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House of Lords

Tuesday, 16 July 2013.

2.30 pm

Prayers—read by the Lord Bishop of Leicester.

Global Partnership for Aid Effectiveness


2.37 pm

Asked by Lord Chidgey

To ask Her Majesty’s Government what progress they have made, as part of the Global Partnership for Aid Effectiveness, in developing and specifying the aid effectiveness indicators outlined in the global agreement reached at the High Level Forum in Busan.

Baroness Northover: My Lords, 10 indicators and associated targets for a framework to track global development effectiveness were agreed internationally in June 2012. The UK has provided detailed feedback on proposed data to be used for each indicator. These data will be collected until mid-September and published in time for a major meeting on development effectiveness in early 2014.

Lord Chidgey: My Lords, I thank my noble friend for that reply. The Busan agreement includes the commitment to strengthen the role of Parliaments in the oversight of the development process by monitoring to ensure that aid is on budget lines that are subject to parliamentary scrutiny. What measures are the Government taking to ensure that the Busan parliamentary scrutiny includes democratic accountability, challenging the view of some that there is no relationship between democracy and development? What plans do the Government have to compensate for the drain on parliamentary capacity in developing countries caused by the high percentage of parliamentary staff trained under aid programmes leaving for more attractive posts elsewhere?

Baroness Northover: As my noble friend will know, parliamentarians are represented in the global partnership steering committee meetings, and DfID certainly believes that democratic government helps to promote sustainable development in the way which he has indicated. That is why we are supporting democratic elections through various programmes and other work, which we will be supporting in 13 countries by 2015. As for his point about the drain in staff, between 2011 and 2012 DfID invested £181 million in public sector reform, which includes improvement of staff performance and retention. We very much understand my noble friend’s point.

Lord Judd: My Lords, is it not very important to realise that if development is to be sustained, it is necessary to have stability and security? Can the Minister give us an assurance that, whatever happens, we will

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continue to give priority to the security sector reform programme, which tries to ensure that there are effective security arrangements that are also based on transparency and human rights?

Baroness Northover: I can give the noble Lord that assurance. He will note that it is a crucial part of the arrangements in the new deal for fragile states, and it also underlies and is an extremely important part of our principles regarding where we are willing to give budget support.

Baroness Hayman: My Lords, although I fully support the development of technical indicators for aid effectiveness, will the Minister confirm that there is manifold evidence that the most effective form of aid is that which concentrates on the social, economic and educational development of women?

Baroness Northover: The noble Baroness is absolutely right, which is why we have put women and girls very much at the centre of what DfID does. Education is part of that. As for the stages of development of various countries, I note that the countries that are most developed have the highest levels of educational enrolment and adult literacy.

Baroness Jenkin of Kennington: My Lords, does my noble friend agree that many of the aid-effectiveness indicators agreed at Busan—for example, the governance indicator which features so heavily at the G8—are already part of the Government’s development strategy?

Baroness Northover: My noble friend is quite right, and if she looks—as I am sure she has—at the recent DfID annual report, she will see that evidence there. It is extremely important that both aid givers, such as the United Kingdom, and aid recipients make sure that they address the requirements laid down in Busan. Only by doing so will we ensure that aid is most effectively delivered and has its greatest effect.

Lord Anderson of Swansea: My Lords, on the drain of staff, how does one seek to resolve the problem of staff of talent being attracted into the private sector, and also into the international organisation sector, with salaries that are perhaps four or five times more than they can get in their own Administrations? That only encourages corruption.

Baroness Northover: The noble Lord might look at the United Kingdom, too, and wonder whether that is a challenge that we also face. Of course it is a challenge, and it is one that we are well aware of. It is encouraging to see that there are very talented people working within, for example, the sovereign wealth funds, which can be useful instruments in the economic development of some of those countries.

Baroness Tonge: My Lords, have the Government made an assessment of the effectiveness of aid to the Palestinians? Can the Minister also tell us whether the Government have made any attempt to recoup the

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cost of that aid from the Government of Israel, who are, after all, responsible under Geneva conventions for the welfare of the people whose land they occupy?

Baroness Northover: The noble Baroness has made this point before. We constantly monitor the situation with the Palestinians. We are very concerned about their situation and frequently make the case about it to the Government of Israel. I would also point out, as I have before, that we need to see peacebuilding measures between the Israelis and the Palestinians, which will be in the interests of both sides.

Lord Ashdown of Norton-sub-Hamdon: My Lords, my driver in Bosnia and Herzegovina earned more than the local Prime Minister. Does my noble friend not realise that unless something serious is done about this problem of the internal brain drain to the international organisations, steps to try to help failed states recover after conflict will be seriously hog-tied?

Baroness Northover: My noble friend has enormous experience, of course. It is lessons such as those which he derives from Bosnia that we carry over when trying to rebuild in fragile states elsewhere, for example in Afghanistan. We are aware of these challenges, which is why the United Nations and the international bodies seek to address them.

The Earl of Sandwich: My Lords, when the Government have discovered which of their programmes are effective, will they make more effort to communicate this to the general public, who are still largely in ignorance of the aid programme?

Baroness Northover: There is sometimes a disconnect between what comes over in Comic Relief programmes, which people sign up to and understand—for example, linking back to the question from the noble Baroness, Lady Hayman, the importance of education and its transformative effect, especially for girls—and the news that sometimes comes out via some of our newspapers. We all need to continue to emphasise how effective and transformative aid can be.

Housing: Rent Levels


2.45 pm

Asked by Baroness Turner of Camden

To ask Her Majesty’s Government what steps they are taking to deal with the level of rents being charged by private landlords, particularly in London, and their impact on housing benefit.

Lord Ahmad of Wimbledon: My Lords, across England, increases in private sector rents in recent years have been modest and below inflation. Over the 12 months to May 2013 private rents increased by 1.3%; this compares with the CPI of 2.7%. We are also encouraging the supply of new homes with a £1 billion build-to-rent fund which will help to keep rent levels down.

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Baroness Turner of Camden: I thank the Minister for that response. Is he not aware that we are facing a bit of a housing crisis at the moment, particularly in London? Younger people cannot afford the deposit to buy a place and cannot afford the rents because they are far too high. Is the Minister aware that following the last war there was also a housing crisis and that the Government then dealt with it by building lots of small houses—the famous prefabs—and also introduced a system of rent controls through the rent tribunals so that people were not pushed into poverty by trying to pay for a roof over their heads? Can we not sometimes learn something from our predecessors?

Lord Ahmad of Wimbledon: The Government are fully aware of the housing challenges. In London the mayor’s housing covenant contains detailed proposals for improving London’s private rental sector. The housing guarantee schemes are intended to help expand the provision of large-scale, professionally managed rented housing and to support economic growth. Of course, as was recently announced, the Government have allocated an additional £3 billion to a housebuilding programme. We are embarked on the biggest housebuilding programme of the past 20 years, and that should be appreciated and commended.

Baroness Maddock: My Lords, my noble friend indicated that one of the problems with high rents in the private sector is lack of supply. Did he see something interesting in the newspaper this week: that in many towns with a high student population the students occupy houses that could be lived in by families if we were to build more proper student accommodation there? Will the Government see if there is any mileage in that?

Lord Ahmad of Wimbledon: My noble friend raises an important point. The Government are forever looking at ways that we can help address the housing challenges in particular cities, and if there are good practices I will take them back and share them across the country.

Baroness Hollis of Heigham: My Lords, is the Minister aware that the highly respected Chartered Institute of Housing reported last week that, because there are so few vacant smaller properties in the social sector, four-fifths of underoccupying tenants who need to move will have to go into the private rented sector where, as my noble friend said, rents are higher and so the housing benefit bill will soar. Does the Minister accept that as a result, 660,000 families will have their lives turned upside down and at the end of it there will be no savings but instead an increase in public expenditure?

Lord Ahmad of Wimbledon: As I said in answer to a previous question, the Government are embarked on one of the biggest ever housebuilding programmes, both for the rental sector and for affordable housing. There are challenges ahead with the housing crisis. I am sorry that noble Lords opposite do not appreciate that. We took on one of the biggest challenges with the housing crisis and, unlike the party opposite, are addressing it head on.

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The Lord Bishop of Leicester: My Lords, more than one-third of privately renting households are families with children, yet typical tenancies remain short-term with little assurance about when rents may rise or how long they will be able to stay in their home. Uncertainty of this kind is particularly damaging for families trying to give their children stability. Will the Government give serious consideration to Shelter’s proposal to develop and promote stable rental contracts that would offer renters a five-year tenancy agreement and tie rent increases to inflation?

Lord Ahmad of Wimbledon: The right reverend Prelate makes an important point. I have seen the Shelter policy. Security of tenure has increased. Recent figures from the English Housing Survey show that only 9% of tenancies are ended by the landlord. We have seen an increasing percentage of people staying in their accommodation for more than two years. That is to be appreciated. We are looking at Shelter’s proposition, which came out in its September 2012 report.

Lord McKenzie of Luton:My Lords, is not the reality that the Government have created a vicious cycle where those deemed to underoccupy cannot move in the social rented sector because of the lack of appropriate smaller accommodation, cannot afford the extra rent payable to stay put because of the bedroom tax and, at a time when rents are planned to rise by CPI plus 1% for the next 10 years, cannot afford to move to the private rented sector where rents are soaring while housing support, the local housing allowance, is to be restricted to a 1% uprating? Is this not bound to lead to greater homelessness, more misery for families and more cost to the taxpayer? Which genius invented these policies?

Lord Ahmad of Wimbledon: I suppose I should ask the noble Lord which genius created these problems. Part of the challenge for this Government is to look at the current crisis. As I indicated, we have embarked on the biggest housebuilding programme both in the private rented sector and in affordable housing. The noble Lord raised housing benefit. The Government have looked at it. It is being raised by CPI, and it will be raised by another 1%, but generally the party opposite should not look at a picture of gloom. There is a picture of optimism emerging in terms of housing for the long term. That will be seen over the next few years.

Baroness Farrington of Ribbleton: Will the Minister explain why, if the Government’s policy of building more houses is so good, it is not starting now?

Lord Ahmad of Wimbledon: It is starting now. We have already committed to build 170,000 new homes by 2015 and a further 30,000 by 2017. As recent announcements have indicated, another 10,000 homes will be on line as well. Over the next four years, 200,000 homes will be coming on line by 2018. That is putting the record straight.

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NHS: Foundation Trusts


2.53 pm

Asked by Lord Warner

To ask Her Majesty’s Government what progress the NHS Trust Development Authority will have made by April 2014 with NHS Trusts becoming NHS Foundation Trusts; and when they forecast that the Authority will have completed its work.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, in the light of Robert Francis’s recent report, we have allowed the NHS Trust Development Authority to agree trajectories for NHS trusts to reach foundation trust status that go beyond 2014 on a case-by-case basis. In doing so, we will ensure that the primary focus of the NHS Trust Development Authority and of NHS trusts themselves is on improving the quality and sustainability of services for patients.

Lord Warner: My Lords, I thank the Minister for that reply. Does he recall that in a recent Written Answer to me he identified 26 acute hospitals under the stewardship of the TDA which have cumulative deficits running into hundreds of millions of pounds? Does he agree that many of them are unsustainable and potentially unsafe and need their services reconfigured? Will he tell the House why the Government refuse to publish the review by Sir Ian Carruthers on the procedures for service reconfiguration and why they resist publication by declining FOI requests?

Earl Howe: My Lords, there is no doubt—and we have never denied this—that there will be a hard core of organisations which will be very difficult, if not impossible, to bring to foundation trust status. For those trusts, it is necessary to look at other options, including, for example, mergers. That work is being taken forward. Although some trusts are in deficit, the NHS TDA is working very hard to mitigate those deficits in-year and when the first quarter board papers are published in September we will know what its predictions are for all trusts for the current year. I will come back to the noble Lord on the report of Sir Ian Carruthers because all FOI decisions are reviewed at regular intervals to make sure they are current. I want to make sure that there is a plan to release that information in due course. I am sure that there is.

