There was a Private Notice Question in the House of Lords this afternoon from LibDem Peer, Lord Dholakia:
“To ask Her Majesty’s Government what action they propose to take to ensure that the security of the United Kingdom is not compromised on 30 November.”
This produced the following response from the Home Office Minister, Lord Henley:
“My Lords, the security of the UK border remains our top priority. Contingency plans are in place and we are satisfied that security will be maintained. We started training additional staff for contingency arrangements in April and adequate resources are now available. Any staff deployed to the front line will have received the training required to operate effectively. Arriving passengers will remain subject to checks at the border by appropriately trained staff.”
There then followed a series of increasingly bad-tempered exchanges between the Minister and Labour Peers with the Minister demanding that Labour Peers condemn the strike, whilst admitting that the Government had been planning for a strike since April. Here are the exchanges with Labour Peers (one of whom was me):
“Baroness Royall of Blaisdon: My Lords, the Government have sponsored speculation about what they will, may or might do to maintain UK security, especially at the borders, on 30 November—everything from bringing in the Army to the idea of staff from the Prime Minister’s Office manning passport control points. However, people need and deserve stability. If they have booked a holiday that day, they need to know whether they can get away. If businesses have important customers coming to the UK, they need to know that their businesses will not be damaged. I should therefore be grateful if the Government would publish, clearly and fully, for the benefit of the country as a whole, what in detail they intend to do on Wednesday in relation to border security.
Lord Henley: My Lords, I am very sorry that the noble Baroness the Leader of the Opposition did not take the opportunity to condemn the strikes that are taking place on Wednesday, which would have been helpful. If all parties agreed that those strikes should not happen we would not have this problem. We shall be operating the appropriate checks with the appropriate people, appropriately trained to make sure that visitors—whether they are coming here as tourists, whether they are coming here for business or whether they are returning UK citizens—can get in without any disruption or with disruption minimised as much as possible. The noble Baroness will also be aware that this is an operational matter and for security reasons it would not be appropriate to comment in detail, as she wishes, on the arrangements.
Lord Tomlinson: Will the Minister comment on reports in today’s press that part of the police force is being drafted in to take over the role of the UK Border Agency at our borders and that their training is alleged to be merely 90 minutes? Is that adequate?
Lord Henley: My Lords, I would not believe—and I would recommend that the noble Lord should not believe—everything I read in the press. I can assure him and the House that everyone assisting on this matter will have the appropriate training necessary to do the job. Yes, some police will be involved but they will have the appropriate training to do the job that they need to do.
Lord Henley: My Lords, any sensible organisation, knowing there was a risk of such things happening—something which has still not been condemned by noble Lords opposite and I am waiting for that condemnation to occur—would make the appropriate arrangements. The border agency started that last April.
Lord Grocott: Given that the Minister has repeated asked people on this side of the House to talk in terms of condemnation, can we take it as read that the Government condemn the cleaners, the dinner ladies, the low-paid workers and those threatened with a weakening of their pension entitlements and an increase in their contributions? Is the Government’s position that they condemn these people for trying in any way to defend their position?
Lord Davies of Coity: My Lords, the Minister has repeatedly referred to this side of the House not condemning the strike. What I want to ask him is this—can he give a categorical assurance that the motivation of the coalition Government is security and not strike breaking?
Lord Henley: My Lords, as I made clear in my original answer, our first priority, our highest priority, our top priority is the security of the United Kingdom. If the noble Lord thinks that we are involved in strike breaking he should think again. We want to make sure that our borders are kept secure. We think that the unions are endangering that security by the actions they are taking. The offer is still open to talk to the Government and others and we wish they would take that up.
Lord Harris of Haringey: My Lords, of course our borders should be kept secure, but are the Government doing enough to negotiate with the unions on this point? Are the Government in fact making every effort to try to resolve this dispute rather than, as the Minister has told us, having been preparing since April for just this eventuality? Is it not that they actually wanted to provoke a strike, for whatever political reasons they may have?
