and it is only right that we should look to see whether improvements can be made. Sir Rupert has found that there are some that can be made.
As for timing, I have to be careful because some of Sir Rupert's suggestions require a great deal of analysis. One problem is that he saw his report as a package-and so may want all of it implemented or none of it implemented-but some parts of it could perhaps be implemented earlier. We have to decide between those two difficult choices.
Lord Henley: My Lords, may I for once offer my congratulations to the Ministry of Justice on offering full consideration of this report, which came out only two weeks ago and needs a great deal of consultation? May I recommend that the Minister passes on such suggestions to his colleagues in the Department of Health, who might have done the same with their Personal Care at Home Bill?
Lord Bassam of Brighton: My Lords, with the leave of the House, my noble friend Lady Kinnock of Holyhead will repeat the Statement entitled "Afghanistan
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That the Commons message of 13 January be considered and that a Select Committee of ten members be appointed to join with the Committee appointed by the Commons as the Joint Committee on the National Security Strategy, to consider the National Security Strategy;
L Cope of Berkeley, L Fellowes, L Foulkes of Cumnock, L Harris of Haringey, L Lee of Trafford, B Manningham-Buller, B Ramsay of Cartvale, L Sterling of Plaistow, B Symons of Vernham Dean, L Waldegrave of North Hill;
Lord Clement-Jones: My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Baroness Thornton: My Lords, this is a small Bill with one substantive clause, but it will have great significance for thousands of the most vulnerable adults and older people. I want to start by considering who this Bill is intended to support.
For those with the highest care needs, this Bill helps to end the lottery of personal care charges. It enables us to give them the peace of mind that their personal care will be provided free of charge, wherever they live. The Bill means that those who have been through a significant incident-an operation, a bereavement, an accident-will be encouraged to receive intensive support to prevent their needs deteriorating. It will enable them to be helped to remain healthy and independent, in their own homes if they wish, and to extend their quality of life and years of life.
It is important to set out what the Bill does. Its substantive clause will amend the Community Care (Delayed Discharges etc.) Act 2003 so that the Secretary of State is enabled, by regulations, to require local authorities to provide personal care free of charge indefinitely to people with the highest care needs living at home. The criteria for defining those with highest care needs will be set out in regulations, with
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We have had and continue to have a wide-ranging discussion about the Bill. A consultation process is taking place. A wide range of stakeholders have joined the debate and added their support to the Bill, and are working with us on the best way to implement it. We issued a consultation document in November which outlined the principles of our proposals. This week we intend to make available a working draft of the regulations, as they might look when laid, based on these proposals. These will assist stakeholders in their understanding of the details of the scheme. The draft regulations are subject to further change in the light of the stakeholder responses as we continue with the consultation process until the end of February. The consultation will close on 23 February, at which point the Government will analyse and consider those responses. We expect the final regulations to be laid soon after Royal Assent.
The NHS was created to end the unfairness that people with the greatest needs faced the highest costs, and that people who had the least were in danger of going without their needs being met at all. Today we all agree that this unfairness exists in social care. If you develop dementia-rather than cancer or heart disease-in old age, you are yet to find the freedom from fear that was promised by the NHS. Reform of care and support is the only fiscally responsible strategy. Failure to reform will lead to huge unmet need and pressure on public finances, within both the NHS and local government for years to come.
We all know that the demographic pressures are rising. Year by year, more people will come into a care system which cannot fully cater for their needs. When the NHS was created there were eight working adults for every person retiring. Today there are four. By 2050 that figure will have fallen to just two. We can expect that by 2026 there will be 1.7 million more adults who need care and support. One in five of us will need care that costs less than £1,000 during retirement. One in five will need care that costs more than £50,000 and, in the worst cases, it could exceed £200,000. We cannot predict our risk, so it is hard to protect ourselves against it. The need for bold, far-reaching reform is undeniable. That is why we have proposed to create a national care service, but this is a major reform and, while it is essential, the earliest possible date that this can be implemented is 2014.
The Bill will enable us to do something-the right thing-now: to give real help to some of those with the highest care needs, and to take steps towards a greater reform. These steps follow the progress that has already been made in recent years with respect to social care. The Bill will build on that progress to create an unstoppable momentum as we move towards the greater reform of social care that is so clearly needed. For those who point to the rising costs of free personal care in Scotland, I point out that the situation there is not comparable to what we are proposing here. The Bill is a step towards greater reform of social care, but is also targeted at helping only those with the highest care needs.
The first aim of the Bill is immediate action for 280,000 people with the highest care needs, including
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Take the example of an 89 year-old woman from Lowton, near Warrington, with very high personal care needs as part of her overall care package. She has a number of visits during the day and one later in the evening, with a care worker attending all visits to ensure safe moving and handling. The overall cost of the care package is extensive. Under measures enabled by the Bill, her personal care-the greatest proportion of that care, estimated at 85 per cent of home community care costs-will be free of charge.
Currently, charges for all personal care at home are potentially means-tested, whereby local councils can determine the amount that people have to pay, in accordance with national guidelines. Community care assessments are carried out to determine the level of a person's needs, based on the criteria laid out in guidance. Despite this, levels of support and charging vary widely across the country. The Bill is about trying to create a fairer system by continuing to provide support that people may use flexibly to support them in the way they want. The Bill does not in itself contain any provisions related to direct payments because it does not need to. The existing legislation ensures that this flexibility of support can continue in relation to free personal care at home, if that is what people want.
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