Baroness Knight of Collingtree: My Lords, following yesterday’s Written Statement, in which the Government indicated total support for the review carried out so expertly by the noble Baroness, Lady Neuberger, on the Liverpool Care Pathway, can my noble friend the Minister confirm that the trusts will take immediate action to implement its recommendations?

Earl Howe: My Lords, I hope my noble friend will allow that that is a little wide of the Question on the Order Paper, which is about bringing trusts to foundation trust status. Nevertheless, I refer my noble friend to

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the Written Answer which was published in


yesterday and which sets out the immediate steps we have taken to instruct all hospitals to review all patients currently on the Liverpool Care Pathway and to make sure that there is a named, responsible clinician for every patient at the end of life.

Lord Hunt of Kings Heath: My Lords, I refer noble Lords to my health interests in the register. Is the failure to publish the reconfiguration paper by Sir Ian Carruthers due to the intervention of the Competition Commission in proposed mergers and reconfiguration of services in the NHS? Is the noble Earl aware that it was reported in the other place this morning that the intervention of the Competition Commission in the Dorset merger will cost £6 million which should have been spent on patient services? When will the Government start to ensure that the foolish intervention by the Competition Commission which is not needed in the health service stops and money that could be spent on patient services is actually spent on them?

Earl Howe: My Lords, I am sure the noble Lord is aware that the provision for reviewing NHS mergers on competition grounds is not at all new. Responsibility for reviewing NHS mergers has moved from one independent body—the Co-operation and Competition Panel—to another, the OFT. This is a continuation of the approach that has been in place since 2009. In all these decisions what matters is what is in the interests of patients. The competition authorities will continue to review whether the potential benefits of a merger outweigh the potential costs to patients.

Baroness Jolly: My Lords, would my noble friend confirm whether any of those trusts yet to achieve foundation trust status were planning to merge with any on today’s Bruce Keogh list?

Earl Howe: I am not aware of any on Sir Bruce Keogh’s list which were planning to merge but, if I may, I will write to my noble friend with further details if that needs clarifying.

Baroness Cumberlege: My Lords, my interests are declared in the Register of Lords’ Interests. Complicated organisations, such as hospitals of every sort, need outstanding, in-depth leadership from all quarters. Does my noble friend agree that clinicians should provide that leadership but that if there is an overwhelming culture of retribution there is no incentive for them to take on these very demanding roles? What incentives can the Government introduce to ensure that the most talented doctors and nurses are attracted to lead the NHS and take on these very high risk jobs?

Earl Howe: My noble friend makes a vital point. If we are to strive for excellence in the health service, leadership is essential. That is the reason why the NHS Leadership Academy has been established—to encourage not only managers but clinicians and nurses to take leadership roles in the health service for the very reasons that my noble friend states.

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Lord Brooke of Alverthorpe: My Lords, given the Government’s commitment to the duty of candour in the NHS, can the Minister give us an indication of some of the reasons why there has been a long delay in the production of Sir Ian Carruthers’s report?

Earl Howe: My Lords, I am not aware of the underlying reasons why Sir Ian Carruthers’s report has not been released. As far as I am aware, that is a matter for NHS England. However, if I can enlighten the noble Lord, I will be happy to write to him. I can say that the programme for bringing trusts to foundation trust status has to be taken slightly more slowly than we thought was appropriate perhaps a couple of years ago. That is because of the Francis report. I make no apology for that, because it is right for trusts to take a longer and harder look at the issues that Robert Francis flagged up.

Smoking: Cigarette Packaging


3 pm

Asked by Baroness Finlay of Llandaff

To ask Her Majesty’s Government what is the basis for the decision not to proceed with standardised packaging of cigarettes.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): Standardised packaging remains a policy under active consideration. The Government have not ruled out its introduction. However, we want to spend more time assimilating information about the likely effect of such a policy in this country and learning from experience abroad. Let me be clear: we are not going soft on tobacco, which is a leading cause of premature death. We have an ambitious tobacco control plan and will press ahead with tobacco control policies, including removing tobacco from displays in shops.

Baroness Finlay of Llandaff: I declare my interest as president-elect of the BMA. As 200,000 11 to 15 year- olds start smoking each year in the UK, what are the criteria and time frames that the Government will use to judge the outcomes of standardised packaging in Australia? The high mortality rate does not appear until about 25 years after these youngsters start smoking. As this is fundamentally a child protection issue, how will the Government now prevent vulnerable children—particularly those in local authority care—from starting smoking, given that the Department of Health’s own systematic review showed that current packs are particularly attractive to youngsters and that they mislead them into thinking that some brands are less harmful than others?

Earl Howe: My Lords, we want to keep a close eye on what is happening around the world before making a decision. We are keeping standardised packaging under active consideration. It has been newly introduced in Australia, and other countries are intending to follow suit, so it is sensible for us to see what we can learn from other countries’ experience. The impacts

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could be several. They could include, for example, health benefits, as well as impacts on businesses such as retailers and tobacco manufacturers, and could possibly bring about a change in attitude to smoking.

On the risk to children, the noble Baroness is of course absolutely right. Evidence suggests that action needs to be taken to reshape social norms around smoking so that tobacco becomes less desirable, less acceptable and less accessible, particularly to the young. That is why we are committed to ending tobacco displays in shops. We have a TV-led marketing campaign to encourage smokers not to smoke at home or in cars and we have banned the sale of tobacco in vending machines, which has removed a source of cigarettes that underage smokers could access as often as they liked. There is a range of work going on.

Lord Naseby: May I—

Lord Foulkes of Cumnock: My Lords—

The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford): We will briefly hear from my noble friend and then go over to the other side.

Lord Naseby: I congratulate my noble friend on not rushing in to another unproven restriction on the consumption of alcohol, particularly one which has legal dimensions that affect intellectual property rights. Can he confirm that consumption of cigarettes is already falling, and that we are already spending something like over £50 million on tobacco control? Is not the greatest problem at the moment illegal smuggling of cigarettes into this country, which costs the Revenue a huge amount of money—close on £200 million—and is consumed principally by young people?

Earl Howe: My Lords, smoking rates in the UK are lower than those in many comparable western societies, but our reductions in prevalence still lag behind those in countries such as Canada and the United States, and in some Australian states. Overall prevalence is gradually coming down, but we still need to worry about smoking take-up by the young. There is no doubt that smoking is a significant cause of health inequalities in the UK.

On illicit trade, the story is quite positive. In 2000 around 21% of the UK’s cigarette market was illicit, whereas the latest estimate from HMRC for 2010-11 is that around 9% of the cigarette market is illicit. That is too much; nevertheless, we are heading in the right direction.

Lord Foulkes of Cumnock: Does the Minister recall that when he was a shadow Minister opposing our legislation, he regularly met Gardant Communications on behalf of Philip Morris International? May I ask him very gently: who does he think had the greatest influence on this U-turn—his friends at Gardant or Lynton Crosby?

Earl Howe: My Lords, I have never adopted a personal position on plain packaging; the noble Lord is wrong about that. As an opposition spokesman, yes,

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I did make it my business to talk to all sectors—to the tobacco companies, to ASH and to other lobby groups—to make sure that the picture I presented from the Benches on which he now sits was a balanced one. I took no personal position, nor, indeed, a position on behalf of the Conservative Party; I need to make that very clear. The decision that the Government have taken has been in no way influenced by Mr Crosby.

Lord Taverne: My Lords, will the Government take into account the effect of postponing a decision, in the light of the very strong evidence cited by the Public Health Research Consortium in coming to the conclusion that such a measure would help to deter smoking? That seemed to be confirmed by the statement by the brand director of Imperial Tobacco that now that advertising was banned, the company should look at the design of packaging. Is it not unwise for the Prime Minister, after the Coulson disaster, the decision on alcohol pricing and the postponement of a register of lobbyists, to have appointed as special adviser to the Government someone who has turned out to be a lobbyist for the alcohol and tobacco industries?

Earl Howe: I emphasise that the Government have by no means a closed mind on the issue of plain packaging of tobacco—quite the reverse. We want to take the time needed to consider fully the many relevant issues around standardised packaging, before making any decision. My noble friend’s last comment might have had greater force if I had been announcing that we would not be proceeding with plain packaging, but that is not the case.

European Union (Approvals) Bill [HL]

First Reading

3.07 pm

A Bill to make provision for approving, for the purposes of Section 8 of the European Union Act 2011, certain draft decisions under Article 352 of the Treaty on the Functioning of the European Union.

The Bill was introduced by Lord Gardiner of Kimble, read a first time and ordered to be printed.

Natural Resources Body for Wales (Consequential Provision) Order 2013

Motion to Approve

3.08 pm

Moved by Baroness Randerson

That the draft order laid before the House on 3 June be approved.

Relevant document: 3rd Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 8 July.

Motion agreed.

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Alternative Investment Fund Managers Regulations 2013

Motion to Approve

3.09 pm

Moved by Lord Newby

That the draft regulations laid before the House on 10 June be approved.

Relevant document: 4th Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 10 July.

Motion agreed.

National Health Service (Licensing and Pricing) Regulations 2013

Motion to Approve

3.09 pm

Moved By Earl Howe

That the draft regulations laid before the House on 4 June be approved.

Relevant document: 4th Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 10 July.

Motion agreed.

Renewable Heat Incentive Scheme (Amendment) (No. 2) Regulations 2013

Motion to Approve

3.09 pm

Moved By Baroness Verma

That the draft regulations laid before the House on 10 June be approved.

Relevant document: 4th Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 10 July.

Motion agreed.

Northern Ireland


3.09 pm

The Parliamentary Under-Secretary of State, Wales Office (Baroness Randerson): My Lords, with the permission of the House, I will repeat a Statement made by the Secretary of State for Northern Ireland in the other place. The Statement is as follows:

“I am sure the whole House will join me in condemning this shameful violence and in expressing our profound sympathy and support for the police officers who have been injured. It is also a matter of the gravest concern that the right honourable Member for Belfast North

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was knocked unconscious as he tried to calm the situation on the streets of his constituency. I am certain that I speak for everyone here in wishing him well.

On Friday evening, following the annual 12 July parades, around 5,000 people gathered to protest against the Parades Commission determination not to allow three Orange Lodges to return home past the nationalist Ardoyne area. This has been the scene of serious disorder in recent years, including shots fired at police by dissident republicans. Violence erupted as the crowd reached the police line on Woodvale Road preventing access to the route past the Ardoyne shop fronts. This has been followed by further disturbances and rioting on each night since then, mainly in the Woodvale Parade/Twaddell Avenue area, but also in the Newtownards Road in east Belfast, Mount Vernon in north Belfast, Rathcoole in Newtownabbey, Portadown and Ballyclare.

During these disturbances, the police have come under attack from a variety of weapons including fireworks, petrol bombs, bottles, stones, bits of masonry, iron bars and ceremonial swords. Last night, four blast bombs were thrown at police officers in east Belfast and a pipe bomb from Brompton Park in the Ardoyne. Water cannon and AEP plastic bullet rounds have been discharged on four successive nights, and 71 police officers have been injured.

I am well aware of the anger felt by many people over the Parades Commission determination in relation to Ardoyne but, however strongly people feel, there can be no justification, or excuse, for the behaviour we have seen in recent days. Attacks on the police are wholly unacceptable and I condemn them without hesitation or reservation. It is also utterly disgraceful that the right honourable Member for Belfast North found himself the victim of this violence, too.

There has been talk of attacks on British identity and culture in Northern Ireland. Well, the sort of behaviour that has been taking place in north Belfast does nothing to promote Britishness or the pro-Union cause; rather, it undermines it in the eyes of the overwhelming majority of people in Northern Ireland and the rest of the United Kingdom. In fact, it is hard to think of anything less British and less patriotic than wrapping yourself in a union flag and going out to attack the people who are there to maintain the rule of law and protect the whole community.

So now it is the responsibility of everyone with influence, including the Orange Order, community leaders and politicians, to do what we can to defuse tensions and calm the situation. We need temperate language over the coming days, and I am afraid that the Orange Order needs to reflect carefully on its role in encouraging mass protests on Friday, in a highly volatile situation, without the careful planning, stewarding and engagement with the police that is so important for keeping people safe when big crowds gather together. While the Orange Order’s announcement of the suspension of its protests was welcome, it is now time for it to call them off completely.