Lord Henley: Come on, my Lords. The noble Lord knows perfectly well that the Government’s doors remain open and that the Government are prepared to negotiate. It is the unions who are being intransigent and it is the party opposite which is refusing to condemn an action that will possibly endanger our security. Because of the actions we have taken, and have been taking since April of this year, we think that we will be able to keep security at the appropriate level at the borders on Wednesday.
Baroness McIntosh of Hudnall: My Lords, given that the Minister is so fixated on the possibility of getting the kind of statement that he would like to hear from these Benches, does he imagine that the people out there who are contemplating going on strike are mostly or even to a small extent members of the party I support? I submit that not only are they not, they are members of all parties and none, and what is preoccupying them is not the question of whether the Labour Party supports them but their concern for their future pension rights.
Lord Henley: My Lords, the noble Baroness accuses me of being fixated on this issue and perhaps I am somewhat naive to be so fixated on this issue. I do not know in which way the members of the unions involved happen to vote. I happen to know that those unions support the party opposite. That is why we are still waiting for that condemnation from the party opposite.
In Question Time in the House of Lords a succession of Labour Peers (including me) pressed the Government on their attitude to the Health Lottery run by Richard Desmond of “Daily Express” and “Asian Babes” fame, which only pays just over the legal minimum of 20% of the money raised to the good causes it supports.
Here are the exchanges:
To ask Her Majesty’s Government what assessment the Gambling Commission has undertaken of the contribution being made to good causes by the Health Lottery.
Baroness Garden of Frognal: My Lords, the Gambling Act 2005 requires that at least 20 per cent of the proceeds of a society lottery go to the good cause that it supports. Each of the 51 society lotteries that are promoted under the umbrella brand of the Health Lottery must comply with this requirement. We understand from the Health Lottery that 20.3 per cent of the proceeds of each individual society lottery will go to the relevant good cause, addressing health inequalities in specific geographic areas of Great Britain.
Lord Faulkner of Worcester: My Lords, may I ask the Minister two questions? First, is she aware of the great concern that has been expressed by the beneficiaries of legally run society lotteries in the health sector, which have benefited immensely from those local society lotteries, about what is seen as the unfair competition from the Health Lottery? Is she aware that the hospice movement is particularly alarmed, because it depends very heavily on society lotteries? In Worcester, for example, our two hospices receive £70,000 a year from the South Worcestershire Hospices Lottery, which pays 50p in the pound—not 20p in the pound—to those good causes.
Secondly, notwithstanding what the Gambling Commission may have decided initially about the Health Lottery’s legality, how can it be legal to have 51 community interest companies linked to the Health Lottery which have no independent existence, but which all have the same three directors and all operate out of the same virtual office? How is that legal?
Baroness Garden of Frognal: My Lords, the noble Lord has great expertise in these matters. In his first question, he raises the concern about the hospices. We share the concern about the potential impact on society lotteries, although a number of existing health-related charities have been supported through the Health Lottery arrangements so far, and we will ensure that the impact on other society lotteries is monitored.
On the noble Lord’s second question, about the legality, he will also be aware that compliance with the requirements of the Gambling Act 2005 is a matter for the Gambling Commission, which has issued the necessary licences for the Health Lottery. As with any major scheme entering the market, however, it will work with the operator to ensure that what is delivered is actually compliant. We expect initial findings from that monitoring to be with us by next March.
Lord Addington: My Lords, would my noble friend give some thought to the idea that charities which are created to allow a lottery to be organised might be against the spirit that was initially taken on in this field? If that is right, will she undertake that the Government might look at the whole legal framework? If it is against the spirit, we can change the rules.
Baroness Garden of Frognal: My noble friend makes a very valid point that, so far, the legality has been in the matter of the fact of the law. However, as I have mentioned, there will be ongoing monitoring and, as he so rightly says, all these things can be changed if it turns out that the spirit of the law is not being respected.
Lord Brooke of Alverthorpe: My Lords, are the Government content with the system that they have in place for monitoring the operations of the Gambling Commission and, if not, what can they do about it? Are they content that Mr Desmond is a fit and proper person, given what was said at the Leveson inquiry last week and the failure of his organisations to associate themselves with the independent press commission, and that this is the way forward given some of the issues which now surround the operation of this lottery?