I would like to pay tribute to the outstanding work of the Police Service of Northern Ireland over recent days. Its officers have demonstrated fortitude, determination and courage in defending the rule of law. They have put their own safety on the line in the

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face of violent attacks and deserve our utmost praise, support and thanks, as do the police officers from Great Britain who provided mutual aid support. I would like to commend the leadership of chief constable Matt Baggott and Justice Minister David Ford. I know that meticulous planning took place to ensure that everything possible was done to try to keep people safe over the weekend of 12 July, including bringing approximately 1,000 mutual aid officers from Great Britain.

Of the 4,000 or so parades that take place annually in Northern Ireland, the vast majority pass off without major problems, including hundreds on 12 July. But any rioting is unacceptable, not least because it undermines efforts to secure economic recovery for Northern Ireland and because it makes competing in the global race for jobs and investment that much more difficult. The way forward has to be through dialogue to find sustainable local solutions to contentious parades, as has been the case in, for example, Derry/Londonderry.

I welcomed the talks that took place between members of the Orange Order and Ardoyne residents before the Parades Commission determination. I know how difficult this will be after what has happened, but I believe that it is vital that local dialogue continues. I also welcome inclusion of parading in the remit of the Executive’s all-party working group and the appointment of the distinguished US former envoy to Northern Ireland, Richard Haass, to chair it. The Government have always made it clear that we are open to a devolved solution on parading if one can be found but, in the mean time, we will not tolerate lawlessness on the streets of Belfast any more than we would in any other UK city.

Last week in this Chamber, issues were raised regarding my powers in relation to Parades Commission determinations. They are set out in the Public Processions (Northern Ireland) Act 1998. Section 9 states that the Secretary of State can only review a determination made by the Parades Commission following a request by the chief constable. The reason why he has not made such a request is because at all times he has been confident that the officers under his command can police the situation, and I fully share that confidence.

So to those on the streets over recent days taking part in this violence I say this. So far, 60 arrests have been made and emergency courts were sitting on Sunday to accelerate the criminal justice process. But that is just the start. No stone will be left unturned in building the case needed for more arrests and more criminal convictions. Those who engage in so-called recreational rioting and attacks on police officers can expect to face the full force of the law. I am confident that for some that will mean that the next 12 July holiday will be spent not in the sunshine following the parades, but locked up in prison living with the consequences of the crimes that they have committed”.

My Lords, I commend this Statement to the House.

3.18 pm

Lord McAvoy: My Lords, I thank the Minister for repeating the Statement made by the Secretary of State in the House of Commons. I assure her of the full support of the Opposition Front Bench for

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the position outlined. I will now repeat the statement by my honourable friend Vernon Coaker, the shadow Secretary of State for Northern Ireland.

“I thank the Secretary of State for her usual courtesy in giving me advance sight of her Statement. I also thank her and her officials for keeping me and my office updated over the course of the weekend. It was very much appreciated and in the best traditions of bipartisanship.

I welcome her Statement. It is right that this House has the opportunity to discuss these important matters. I unequivocally condemn the violence that has taken place in Belfast over the last number of days and nights. There is no justification for it. The disgraceful attacks on the police have resulted in dozens of injuries, and a very deliberate attempt to murder officers by throwing blast bombs at them last night was shameful.

I pay tribute to the PSNI and colleagues from other UK forces for their bravery and determination in upholding the law. Can the Minister update us on the status of injured officers? Are any still receiving treatment? How many have returned to duty? How many are PSNI officers and how many are from other forces? How many mutual aid officers are still undertaking duties in Northern Ireland, and how long is that expected to continue?

We know that policing these large-scale public order incidents is costly. Does the Secretary of State have an estimate of how much the policing operations have cost to date? Who will meet this cost? Will it be her department, the Department of Justice or a combination of the two? There is always a concern about the involvement of paramilitaries in or on the margins of contentious parades and protests. Has she looked at who is involved and who is being arrested? Is there any indication that loyalist paramilitaries or dissident republicans have organised, or taken part in, the violence?

The origins of the appalling scenes we have witnessed lie in the dispute around parading. We have been here before. Does the Secretary of State agree with me that meaningful dialogue and working towards local agreement is the key to finding a solution? It has worked well in other places. The Orange Order held a peaceful, enjoyable and colourful celebration on the 12th in the UK City of Culture, Derry-Londonderry. It was a huge success, attended by thousands of people, and was able to happen because of years of dialogue and communication between neighbours in an atmosphere of respect and good will. Will the Secretary of State update the House on what discussions she has had with the First and Deputy First Ministers, the Orange Order, residents’ associations and local political and civic representatives over the weekend? Does she agree that she has an important role to play in having further discussions over the coming days and weeks in north and east Belfast? As well as condemning the violence that has taken place, we need to work to ensure that it ends and does not recur in the future.

My view is that the British and Irish Governments still have a hugely significant role to play in helping to resolve all these issues. They should both be involved in the talks convened by the First Minister and Deputy First Minister, which are being facilitated by Richard Haass. Does the Minister agree? Will she confirm that

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the Northern Ireland Office is working with the OFMDFM on this? It is crucial to bring people together to look at what needs to happen now to prevent a repeat of what happened over the weekend, when a disagreement that was not addressed led to significant tensions between communities and ended in unacceptable violence. That is the main message I wish to send out today. I encourage all those working to find a solution to these matters to keep going and not give up, and to keep talking. I say to those involved in parading and protesting—unionist and nationalist—that respecting the law, your neighbour and the wishes of people right across a community to live in peace is the only way forward. It has been done and can be done”.

3.23 pm

Baroness Randerson: I thank the noble Lord for his comments, and particularly welcome his condemnation of the violence and the stress he laid on the importance of respect in the situation in which Northern Ireland finds itself. I also thank him for his support for those so closely involved in controlling the violence. They have had a very difficult job in the past few days.

The noble Lord asked a number of questions. Seventy-one police have been injured and we believe that six have been hospitalised, of whom two were police serving under the mutual aid scheme. There were more than 1,000 mutual aid officers in Northern Ireland at the weekend and yesterday.

The noble Lord asked about the cost of the problem and who bears it. This is where the real tragedy lies financially, because the Department of Justice in Northern Ireland bears that cost. That puts even greater stress and pressure on the police budget. The economic implications are very serious because of the impact it has on Northern Ireland, but it has immediately a massive financial impact on the Department of Justice.

The noble Lord asked about paramilitary involvement. That is something that will be very carefully investigated. He also asked about the Secretary of State’s discussions. She has had a whole range of conversations and meetings, both prior to and over the weekend. She was, of course, in Northern Ireland throughout this period. She is very supportive of the work that will be done by Richard Haass and the work that is being done by the Executive, the First Minister and Deputy First Minister, to bring a more peaceful situation back into play.

Baroness Stowell of Beeston: My Lords, before the clerk starts the Clock, in the interests of all noble Lords with an interest in this matter, may I remind the House that the Companion guides us that all Statements are an opportunity for brief questions only?

3.26 pm

Lord Shutt of Greetland: My Lords, I, too, thank my noble friend for repeating this Statement. I am happy to endorse her condemnation of shameful violence and to express sympathy. But can we also do some encouraging? There is still one gap from the Belfast agreement which was toyed with for a period and then put aside. That is the engagement of a civic forum, so

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that there can be genuine discussion with so many people about the shared future that Northern Ireland needs.

I have one further point and a question. It is one thing having these anniversaries and annual events—we worry about what is going to happen on the 12th—but we are moving to a period when we are going to be celebrating centenaries. These centenaries will be coming up very shortly. They are opportunities to celebrate, but some might see them as opportunities to be violent. Will my noble friend confirm that there are real plans and thought-through initiatives with this Government and the Government of Ireland and the devolved Assembly, to see that when the centenaries are celebrated, they really are celebrated and do not provide a further opportunity for violence?

Baroness Randerson: I thank the noble Lord for his questions. In relation to his comments about a civic forum, the situation in Northern Ireland is such that this process is worth reconsidering. In view of the recent A Shared Future document, issued by the Executive, and the recent Cardiff conference, which addressed issues of concern from the past and dealt with facing the decade of anniversaries and centenaries to which the noble Lord referred, this is an interesting concept which I am sure will be raised again and again. It would obviously help to engage a wider spectrum of the community in dealing with these problems. I have used his name already, but Richard Haass has, of course, the issue of the anniversaries that are coming up within his remit of reviewing of the past and how it should be dealt with. It will undoubtedly be something which is of interest to him in his work.

Lord Kilclooney: My Lords, the riots must of course be condemned without any reservation whatever. However, it is important to analyse their cause, is it not? Unless we understand the cause, we will never get the solution. Can the noble Baroness confirm that many Members of our House approached her last week to warn her that there could well be violence as a result of the determination made by the Northern Ireland Parades Commission? The violence was predictable and predicted. Can she confirm that the chief constable concluded that he could not police the decision of the Parades Commission: that the PSNI would be incapable of doing so? As a result, 16% of police officers on the streets of Northern Ireland are now from England, Wales and Scotland. That is the kind of situation that the Parades Commission has led us into in Northern Ireland. Would it not be better if we had a Parades Commission that had widespread consent in Northern Ireland and attracted support? At the moment, it does not. Would it not be better to have an independent chairman of the commission who is not tainted by party politics, has not been involved in an elected position against unionism but is totally impartial and independent?

Baroness Randerson: The noble Lord referred to an informal meeting held last week. It is indeed the case that the Parades Commission’s determination was discussed at that meeting and a number of views were put. I have to say to the noble Lord that the chief

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constable was confident that he could police the parades but felt that it was important to have additional support under the mutual aid scheme. It is indeed the purpose of that scheme that events such as this should be dealt with in that way. The noble Lord referred to the status of the Parades Commission. It is of course a lawfully constituted authority that is independent of government. Its determinations must be obeyed. It is not a devolved authority and was set up by an Act of Parliament. It is essential that its determinations are duly obeyed on all sides in Northern Ireland. It is important to note also that the decisions of the PSNI, the chief constable and the Parades Commission, and the way in which they acted, were based on the experience of previous years and the problems that had previously been experienced at this time of year.

Lord Dubs: My Lords, many of us will feel utterly dismayed, saddened and angry at the events in Belfast when, yet again, the PSNI bravely had to bear the burden of this violence unleashed at it. Does the Minister agree that one of the tragedies is that there seems to be very little political leadership for the loyalist community? There was such leadership at the time of the Good Friday agreement, and it gave the loyalist community a sense that they had a stake in what was happening. I ask the Minister and her colleague the Secretary of State to engage in discussions with the First Minister, the Deputy First Minister and David Ford to examine what the problems are in parts of Belfast where members of the loyalist community seem to have the sense that there is nothing for them in the peace process. They are then too easily persuaded that the only way out is violence against the police. Real problems need to be addressed in the loyalist community in terms of lack of jobs and hope for the future. Will the Minister and the Secretary of State take an initiative with the people in Northern Ireland to deal with that?

Baroness Randerson: The noble Lord makes some extremely important points, and there is the issue of there having been a process of change in loyalist politics and its leadership—but that is now devolved in large part, and the leadership in the Assembly has to develop from within and cannot be dictated from outside. I agree with the noble Lord about the significance of poverty among many in the loyalist communities in Belfast. It is therefore all the more important that Northern Ireland makes the most of the economic package which was agreed recently between my right honourable friend the Secretary of State and the Executive, the First Minister and the Deputy First Minister. That economic package had a specific purpose of reinvigorating the economy in the poorest parts of Belfast.

Baroness O'Loan: My Lords—

Lord Tebbit: My Lords—

Baroness Stowell of Beeston: Perhaps we can hear from my noble friend Lord Tebbit first.

Lord Tebbit: Is it not the case that violence begets violence? The Parades Commission gave in to the violence of the republican community against these

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parades. Now, of course, they are faced with the violence of the unionist community against the surrender to the republicans’ violence. How do you break out of that?

Baroness Randerson: The Parades Commission makes its decisions based on the evidence before it and according to the protocols it follows. As I have said, the Parades Commission is independent, it is at arm’s length from Government and it is the duly constituted authority undertaking an extraordinarily difficult, problematic task. It has to deal with that to the best of its understanding. I hope that noble Lords will accept that the work of the Parades Commission is very difficult indeed. I thank the noble Lord for his question.

Lord Rogan: My Lords, I, too, join in condemning the widespread violence, and in expressing my sympathy and support for the police officers of Northern Ireland. I should like to pay tribute to the valiant work of the Police Service of Northern Ireland over recent days and weeks. Its officers have shown their professionalism and personal courage in defending the rule of law and protecting society. I come from a police family. I have many relatives who served in the RUC. I personally served as a special constable for many years, and today, I have a son and daughter-in-law who stood on the streets of Belfast hour after hour over the past few days. So let us also recognise the support and the encouragement these officers receive from their families at home, wondering night by night in what condition their loved ones will return.

Since assuming office, the Secretary of State has been less than visible. The noble Lord, Lord Dubs, made a very interesting contribution. Can the Minister emphasise to the Secretary of State how crucial it is that she engage with, and be seen to engage with, the authorities in Northern Ireland to help alleviate the social, economic and cultural problems which contribute to the volatile situation in unionist working class areas?

Baroness Randerson: I thank the noble Lord for his moving tribute to the police. That tribute to their bravery, from first-hand experience, is very significant and says far more than anything that I could say standing here today.

The noble Lord referred to the significance of the leadership provided by the Secretary of State. It is important to remember that many of the levers that used to be within the hands of the Secretary of State no longer are, as policing and justice are devolved. However, the Secretary of State retains the ability to intervene if, following the determination of the Parades Commission, the chief constable of the PSNI had believed that he could not cope with the situation. However, he never felt that.

Perhaps I may make a very important point. The Secretary of State had the Justice Minister, the PSNI and the Parades Commission around the table for discussions prior to 12 July. Those were significant discussions and very important leadership was shown. The Secretary of State was there throughout the weekend and she is there on a very regular basis. There is no question of her lacking active engagement in this issue.

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Baroness O'Loan: My Lords, is the Minister aware of the widespread community support for the Parades Commission and of the fact that there are now very few contentious parades that remain to be resolved? The situation in respect of those contentious parades can be resolved only by discussion. Is she also aware of the extent of the work that was done, for example, in Derry to achieve the level of harmony which existed on 12 July this year?

Baroness Randerson: The noble Baroness makes a really important point—that is, to refer us to the past and indirectly to point out the terrible situation that existed prior to the existence of the Parades Commission. It is important to bear in mind that there are many hundreds—thousands—of parades at this time of year in Northern Ireland. The city of Derry/Londonderry, for example, has done a superb job in making sure that its parades are successful and enjoyable and that they do not cause trouble. I had an extremely interesting meeting with the mayor of Derry/Londonderry, in which he pointed out the very simple and straightforward ways in which the sting has been taken out of the situation in that important city. I absolutely agree with the noble Baroness when she says that the Parades Commission has widespread support. The vast majority of the public in Northern Ireland are not interested in a return to the problems of the past.

Lord Morgan: My Lords, Griffith observed that Irish history was trapped between the dead past and the prophetic future. Is this not a particularly tragic and all-too-familiar example of it? This is exploiting a battle that happened well over 300 years ago for sectarian provocative purposes. It seems to me that the problems lie far deeper than simply the social and economic circumstances of Northern Ireland. Could there not be a totally different way of celebrating the cultural and historic traditions of unionism? By definition, these events are going to be violent and produce casualties. We know that they are—it happens every year. They are as much a part of the calendar of our country as, let us say, Remembrance Sunday, and they have equally sad connotations. Is there not some peaceful historic or cultural way of celebrating unionism rather than these provocative battles? If not then frankly it is not worth celebrating.

Baroness Randerson: The noble Lord, coming from the same part of the world as I do, is well aware of the importance of history to us all. It is of course extremely sad when history becomes so embroiled in violence. I say to him that it is important that as the years go by the people of Northern Ireland are able to embrace the future, and to let go of the past while not ignoring or neglecting it. They should be able to celebrate it in a positive way. I point to the importance of the Derry/Londonderry City of Culture in that transition process, because it does not shy away from the traditions and problems of the past. It embraces them and makes them part of a cultural experience.

Lord Browne of Belmont: I join the Minister in condemning unreservedly the recent street violence in Belfast, and in paying tribute to the bravery and

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strength of the police men and women from all parts of the United Kingdom who formed the front line in protecting the rule of law. However, does the Minister agree with me that the remit of the proposed all-party talks, under the chairmanship of Richard Haass, should include consideration of a change in the law to make the default position an unrestricted right to parade peacefully anywhere in Northern Ireland, unfettered by the arbitrary edicts of an unelected quango? Surely this is the only acceptable legal model for the mature and tolerant society which we are all trying to create in Northern Ireland.

Baroness Randerson: I join the noble Lord in the hope that in future years it will be possible to hold parades that are entirely peaceful. Unfortunately, the events of this year have made his hopes even further off than they were before.

NHS: Keogh Review


3.46 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, with the leave of the House I shall now repeat a Statement made in another place earlier today by my right honourable friend the Secretary of State for Health on the Sir Bruce Keogh review. The Statement is as follows.

“Mr Speaker, I would like to make a Statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.

Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS, nor of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership and failed to prioritise compassionate care. The system’s reputation mattered more than individual patients; targets mattered more than people.

We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on. Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series of ‘deep-dive’ reviews into other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005 thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.

Worryingly, in half of those trusts, the CQC—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as ‘compliant’ with basic standards. Each of the trusts has seen substantial changes to its

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management since 2010, including a new chief executive or chair at nine of the 14. However, while some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I announce today necessary.

This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away rather than waiting until the report was finished. We will be publishing all those reports today, alongside unedited video footage of the review panel’s conclusions, all of which I am placing in the Library. I shall also today set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.

Sir Bruce judged that none of the 14 hospitals is providing consistently high-quality care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation; failure to act on data or information that showed cause for concern; the absence of a culture of openness; a lack of willingness to learn from mistakes; a lack of ambition; and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams. So today I can announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new Chief Inspector of Hospitals, Professor Sir Mike Richards, who starts work today.

The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of ‘accepting sub-optimal care’; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were immediately closed; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where there were both male and female patients present.

The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 ‘never events’ in just three years, and the panel had serious concerns about the way ‘Do not attempt resuscitation’ forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire NHS Trust, where the panel highlighted issues of poor governance, inadequate

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staffing levels and high mortality rates at weekends. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.

The list continues: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven ‘never events’ in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too many unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long A&E waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.

For these 11 trusts, special measures will mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will be partnered with high-performing NHS organisations to provide mentorship and guidance in improving the quality and safety of care.

Three of the 14 hospitals are not going into special measures. They are Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and Blackpool Teaching Hospitals NHS Foundation Trust. While there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.

This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress that this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate this in government time.

The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this—and we should remember that there continues to be much good care, even in the hospitals reviewed today. Just as we cannot tolerate

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mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for government Ministers to put pressure on the NHS to suppress bad news, because in doing so, they make it less likely that poor care will be tackled.

We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the Chief Inspector of Hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.

Hand in hand with greater accountability will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary managers such as David Dalton in Salford Royal and Dame Julie Moore of University Hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.

At all times the Government will stand up for hard-working NHS staff and patients, who know poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this Statement to the House”.

My Lords, that concludes the Statement.

3.57 pm

Lord Hunt of Kings Heath: My Lords, before responding, I declare an interest as president-elect of GS1, chair of an NHS trust and a consultant trainer with Cumberlege Connections. First, I thank Sir Bruce Keogh and his team for this important review. I know Sir Bruce and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, the Opposition accept the findings of this report in full.

At Health Questions earlier today in the other place, the Health Secretary claimed that this was a historical report, going back to 2005. However, it is not. These trusts were identified on the basis of mortality data for 2011 and 2012—this report is about this Government’s failings, happening on this Government’s watch. Anyone who supports the NHS must always be prepared to shine a spotlight on its failings so that it can face up to them and improve. However, in doing so, we must be fair to staff and to the NHS as a whole. In his report, Sir Bruce puts the failings at the 14 trusts in their proper context, by concluding that,

“mortality in all NHS hospitals has been falling over the last decade … by about 30%”.

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He rightly reminds us of decades of neglect in the NHS in the 1980s and 1990s, when the noble Earl’s Government were in charge. Of the challenge facing the previous Government in their early days, he says:

“The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment”.

The noble Earl spoke about targets. The disgraceful record of his Government, with a target that they had in the patient’s charter of a maximum 18 months’ wait for treatment as an in-patient, was brought down by the targets that he decries to a maximum of 18 weeks. That is why we had targets.

In fact, the balanced picture in this report bears no resemblance to the Government’s leaking of the report over the weekend but it exposes one of the most cynical spin operations ever seen in this country. Nowhere in this report does a claim of 13,000 avoidable deaths appear. Indeed, Sir Bruce is absolutely clear. He says:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”.

Yet that is precisely what this Government chose to do in advance of this report.

In the past few minutes, details have emerged of an e-mail that Sir Bruce Keogh has sent. He is clearly very angry about the report’s leak by the Government to the press, and specifically about the 13,000 lives allegedly lost. The noble Earl talked about accountability, so will his Secretary of State be accountable for the disgraceful actions that occurred over the weekend in his department? Will the Secretary of State consider his position? He should certainly do so.

On mortality rates, does the noble Earl recognise that Robert Francis himself said that,

“it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care”?

Does he also accept the comment of the Liberal Democrat MP Andrew George that the leaks by the Tories on the Keogh report were obviously designed to mislead the media?

The result has been that these unfounded claims, spun out by the Government, will have alarmed people in the 14 areas affected. They have questioned the integrity of the staff working in those hospitals in difficult circumstances, all for their own self-serving political ends. This is unworthy of any responsible Government. On reading this review, the diversionary spin now makes sense as it is clear that those 14 hospitals have all shown signs of deterioration on this Government’s watch.

The noble Earl suggested that pressure had been put on the regulator to tone down criticisms. Does he accept the word of the noble Baroness, Lady Young, the former chair of CQC? She has written that CQC was not pressured by the previous Government to tone down its regulatory judgments or to hide quality failures.

Let me turn to staffing. One of the report’s central findings is that staffing is a major concern in all these trusts. The review states that,

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“when the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas”.

The review team has already had to intervene in three areas on staffing to protect patient safety. Five of those trusts had warnings left in place by the previous Government. Does the noble Earl accept that it is shocking that they have been allowed to cut front-line staff to unsafe levels on his watch? The great sadness is that it appears that Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified dangerous cuts to front-line staff as a primary cause of care failure.

Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Can the noble Earl ignore this authoritative call any longer? What action is he going to take to ensure safe staffing levels in these 14 trusts and across the NHS? We accept that the loss of more than 4,000 nurses during the lifetime of this Government has now been laid bare as a monumental error. Will he intervene to stop those job cuts? Will he apologise for the fact that seven out of the 14 trusts investigated by Keogh have cut more than 1,000 nursing jobs since the election?

The noble Earl tells us that of the 11 trusts going into special measures, each hospital will be partnered with high-performing NHS organisations to provide mentorship and guidance in improving the quality and safety of care. That is to be welcomed but can he guarantee that this will not be deemed to be collusive action by the competition authorities?

I turn now to A&E performance, which is the barometer of the health service and the wider indicator of problems across the health and social care system. The report highlights major failings in A&E at many of the trusts. Of course, we know we have come through just about the worst winter we have had for a decade. At the end of last year, all 14 were in breach of the Government’s A&E target. Sir Bruce is clear that urgent action is needed to improve A&E, saying:

“We have established that one of the primary causes of high mortality in these 14 hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients … all trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellations of operations due to bed shortages and difficulty meeting waiting time targets”.

Will the Government take immediate steps to work with the whole health economy to bring the 14 back up to national standards?

Even given the appalling way the Government have handled the Francis review, people will want solutions rather than politics so surely the right response is to accept the Francis recommendations in full, including the one on staffing levels. I can assure the noble Earl that if he were to do so the Opposition would work with him to ensure their swift passage through Parliament.

In conclusion, it is a sad fact that mistakes will be made in any walk of life, even in the National Health Service. The only real answer to all of these problems is for both sides of the House to recommit to full openness and transparency in the National Health Service. People who have been let down deserve nothing less.

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4.07 pm

Earl Howe: My Lords, I am disappointed that the noble Lord should have chosen to turn this occasion into a rather poorly directed political tirade. I can assure him that I am perfectly capable of trading party political debating points with him; I have a great deal of material in my brief which I will not hesitate to use if he pushes me. However, I choose not to because I think this is an occasion for reflecting in a mature and considered way, as befits this House, on a very important report. Therefore I begin with a welcome—I am glad that the noble Lord and his party accept the veracity of the report. It is a fine piece of work. It was done very thoroughly and very rapidly and we are grateful to Sir Bruce.

The noble Lord said a lot about mortality data with which I agree. At a national level, mortality has improved; however, the 14 trusts selected for these deep-dives had long-standing performance issues on mortality rates, some going back to 2005 or even earlier. Therefore, it is only partially true to say that this is a problem that happened on our watch. We want to make sure that we are lifting the lid on any failures of care that need to be tackled and we are not afraid of doing that. Again, the noble Lord was right to say that while higher mortality rates do not always point to deaths that could have been avoided, they indicate that there could be issues with the quality of care. That is why we decided to ask Sir Bruce Keogh to carry out these inspections and to give us his findings.

The rationale for the review was that the 14 trusts were outliers for at least two consecutive years on one or other measure of mortality. I agree with the noble Lord that it is pointless to bandy figures around, and I am not going to do that. He rightly quoted Bruce Keogh saying that it is clinically meaningless and academically reckless to use mortality formulae to quantify actual numbers of avoidable deaths. That reflects Robert Francis’s view, but we now have clear evidence that those mortality data were indicative of more deep-seated problems. That has been the value of this exercise, I suggest. I cannot comment on the letter written by the noble Baroness, Lady Young; I have not seen it. However I am sure the House will agree that the report by Sir Bruce has challenged us all to look again at why poor care persists in some hospitals.

As regards staffing levels, the number of front-line staff has gone up since May 2010. There are 6,000 more doctors and 1,000 more midwives, for example. On staffing, one can be too simplistic. It is not simply about the crude numbers. It is not simply about nurses. The number of staff on the wards will vary according to skill mix, clinical practice and local factors. It is right that nurse leaders have the freedom to agree their own staff profiles. That gives flexibility to respond dynamically to changes in patient demand and workforce supply. I do not in the least dismiss the potential concern that staff may in some instances have been stretched, but I do not think we can make generalisations of the kind that the noble Lord was suggesting that we did.

On A&E, as the noble Lord knows, urgent care boards have been working flat out since May with local A&E departments to develop individual plans in

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order to improve A&E performance in all areas where targets have not been met, and that includes the 14 trusts considered by the Keogh review. However, this is not only about A&E; it is about how the NHS works as a whole, how it works with other areas, such as social care, and how it deals with an ageing population and more people with long-term conditions. Dealing with these pressures means looking at the underlying causes. That is why, together with NHS England, we are putting together a strategy that focuses on the people who are the heaviest users of the NHS: vulnerable older people and those with multiple long-term conditions.

There is no doubt that people are right to focus on the funding of social care. That is exactly why we in the Department of Health have allocated significant additional funding to local authorities, including a transfer from the NHS that is worth £1.1 billion a year by 2014-15. We have also announced as part of the spending round that has just concluded a local integration fund of £3.8 billion across health and social care in 2015-16. Pooling budgets in that way will help drive down the costs to the acute sector by tackling the acute and expensive pressure points in the system, such as A&E, by improving prevention, reducing unplanned hospital admissions and allowing people to stay in their own homes and live independently.

I agree with the noble Lord that many of the messages in Sir Bruce’s report—in fact, all of them—are urgent. As he knows, in the Care Bill, we are looking at the whole question of openness and candour in a number of respects. Although the duty of candour is not one that we plan to build into the Care Bill, it is very relevant to it. It will be introduced by secondary legislation. The key challenge is a change in behaviour rather than the law. That is why the legislative changes arising out of Francis are targeted and carefully designed to support a culture of openness.

I hope that I have answered most of the noble Lord’s questions; those that I have not answered, I will write to him about.

4.15 pm

Lord Warner: My Lords, I want to ask the Minister about the Government’s future intent. Are he and his colleagues now satisfied that Sir Bruce has found an indicator or indicators which require constant attention, year on year? Can we expect to see, either by Sir Bruce or by the new Chief Inspector of Hospitals, an annual look at the outliers on mortality rates and a regular report to Parliament about the findings of the exercise? Is this going to be institutionalised as part of the performance management of the NHS?

Earl Howe: We will see the Chief Inspector of Hospitals picking up the baton, as it were, from Sir Bruce Keogh, whose way of working in this exercise has been very instructive. His judgments were based on talking, not just to a few people in the trust, but to patients, a wide range of staff and, in some instances, people outside the trust. I am sure that Sir Mike Richards, the new chief inspector, will want to learn from that. It will be up to the CQC to decide whether this will be institutionalised. Its methodology is evolving. The hospital aggregate rating system will have a role to

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play in systematising the evaluation of performance and in any future instances of very poor care we will no doubt see a level of transparency from the CQC which we have, perhaps, not had before. However, I would not want to commit the CQC to reporting annually to Parliament in a particular way. It will report annually to Parliament but it is largely up to it how it does it.

Baroness Jolly: My Lords, we welcome the drive to improve quality in these trusts and across the NHS, based on the eight ambitions for improvement held in the report. In the Statement read by the Minister, the Secretary of State said:

“In some cases, trust boards were shockingly unaware of problems discovered by the review teams”.

Surely the boards were in receipt of data on quality. If not, why not? If so, why was action not taken? What attention is being paid to issues of trust board governance and its support and development?

Earl Howe: We will now see follow-up action by the CQC, not least in the area of trust governance where the quality of that governance has been called into question by Sir Bruce. That will be done rapidly. It is by no means the case that governance is defective in every trust, but question marks have been placed on some and it is important that assessments are made, not just by the CQC, but by the Trust Development Authority and Monitor as the two bodies responsible for overseeing the provider section. It may be that the CQC will be asked to carry out further work, but we are looking, for the time being, to the TDA and Monitor to do that.

Baroness Emerton: My Lords, how did Bruce Keogh’s team determine whether staffing levels were short, inadequate or low, as was mentioned in the Statement, when we have not actually got a base against which to measure staffing levels? We raised this all the way through the passage of the Health and Social Care Bill and we have been raising it during the passage of the Care Bill. What was the evidence for low staffing?

Earl Howe: I know that this is a concern of the noble Baroness and I understand that. She will know that work is going on to try to frame better rules of thumb and guidance on staffing numbers. When Sir Bruce looked at this area he had very closely in mind the precept that Robert Francis gave in his report when he said:

“To lay down in a regulation, ‘Thou shalt have N number of nurses per patient’ is not the answer. The answer is, ‘How many patients do I need today in this ward to treat these patients?’ You need to start, frankly, from the patient, as you do with everything”.

That was the basis of Sir Bruce’s assessment on that issue.

Baroness Armstrong of Hill Top: My Lords, will the Minister acknowledge that Sir Bruce Keogh made it absolutely clear that over the past decade there has been significant improvement in mortality rates across the National Health Service? He said that, because of the increasing complexity of the patient, that improvement

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is probably greater than the 30% that is measurable. Will he therefore congratulate those hospitals—the vast majority—that have led the improvement? At the same time, of course, we must tackle poor performance and make it clear that that is unacceptable. However, in doing so we have also to acknowledge the significant improvement that has happened over the past decade.

Earl Howe: I applaud that and we should all celebrate the success of outstanding hospitals—there are many in the health service—which have led the way in improving mortality rates over the past few years. The noble Baroness is quite right. Indeed, Sir Bruce suggests that those hospitals should now be asked to partner with some of the hospitals that are struggling in certain respects to show the way, whether that is on governance, on systems in A&E, on quality of surgical outcomes or whatever it happens to be. That is an appropriate idea, and we should undoubtedly ensure that it is taken forward. However, as the Statement itself reflects, the 14 hospitals that are under the microscope at the moment are not representative of the quality of care that the NHS delivers day in and day out, which is of a very high standard by any benchmark.

Lord Cormack: My Lords, I accept what my noble friend has just said, but he will understand that there will be concern throughout the country at this very disturbing indictment—because that is what the report is. Will he talk to the new chief inspector to consider whether we can have a form of assessment of hospitals—the noble Lord, Lord Warner, effectively referred to this—so that patients throughout the country know whether their local hospital is graded as being excellent or not? Will he also ensure that there is a debate on the Floor of this House, as there will be on the Floor of the other House?

Earl Howe: I can certainly use my best endeavours through the usual channels with regard to my noble friend’s latter question. On his first point, he is absolutely right. That is what led us to believe that aggregate hospital ratings, provided that they are produced in a sophisticated and careful way, will be very informative to the general public and to patients in a local area, and to professional staff within the health service. The Healthcare Commission, of old, used to produce aggregate ratings. They fell into disuse and, I have to say, into some disrepute, because they were so broad brush as to be meaningless. When we asked the Nuffield Trust to look at this area, it told us very clearly that, as long as we adopted a nuanced and sophisticated approach so that what was assessed was not just a hospital trust or an individual hospital within that trust but rather the performance of individual medical teams and units within a hospital, we would provide useful information to the public. However, that information needs to be accessible.

Baroness Masham of Ilton: If the chief inspector, when visiting failing hospitals, finds a lack of senior sisters on the wards and a shortage of doctors working in emergency medicine, what is he going to do about it? Does the Minister realise that there is a serious shortage of emergency medicine doctors?

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Earl Howe: The noble Baroness is right. There is a serious shortage in certain specialties, and emergency medicine is one of them. Work is currently going on in Health Education England to ensure that we boost the numbers in that specialty. As for what the CQC can do, there are a range of actions available to the chief inspector. In most such instances he would draw the attention of the chief executive and the hospital board to whatever problem he had found, and it would then be incumbent on the trust to put its own house in order within a reasonable space of time. That would be the norm. We should not forget that commissioners of care, too, will be encouraged to join in that conversation, to ensure that providers are properly held to account through the NHS contract. There are a range of actions that could be appropriate, and only in the most extreme cases will warning letters have to be issued or more drastic action taken.

Baroness Smith of Basildon: Despite the rather alarmist —and, as it turns out, inaccurate—briefing over the weekend, this is, as we have heard, not a historical report; it is about what is happening here and now in 14 hospitals in the NHS. I was sorry that the Minister skirted round the problems of staffing in the NHS. My local hospital, in Basildon and Thurrock University Hospitals NHS Foundation Trust, is named in the report as one of the 14 hospitals. Yet since the general election it has lost 345 nursing staff. The report found,

“inadequate numbers of nursing staff … compounded by an over-reliance on unregistered support staff and temporary staff”.

The noble Earl himself referred to this when repeating Jeremy Hunt’s Statement. May I tell him that that hospital is now recruiting 200 staff this week? That is welcome, but it can be no coincidence that, after the report, it is recruiting the staff that it needs. Does he now really believe that the £3 billion spent on reorganising the NHS was the best value for money, when staffing levels are so low?

Earl Howe: It was not £3 billion that was spent on reorganising the health service. As the noble Baroness knows, it was probably less than half that figure. The important point is that the saving in this Parliament will be at least £5.5 billion, with a £1.5 billion saving every year thereafter. I therefore suggest to her that it is meaningless to bandy that figure around. I am very glad that Basildon hospital is taking the action that it is. It has recently undergone significant leadership changes. A transformation programme is under way, and that is part of it.

Lord Elystan-Morgan: The Statement repeated by the noble Earl makes the point that the story does not end with the 14 failed trusts. Does he agree that there is clear evidence of the acceptance of standards that are not worthy of our community or of the National Health Service, and that, very probably, such a situation is not unassociated with the lack of a hierarchy of discipline in nursing? Will the Government therefore give an undertaking that, by way of an agonising reappraisal of the situation, they will concentrate on establishing whether the institution of the hospital matron could be considered again, as a post that was effective and seemed to operate well? Many people the

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length and breadth of this land believe that to some extent we should revert to that system, rather than worshipping at the altars of accountancy and management.

Earl Howe: The noble Lord makes an extremely important point. Those hospitals that I have visited where the standard of care is manifestly excellent have all had nurse leaders at board level whose responsibility it is to make the quality of nursing care absolutely centre stage at every board meeting and to transmit to every nurse in that hospital what good quality care looks like. Whether we call that person a matron or not is perhaps a matter that we can discuss at leisure—but the point that the noble Lord makes is extremely valid.

Lord Black of Brentwood: My Lords, I agree with my noble friend very strongly that failure should never be a consequence-free zone. But would he agree that, for far too long, the bitter truth is that it was a consequence-free zone? My late mother was treated in the Basildon and Thurrock University Hospitals NHS Foundation Trust in 2008 and 2009, on two occasions. On the first occasion, she sustained an injury after being left on the toilet for 40 minutes, from which she never recovered. On the second occasion, having been admitted suffering from a heart attack, she was shifted between wards three times in 24 hours. I wrote to the chief executive and he wrote back to me with 11 separate apologies. I wrote back to him saying that apologies were no good unless something happened.

I agree with the noble Baroness, Lady Jolly, that boards must have responsibility. Would my noble friend agree that they must have responsibility for scrutinising data and, above all, looking at complaints, otherwise nothing will ever change?

Earl Howe: My Lords, the historical culture of that particular trust has been focused on financial targets, and the tone from the top now needs to focus on improving quality and long-term sustainability. There is a string of issues identified in Sir Bruce’s review, all of them urgent. The good news is that I know that the current management is addressing those issues. I am naturally sorry to hear of the personal experiences of my noble friend’s family.

Baroness Jay of Paddington: My Lords, I wonder whether I can assist the noble Earl, and indeed the House, by quoting directly from the letter from the noble Baroness, Lady Young of Old Scone. The noble Earl referred to it earlier and said that he was not aware of the details. This is a letter to the Prime Minister from the noble Baroness, dated yesterday, in which she says that he has been “misled” in the response that he gave in Prime Minister’s Questions. She says that the CQC, of which she is a former chair,

“was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures”.

She goes on to say:

“So I am afraid neither my evidence to the Francis Inquiry nor my current recollection … can be interpreted to support the view that, in the words of your answer at PMQs ‘there was a culture under the previous Government of not revealing problems in the NHS’”.

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She finishes the letter by asking:

“How can this misapprehension best be corrected for the record?”.

Perhaps the noble Earl can suggest that.

Earl Howe: I am rather sorry that the noble Baroness should have raised that, as I was rather keen to protect the noble Baroness, Lady Young, from any embarrassment, because I think that the whole House respects her. All I can say is that the substance of the letter to which the noble Baroness refers is diametrically opposite in content to the evidence that the noble Baroness, Lady Young, gave to the Mid Staffs public inquiry.

Lord Cotter: In the report there are, quite rightly, robust words about poor management. However, I refer the Minister to a point that I and others have raised in the past. There is a great concern in the health service about untrained, or poorly trained, healthcare assistants. Nurses have said to me that they are held responsible for the work done, often by untrained or inadequately trained people. I have raised this before. Can I ask the Minister to look at it again as a very serious issue?

Earl Howe: We are indeed looking at it very urgently at the moment in the light of the review published a few days ago by Camilla Cavendish, which focuses on exactly that issue.

Lord Sutherland of Houndwood: My Lords, one thing that is very positive in the Minister’s Statement, and in the way in which he responds to questions, is that he clearly understands that this is a multifaceted problem and that there is no single way in which to deal with the whole set of issues. That being said, there is, of course, a “but”. The “but” is that one element of the government response—already referred to at least twice—is the role of the future Chief Inspector of Hospitals. The view taken, and reiterated again today, is that the inspector should be within the umbrella of the CQC. For some of us, at the moment, the CQC is part of the problem. It has not solved all our problems. I share the hopes of the Government that the CQC will remove itself from its current difficulties. However, in the mean time at least—or, in my view, in the longer term—a chief inspector should have both the responsibility and the authority of reporting directly to Parliament, as does the Chief Inspector of Schools. That would be a helpful element of transparency.

Earl Howe: I would have agreed with the noble Lord had he made those comments 18 months or two years ago. However, the CQC has turned a very important corner. It has new leadership and has articulated new ways of working. The leadership of the CQC commands high levels of confidence in every quarter of Parliament. I am encouraged by that. However, the point that the noble Lord makes about transparency is vital. The CQC is very clear that it is not its function to gloss over poor care when it is found, nor indeed to fail to celebrate good care when that is found.

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Arrangement of Business


4.36 pm

Baroness Anelay of St Johns: My Lords, before my noble friend Lord Howe begs to move that the House resolves itself into a Committee on the Care Bill again today, I will say a brief word about progress on the Bill.

I hope that it might help the House if I indicate that the usual channels have agreed that the Committee stage of the Bill will definitely complete before we rise for the Summer Recess on 30 July. The usual channels have further agreed that in order to facilitate that result, the Committee should continue to sit on each of our three remaining days until we have reached the advertised target. The usual channels are confident that, with the help of all involved, it need not take us beyond 10 pm on any night, although of course both sides of the House are willing to sit later if that is what it takes to conclude the Committee stage before the recess.

I draw the attention of the House to the fact that today’s target is slightly more modest than would have been expected, going by the calendar. Today’s target is the group beginning with Amendment 92ZZV. That is a little less than would have appeared from last week’s calendar. I give the House an assurance that we will still reach the target next Monday, as advertised in the calendar. There are a lot of Zs and Vs in this, but it means that noble Lords taking part in debates on this Bill can have certainty about the business on Monday 22 July and Monday 29 July, as well as having the certainty that tonight we will rise after we have considered government Amendment 92ZZAA. That means that next Monday, we will begin with some amendments on portability from the noble Baroness, Lady Campbell of Surbiton.

Care Bill [HL]

Care Bill [HL]1st Report from the Delegated Powers Committee

Committee (6th Day)

4.38 pm

Relevant document: 1st Report from the Delegated Powers Committee.

Clause 12 : Assessments under sections 9 and 10: further provision

Amendment 88M

Moved by Lord Low of Dalston

88M: Clause 12, page 10, line 38, leave out from “which” to end of line 40 and insert “a person with expertise in a specified matter must carry out the assessment on behalf of the authority”

Lord Low of Dalston: My Lords, in moving Amendment 88M, I will speak also to Amendment 92ZZN, both of which are in my name. These amendments would ensure that regulations specify in what circumstances a specially trained person must carry out an assessment or reassessment. A number of groups of disabled people may need a specialist assessment. For a deafblind person,

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for example, the ability to access a specialist assessment carried out by someone who understands the impact of deafblindness is a critical first step in the process of getting adequate and appropriate care and support. Assessors who do not have these specialist skills—for example, a generic assessor who assesses older people or a single sensory assessor who knows about visual impairment but not about deafness and blindness and how they interact—often offer deafblind people inappropriate mainstream or single-sensory services which are inaccessible and do not meet their needs.

Similarly, community care assessors can easily misunderstand the needs of someone on the autistic spectrum if they do not have experience and knowledge of how to communicate with someone with autism, or of the impact of the condition of autism on someone’s day-to-day life. People with autism can lack insight into their own condition and may struggle to define their needs. For example, if a person with autism is asked, “Are you able to wash yourself on your own?” they may reply, “Yes”, but omit to mention that this is with verbal prompting at every stage. I hesitate to venture on to this ground with the noble Baroness, Lady Browning, in the Chamber. Perhaps she will intervene in the debate later to supplement or, indeed, possibly correct what I am saying. However, what I have said so far is a fair reflection of the situation as it has been explained to me.

In addition, some people with autism may be non-verbal or have limited capacity to communicate or take part in the process unless substantial adjustments are made. People with profound and multiple learning difficulties and people who display challenging behaviour are two further groups where it is vital that they have a specialist assessment undertaken by an expert. People with PMLD do not use formal communication such as words, signs or symbols and may rely on others to speak up for their needs. Staff carrying out the assessments will need to have skills to ensure that people with PMLD can be meaningfully involved in the assessment process and have the opportunity to influence decisions made about their lives. It is also important that people with PMLD have advocates who are trained in non-instructed advocacy techniques.

Councils in England and Wales have to follow statutory guidance on how to provide care services for deafblind people. This guidance, Social Care for DeafblindChildren and Adults, requires local authorities, when assessing the needs of a deafblind person, to ensure that an assessment is,

“carried out by a specifically trained person or team, equipped to assess the needs of a deafblind person—in particular to assess their need for one-to-one human contact, assistive technology and rehabilitation”.

In the five years following the introduction of the Social Care for DeafblindChildren and Adults guidance in 2001, we saw the number of deafblind people provided with appropriate specialist support increase by 60%, which says a lot about the importance and value of specialist assessments of the kind I am talking about. The RNIB has obtained figures from the National Adult Social Care Intelligence Service showing that the numbers of blind and partially sighted people in receipt of local authority-funded care and support dropped by 35% between 2005-06 and 2011-12. This

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compared with a drop of only 16% for all adults with care needs. This is worrying and could indicate that generic needs assessments inadequately capture the needs of blind and partially sighted people and reduce their chances of being judged eligible for social care.

4.45 pm

Following the passing of the Autism Act 2009, councils in England have had to follow statutory guidance —known as Implementing Fulfilling and Rewarding Lives—on improving support for adults with autism. The guidance is clear that councils should develop specialist training for community care assessors. It recommends that,

“as far as possible, assessment of needs be carried out by a professional who has a good knowledge of autism and reasonable adjustments made to the assessment process to enable the adult with autism to take part fully”.

However, research carried out by the National Autistic Society found that only just over half of English local authorities had training available for their staff.

Where assessors are not trained to assess people with PMLD, or people with challenging behaviour, they will not get a full grasp of the complex needs that the individual has and understand what needs to be put in place to meet those needs. This will place the subsequent package of care at higher risk of failing or being inappropriate. This was the case for many of the individuals who ended up in assessment and treatment centres like Winterbourne View. They did not get the right support that they needed to live in the community.

The Law Commission in its report on adult social care recognised the importance of specialist assessments, particularly for deafblind people, stating that,

“in some cases, a specialist assessment should always be required and indeed this is acknowledged in statutory guidance. At a minimum, we suggest that the existing requirement in statutory guidance for a specialist assessment for deafblind people should be elevated to the regulations”.

The Care and Support Alliance was pleased when the draft Care and Support Bill included in Clause 12, which set out matters to be covered in regulations, paragraph (c), which reflected the Law Commission’s recommendation to,

“specify circumstances in which a person with expertise in a specified matter must carry out the assessment on behalf of the authority”.

The draft Care and Support Bill also included a similar paragraph relating to reassessments. Unfortunately, the relevant paragraph—paragraph (f)—in Clause 12 in the current Bill has been changed so that the obligation is to,

“specify circumstances in which the local authority must, before carrying out the assessment or when doing so, consult a person who has expertise in a specified matter”.

Furthermore, the reassessment paragraph has not been included at all. The CSA is very concerned that this will lead to many disabled people being assessed by someone without specific training in their disability. This would be a retrograde step. Consulting someone with the relevant expertise is not enough; the assessment should be carried out by such a person. These amendments would reintroduce the wording from the draft Bill into Clauses 12 and 27 to provide the necessary strengthening. I beg to move.

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Lord Touhig: My Lords, I support Amendments 88M and 92ZZM in the name of the noble Lord, Lord Low of Dalston, and myself. Assessments must be carried out by assessors with the necessary training and expertise to understand the needs they are assessing. This point has been made time and again in this Chamber. The noble Lord, Lord Low, also referred to the Autism Act. The Department of Health has provided clear direction that autism training is essential for community assessors to ensure that the needs of adults with autism are fairly assessed. Here I declare an interest as a vice-president of the National Autistic Society. The noble Lord, Lord Low, also told us of the too few local authorities that have awareness training in place— 70 out of 152 local authorities have still not got a proper awareness training in place as part of their equality and diversity training.

Crucially, a National Autistic Society survey found that one in three social workers did not have a good understanding of autism. This is, in part, because adults with high-functioning autism or Asperger’s syndrome can have less obvious, hidden needs that can be hard to pick up in any assessment. That is why the assessor must have the necessary training and expertise. Failure to assess needs can mean that autistic people and others with disabilities are denied the support they need to live independently. As we all know, this makes it much more likely that in later life they will have a significantly greater need for support.

We are simply asking in these amendments to ensure that the needs of people with autism and other conditions are expertly and properly assessed. In that way, one can ensure that people will have a good quality of life—the sort that we in this Chamber take for granted. We are not asking for much and I hope that the Minister will agree with that.

Baroness Wilkins: My Lords, I strongly support this group of amendments. The consolidation of the care and support legislation into one Bill is very welcome but not if it lessens existing essential provision. As both noble Lords have clearly described, the initial assessment of someone’s needs is critical and must be carried out by someone who is appropriately qualified and understands the impact of the impairment and the types of support that are needed. As we have heard, the Bill does not provide the same requirement as the current statutory guidance. I therefore hope that the noble Earl will recognise the critical importance of specialist assessment for people in these groups and allay the concerns of organisations such as Sense and the RNIB.

Baroness Wheeler: My Lords, I do not have a great deal further to add on this issue, given that we fully supported this approach in the earlier debate on our amendment. The noble Lord, Lord Low, and my noble friend Lord Touhig have made their case powerfully for the need for specialist expertise in assessing people with complex care and support needs—for example, deafblind people, people with autism and those with profound and multiple learning difficulties.

As the noble Lord, Lord Low, pointed out, the draft Bill originally provided for the regulations to specify the circumstances in which a person with expertise in a specialised matter must carry out the assessment

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on behalf of the authority. However, this was altered in the published Bill, with the only requirement being consultation with a specialist. Noble Lords are right to consider this to be a retrograde step and I look forward to the explanation from the Minister on this and an undertaking to reinstate in Clauses 12 and 27 the current approach, as the amendments propose.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, I thank the noble Lords, Lord Low and Lord Touhig, for bringing forward these amendments. I say straight away that I fully support the intention of Amendment 88M, which is to ensure that local authorities engage a suitable expert when carrying out complex assessments. The assessment will remain an integral part of the process of determining a person’s care and support needs and whether these meet the national eligibility criteria. To ensure that this is done correctly, it is essential that the person carrying out the assessment has the right knowledge, skills and competence. We heard from users of care and support during the engagement on the draft Bill about the importance of the assessor having knowledge of the condition that the person may have, whether they are, for example, a frail older person, a person with mental health problems or a person with autism.

Care managers and social workers are trained to carry out assessments. Their skills and experience will allow them to assess people with various conditions such as physical disability. There are, however, certain complex conditions where these skills are not sufficient to allow assessments to be carried out effectively. I am particularly thinking about a person who is deafblind—the example, given by the noble Lord, Lord Low. In those circumstances, most care managers would find it very difficult, if not impossible, to communicate with the person. It takes someone with expertise to carry out an assessment properly and identify the person’s needs and the outcomes they wish to achieve.

I agree with the noble Lords that, in such circumstances, the local authority must engage a person with the relevant expertise to carry out the assessment. That continues to be our policy. I also accept that if the adult’s condition is so complex at the assessment stage as to require the services of an expert in the field to provide advice, then it makes perfect sense for this to be repeated when the plan is to be reviewed. I should like to reassure the Committee that the Bill already has provisions in place to allow this joined-up approach to occur if an adult’s circumstances have changed in a way that affects the care plan. Clause 27(4) states that the local authority must, to the extent it considers appropriate, carry out a fresh needs assessment. In doing so, it would have to follow the requirements of regulations to consult a person with expertise. I hope I have reassured noble Lords of our agreement to the principles that they raise. In the light of what they have said in support of the amendment, I will look again at Clause 12 to ensure that we are giving ourselves the relevant powers to achieve our aims. I hope that the noble Lord, Lord Low, will find that undertaking welcome.

Baroness Barker: In Clause 27 it appears that it is only the local authority that has the power to ask for there to be a reassessment, not the individual. Is there

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a provision somewhere in the Bill that enables an individual to trigger a reassessment, or does that power lie with the local authority alone? If the Minister does not have an answer to hand, perhaps he might write to me.

Earl Howe: I shall do my best to answer my noble friend in a moment or two, but I am aware that I did not answer a specific question raised by the noble Lord, Lord Low, as to why we changed the wording in Clause 12(1)(c) of the draft Bill. We widened the scope of the powers following consultation—for example, to add a power to specify when an expert must be consulted —and in widening the powers the wording was slightly amended. We are happy to look at this again in order to make sure that it continues to meet the policy intention. In answer to my noble friend Lady Barker, I would refer her to Clause 27(1)(b), which refers to the right of an individual to request a review.

Lord Low of Dalston: My Lords, I am grateful to all those who have spoken in support of these amendments. I am also grateful to the noble Earl for his response. I thought we were going to be in the position where we had to say that we welcomed his support for our principle but we were disappointed that he was not willing to review the legislation to make sure that it put the principle into effect on the same basis as our amendment seeks to achieve. However, lo and behold, the noble Earl, not uncharacteristically, has come more than half way to meet us by saying that he is willing to look at the Bill again just to make sure that the policy intent, which he shares with us, is carried into effect. I welcome that very much. If it would assist the achievement of a consensus on this for us to meet, I would welcome that. I am very conscious of the calls on the Minister’s time as a Bill such as this goes through the House, so it may be that a meeting with officials would suffice. If further dialogue with the department would help to establish that we were fully on the same page on all this, I would welcome that very much. However, for now, with the very full assurances that the Minister has given us, I beg leave to withdraw the amendment.

Amendment 88M withdrawn.

Amendment 88N not moved.

Clause 12 agreed.

Clause 13 : The eligibility criteria

Amendments 88P to 88PC not moved.

5 pm

Amendment 88Q

Moved by Baroness Grey-Thompson

88Q: Clause 13, page 12, line 17, leave out subsection (7) and insert—

“(7) Needs meet the eligibility criteria when—

(a) there is, or will be, an inability to carry out several personal care or domestic routines, and/or

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(b) the individual will be unable to maintain control over several aspects of their day-to-day life, or

(c) involvement in several aspects of work, education, training or recreation cannot or will not be sustained, and/or

(d) several domestic, family and personal relationships cannot or will not be sustained, and/or

(e) there is a risk of abuse or neglect; they form part of a combination of needs described in paragraph (a).”

Baroness Grey-Thompson: My Lords, Amendment 88Q relates to the eligibility for social care. This is a probing amendment in order for the Committee to debate the most critical area of social care reform for working-age disabled people—that is, whether they are eligible to receive the care and support that they need to lead independent lives.

The Government’s regulations have now confirmed that the Care Bill will be nothing more than an unachievable aspiration for more than 100,000 working-age disabled people and more than 150,000 older people who have significant care needs but will not be eligible for support. It is not my intention to debate the nuances of the regulations that have been published in draft, and the Minister would, rightly, tell me that this is not the time or the place to do so. However, it is my intention to focus on the policy principle concerning who should be eligible for social care and support. I also thank the Minister in another place for taking the time to meet me yesterday to discuss my amendment.

The difference that good-quality social care can make cannot be underestimated. It is the difference between being isolated, living locked up and staring at the same four walls or being set on the path to living a full and independent life. The recent Time to Invest in Care publication described the situation faced by David, a 23 year-old man with autism and schizophrenia who currently lives with his parents. David needs support to engage in activities and look for suitable jobs. He needs guidance to gain a better understanding of social rules and to develop his awareness of dangers in the community. He also has difficulty in understanding boundaries in regard to friendships. As a result of receiving the right social care and support, David has a volunteering job and is now working towards moving into supported living and leading an independent life. This is the difference that the right social care support can make.

However, under the current eligibility system David has been assessed as having only moderate care needs. This means that, under the eligibility regulations set out alongside the Care Bill, David would not be entitled to support and his future would therefore be far less positive. Essentially, the Government’s regulations mean that David should not receive this formal social care support.

That brings me to the policy intention of the regulations. I very much welcome the pause in the proceedings of the Care Bill in this House so that time has been allowed for us to look over the regulations that have now been published in draft. I have read them with interest and there is much in the direction of them that is to be welcomed. They represent a real improvement on the current system. Particularly positive is the focus on well-being and, specifically, the inclusion

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of shopping and managing household finances in the definition of basic household activities. This appears to be a very progressive step which joins up the regulations with the very first clause of the Bill, which has been widely praised, and I congratulate the Government on that. It is also a very brave and positive step to end the postcode lottery in care provision.

However, I have very real concerns about the Government’s intention—as stated by the Minister in another place in his foreword to the draft regulations—that in terms of practical outcome the regulations will be equivalent to “substantial” under the current system. This will be devastating news to the hundreds of thousands of disabled and older people with significant care needs who will be excluded from receiving formal social care.

The Minister is aware that historic underfunding of the social care system, the pressures of an ageing population and a 33% reduction in local council budgets by 2014-15 have led to many local authorities raising the threshold at which disabled and older people become eligible. In 2005, 50% of local authorities set their eligibility criteria at “moderate”. By 2012, 84% had set the eligibility criteria at the higher level of “substantial” needs. The result is that since 2008 90,000 people have fallen out of the care system.

The excellent report, The Other Care Crisis, illustrates the impact that this has had. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, such as washing, dressing and getting out of the house—all things that we take for granted. The Care Bill will not resolve this crisis in care if the regulations are set at the level currently proposed. In fact, by setting a national minimum threshold at a level which maintains this crisis, the Government appear to be reducing their ambition for their social care reforms.

One point which has not been picked up is that the Government also appear to be reducing their ambition for the cap on care costs. While it is a welcome and important measure to attempt to cap the catastrophic costs of care that some people face, particularly in their old age, the Government have made it clear that the cap will only be triggered once an individual has been deemed eligible for care. Setting the bar for eligibility too high effectively means that there will be hundreds of thousands of people who think that they will not have to sell their homes to pay for care in their old age, yet will not be eligible for the cap itself. They will still have to pay for the cost of their care, even well above the £72,000 threshold, unless they are deemed eligible by their local authority.

For working-age disabled people the cap on care costs is irrelevant. The recent joint parliamentary inquiry, co-chaired by my noble friend Lady Campbell of Surbiton, highlighted the fact that the introduction of the cap was never designed to answer the care crisis for disabled people under 65. The inquiry was clear that the most crucial aspect of reform for working-age disabled people is where the eligibility for care is set. For them, this is the difference between living an independent life and spiralling into crisis.

I also have very real concerns that those disabled people who are set to lose out as a result of the Government’s welfare reforms will be the same people who will lose out on social care. It is highly likely that

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an individual who has significant care needs, but who falls just short of the current threshold, will be one of the half a million disabled people who will not get the personal independence payment under the new system. This means that not only will the social care that enables them to live independent lives be beyond their reach, but their financial independence will also be threatened further.

It appears to me that there is a clear group of disabled people whom the Government deem not quite disabled enough to receive support. Providing them with just enough support to remain independent will prevent them spiralling into crisis, costing local authorities much more money in crisis emergency care. I also believe that there is a clear economic argument to be made here. Economic modelling, carried out by Deloitte and published in the Ending the Other Care Crisis report, found that an investment of £1.2 billion in a lower eligibility threshold, equivalent to the current “moderate” level, would lead to substantial returns across government. This would include a £70 million saving to central government through increased taxes and reduced welfare spending. There would also be a £570 million saving to the NHS and local government through the avoidance of expensive crisis care.

The Government made a very welcome investment of an additional £2 billion at the recent spending review. I urge the Minister to use this money to invest in a lower national eligibility threshold, not just to ensure that his ambition for a care-based system on well-being becomes a reality, but for the savings it could generate as well.

In conclusion, as Members from across the House have repeatedly made clear, the Care Bill is a very good piece of legislation, and is welcome. However, we must make sure that disabled and older people who have significant care needs do not fall out of the social care system. If the eligibility threshold continues to be set at the level the Government have proposed, hundreds of thousands of disabled and older people will be shut out of the care system. There will be real concerns that the Government’s admirable focus on well-being will be far from reality for these people. I beg to move.

Lord Low of Dalston: My Lords, I am glad to support Amendment 88Q, put forward by the noble Baroness, Lady Grey-Thompson. As she has explained, the amendment seeks to ensure that the national eligibility threshold, a welcome feature of the Bill, is set at a level which will not exclude this group of more than 100,000 disabled people with significant needs from the social care system.

I would like to focus particularly on the role of the eligibility threshold in creating a truly preventive care system. While I welcome the explicit duty on local authorities actively to take steps to prevent delay or reduce the need for care and support, I fear that the regulations published last week on the national eligibility threshold will impede the realisation of this vision. In confirming their intention to set the threshold at a level equivalent to “substantial” under the current criteria for fair access to services, the Government would exclude more than 100,000 disabled people with moderate care needs from the care system. These are people who need support to get out of bed in the

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morning, wash, eat, get out of the house and participate in the community—the most basic of tasks that you need to be able to do in order to live a fulfilling life.

Moreover, denying disabled people with moderate needs the care and support they need is a false economy. If their needs are not met in the care system there is a real risk that they will escalate to a point where they have to be dealt with further down the line once they reach crisis point. This does not come cheap. It could lead to longer hospital stays, frequent readmissions, even the need for residential support, not to mention the lost tax revenue resulting from disabled people having to give up work as a result of losing social care support. This happens in one in three cases of working-age disabled people who need care.

Take, for example, the case of Elizabeth, of which I have been made aware. She used to have seven hours of key worker support a week to help with managing her bills and shopping. Following a letter from her council she was told, with no consideration of the impact it would have on her independence, that her hours would be reduced to three per week. As a consequence of losing this support she fell into a crisis. As she said, “I did have a job—I was working with disabled people—but I left because I couldn’t cope. I thought it wasn’t fair on the clients. I was going through a bad time, overdosing a lot”.

This case illustrates how only a small amount of timely support can pay real dividends. Support with shopping and managing her bills helped Elizabeth maintain an independent life. However, as a consequence of losing her support she was left in crisis, resulting in her making several suicide attempts and becoming reliant on more expensive medical services.

Under the current draft regulations Elizabeth would be shut out of the care system. I have real fears that cases such as hers will be replicated up and down the country. Indeed, despite the Government’s supportive words about prevention I am concerned that they are effectively regulating for prevention to be taken out of the care system. The consultation document published last week on the draft minimum eligibility threshold states that for those people who are not eligible for care— namely, the 100,000 disabled people with moderate care needs—local authorities will make available universal support, including information, advice and preventive services.

However, this implies that coverage of such services is comprehensive, consistent and of adequate quality when we know that this is not the case. The reality is that many such services have already been axed or are at risk of closure. Indeed, research by the Red Cross has found that nearly two-thirds—64%—of councillors said that their local authority had cut or frozen funding for prevention and lower level social care since the last local elections. This means that universal services will simply not have the capacity to provide the adequate preventive support that the Government intend. People who are not eligible for care will continue to face a postcode lottery of support and will be allowed to fall through the gap between the care system and universal services.

I end by emphasising that setting eligibility at a lower level is the essence of prevention. We cannot have a system where you have to reach crisis point

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before you can get the support you need. Early intervention and preventive support can also have significant financial benefits. Research undertaken by Deloitte on behalf of disability charities found that investing in people with lower levels of need provides a net positive return of at least 30% to the Government. I therefore hope that the Government will be prepared to take these points on board and ensure that the regulations on eligibility underpin rather than undermine the vision of a truly preventive care system, glimpsed in Clause 2 but, sadly, not yet fully followed through in later clauses.

5.15 pm

Baroness Wilkins: My Lords, I strongly support this amendment. If the Government do not agree with the intention behind the amendment, it is clear that they accept, no doubt at the Treasury’s insistence, that the social care crisis should continue for years to come. As we have already heard, the social care system is currently failing to support four out of every 10 disabled people of working age to do the basic things in life such as washing, dressing, eating and getting out of the house. The proposed national eligibility threshold will do nothing to change this. The cap on care costs for these people will be a fiction; unless their needs are assessed to be at the equivalent of “substantial” under the current FACS criteria, they could well spend a small fortune paying for care, none of which would count towards the overall cap.

The public would be shocked to learn that the level of needs spelled out in the amendment in the name of the noble Baroness, Lady Grey-Thompson, is not covered by the cap on care costs. The Government envisage that people whose needs are below the proposed national eligibility threshold will be helped by the universal preventive services covered in Clause 2. However, as the Care and Support Alliance points out, many of these services have already been axed in the cuts or are at risk of closure. The £2 billion funding is very welcome, but we need the Government to be clear with the public that they are endorsing the continuation of the social care crisis unless a major shift of resources takes place.

Baroness Jolly: My Lords, I, too, am delighted that these amendments have given us the opportunity to debate the eligibility criteria and I echo the comments of noble Lords who know better than I do how this will affect them. Eligibility is a critical issue, which affects both disabled people and older people with care needs—disabled people account for one-third of the people affected by the Bill and elderly people the other two-thirds.

The Joint Committee warmly recommended the introduction of a national minimum eligibility threshold as a key way of resolving the current postcode lottery in social care. The new eligibility framework and national threshold proposed in the Bill will go a huge way to alleviate the lottery of care and will be vital in ensuring that there is more clarity and consistency in the provision of care for disabled people and the elderly in England.

The focus on well-being in the Bill was hugely welcomed by the committee. This principle is the thread that runs through the Bill and will ensure that

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the care system not only delivers basic support but promotes older and disabled people’s independence, allowing them to realise their potential through participating more fully in their communities. This is a bold vision for the future and one that could truly revolutionise the care system. It is therefore key that these two elements of the Bill work seamlessly together so that the well-being principle is at the forefront of the Government’s mind when considering who will be eligible for care, something that the committee explicitly recommended in its report on the Bill.

However, as the Government have rightly recognised, social care is not merely about allowing people to “survive” but about enabling them to live full and independent lives. The Bill explicitly places a duty on local authorities to provide care that promotes the well-being of individuals. In a conversation yesterday with the Minister for Care and the noble Baroness, Lady Grey-Thompson, it was acknowledged that the draft regulations, which have already been referred to in this debate, were just that—draft. Much more can and needs to be done to make them asset or strength-based. Can my noble friend ensure that the work on the draft regulations proceeds at pace so that they are fit for purpose and meet the needs and requirements of all within the scope of the Bill? Can he also ensure that any work involves those from the sector and expert Members of this House?

Lord Rix: My Lords, the Minister knows perfectly well where I stand because I already talked about eligibility at Second Reading and in the debate last week on the future funding of health and social care, led by my noble friend Lord Patel. I was backed in that part of the debate on the question of someone having to reach a level of substantial disability before becoming eligible for care. It should be the right of all people with a disability at least to be assessed properly, from the lowest level of disability to the highest. A level may be set where tens of thousands of people are excluded, such as people with a learning disability. Many are already being excluded by local authorities and being denied the use of day centres, or whatever. I can only plead with the Minister to say something which would give a glow of optimism to all of us who are totally and utterly opposed to the level which the Government are likely to set.

Lord Touhig: My Lords, I support Amendment 88Q, which was so powerfully moved by the noble Baroness, Lady Grey-Thompson. I certainly welcome the Government’s intention to establish national eligibility criteria, so that local councils across the country will be required to provide care for all those with a minimum level of need. However, I share the concerns which were so well articulated by the noble Baroness and the noble Lord, Lord Low of Dalston, that setting the fair access to care services criteria at “substantial” is simply plain wrong. It is wrong because it will exclude many people who I know with autism, and who have a low-level need of support. They will no longer be able to live independently if the level is set at substantial.

Setting the threshold at this level also seems to be running counter to the Government’s stated intention in the Bill, which is to focus on prevention. The

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requirement for people to have a physical or mental impairment to qualify for support could mean that those without a diagnosis will be excluded and miss out altogether. A great many people with autism do not get a diagnosis. I have been dealing with a case recently where people have been waiting four years to get their daughter diagnosed. I join the National Autistic Society—again, I declare an interest as a vice-president—in urging the Government to reconsider this and set the threshold at something equivalent to “moderate”. That is by far the fairest and best way to do it.

I make no apology for saying something which I think I have said about three times in this Committee: there is substantial evidence from the National Audit Office and NICE to indicate that investing in services for those with a moderate need is cost-effective. New economic modelling by Deloitte, published recently, shows that every £1 invested in support for people with autism and other disabilities who have moderate needs, generates a return across the piece of £1.30. That is not to be ignored and should be part of our consideration. There is much merit in this and I rather feel that the Minister, who is a decent and honourable man, will see that there is. I am sure he is going to give us some good news; at least, I hope he will.

Baroness Hollins: My Lords, I would have added my name to this amendment because it is excellent and necessary. I, too, hope that the noble Earl will see the sense of it. Certainly, people’s fears that the Government would propose to set the national eligibility threshold too high have been confirmed. Rather than celebrating the achievements of councils that have been able to provide highly valued, innovative and low-cost services to people with low and moderate needs, we are instead to fall in line with the majority of local authorities, with the false hope of avoiding financial strain. Failing to provide services to people with moderate care needs is, at best, a missed opportunity to encourage preventive care and significantly improve the quality of life for a highly disadvantaged group of people. At worst, we are leaving a considerable proportion of people with a lifelong disability to fend for themselves.

Case reports of those recently excluded from receiving support are extremely troubling. We have heard some examples already today with some people losing all daycare provision and facing an isolated life at home. Other case reports demonstrate the importance of lower levels of support. I want briefly to give the example of Frances, a middle-aged woman with a mild to moderate learning disability who has always struggled to understand and manage bills. Since receiving a few hours support a week she has finally had relief from receiving constant threats and eviction notices. How long will her support survive before she is declared ineligible? Clearly the resources of the state are limited but they need to be used wisely, and I believe that our care system must encourage and incentivise local authorities to provide lower intensity interventions that can make a difference to the quality of life for many people.

On the face of it, opting for a moderate national eligibility threshold may sound as if it would require considerable additional funding, but providing these services to a group who by definition are often highly

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vulnerable and disadvantaged could result in great savings by avoiding more costly acute care later. I hope that the Government will rethink this amendment.

Baroness Greengross: There are vast numbers of older people—for whom this Bill is designed, in terms of quantity—who we know want to stay in their own homes in their community. Early intervention can make that possible. If we delay, the alternative is crisis-driven. It leads to many older people going into expensive care homes where they do not want to be and from which they do not emerge again or into hospitals, adding to the problems we know about with frail elderly people. I very much hope the noble Earl will reconsider and enable people with moderate needs to have access to services.

Lord Warner: My Lords, I hesitate to intervene in the debate on Amendment 88Q but I feel under some obligation to share with the Committee some of the thinking of the Dilnot commission where we went into this issue and set out our views in our report. I declare my interest as a member of that commission. I suspect that what I am going to say may be thought of more advantageously by the Minister than by those who tabled the amendment; however, it is important that we consider these factors.

First, we made it very clear in the report that,

“we believe that those who develop a care and support need during their working life should be assessed in broadly the same way as an older person”.

We tried to create an architecture that was reasonably consistent between the needs of those of working age and older citizens. Secondly, when we were asked to undertake this assignment we were asked to consider the feasibility of introducing this and the affordability of the changes. We wrestled with this quite a lot in our deliberations but we concluded in recommendation 6 of the report:

“In the short term, we think it is reasonable for a minimum eligibility threshold to be set nationally at ‘substantial’ under the current system”.

Our concern in doing that was not just that we were mealy-mouthed stooges of the Treasury but the overwhelming amount of evidence given to us about underfunding of the adult social care system over a long period. We considered that and said in the report that it was seriously underfunded and that funding had failed to keep pace with demographic changes in people of working age and those who were not. We thought that the deficit had to be made good but that that was a matter for the Government of the day and would need cross-party consensus if improved funding for social care was to be maintained.

5.30 pm