Baroness Garden of Frognal: My Lords, as I say, it is for the Gambling Commission to look at this. We recognise all the issues around Mr Desmond and his other organisations, but those are not perhaps directly relevant to this. One thing that the Government have done is to merge the Gambling Commission and the National Lottery Commission, which we expect will make regulation easier and create cost savings but also help to produce a more robust form of monitoring.
Lord Collins of Highbury: My Lords, may I press the Minister on the issue of what I consider, as I think many would, an apparent loophole exploited by the Health Lottery with its 51 separate companies? Will she give an assurance that this loophole will be examined and perhaps closed by the Government, bearing in mind that the Health Lottery has a turnover of £510 million a year and is in effect an alternative national lottery, affecting funding not only for other health charities but for the arts in general?
Baroness Garden of Frognal: My Lords, the noble Lord raises an important point about the issue of whether the Health Lottery will impact on the National Lottery. We are well aware of the vast amount of good work that the National Lottery does for the arts and a whole range of charitable organisations in this country. This is the first time that a lottery has been set up in this mode, with 51 society lotteries under an umbrella. It is a new model, which is why we are looking to the Gambling commission to report back to the Government on how it is going to operate. Of course, the Health Lottery has been going for only eight weeks so it is early days as yet to see how it will pan out, but I hope that the noble Lord will rest assured that the Government are monitoring the situation.
Lord Haskel: Following on from my noble friend Lord Faulkner’s question, should the Minister not be speaking up for those charities that give 50 per cent of their income rather than those that give only 20 per cent?
Baroness Garden of Frognal: My Lords, I am sorry if I was not speaking up loudly. One indeed commends the society lotteries that give on average 51 per cent to good causes overall, which is a much more significant proportion than 20 per cent. The question remains whether this will be a form of raising additional funding for good causes, and only time will tell whether that is the case.
Lord Harris of Haringey: My Lords, is it not the case that the public assume that a much higher proportion of the money that they put into these lotteries is going to the good cause concerned? Should the Government not be looking to raise the 20 per cent threshold to a more realistic figure? That may then squeeze out those who see setting up these lotteries as a way of making extra cash for themselves rather than for the charities that they are supposed to be supporting.
Baroness Garden of Frognal: My Lords, the raising of the threshold has been under discussion. We feel that at the moment, with the Health Lottery still so new, this is not the moment to change the thresholds for the lotteries as a whole. As I say, though, we are monitoring the situation since, as far as we are concerned, it is a new set-up in the lottery world. We shall wait and see, with the promise of a report of that monitoring early next year.
Lord Brooke of Sutton Mandeville: When I had the privilege of moving the Second Reading of the National Lottery etc. Bill in 1993, I gave way 28 times in the hour it took me to complete my speech. It was perfectly clear at that time that scrutiny of the lottery was being carried out extremely effectively by Parliament. I hope that the amount of time that we need to scrutinise this new development will be shorter rather than longer.
Lord Faulkner of Worcester: If the Minister reads the prospectus of the Health Lottery, she will see that in order for it to meet its targets of paying money to the 51 community companies it will need to raise something in the order of £250 million a year from the British public. Where does she think that money is going to come from? Surely it will be from existing charity giving, existing society lotteries and the National Lottery.
Baroness Garden of Frognal: My Lords, this is one of the things that we shall need to look at. At the moment, the Health Lottery is raising £2 million to £3 million a week compared with the National Lottery which is raising somewhere between £150 million and £190 million a week. So the latter is still far and away the major source of public money in this area but, to pick up an earlier question, it is very important that the public are made aware of just how much of their money is going to good causes from the Health Lottery compared with how much goes to good causes from society lotteries and indeed the National Lottery.”
Apart from the Minister (Baroness Garden) and interventions from LibDem Lord Addington and Tory Lord Brooke of Sutton Mandeville, only Labour peers seemed interested in the issue.
I am in “I told you so” mode. In August 2009 – months before the General Election – I asked the question:
I described this as
“I have had a nightmare: David Cameron and the Conservatives win a General Election next summer, despite slow but steady improvement in the UK economy; George Osborne is appointed Chancellor and slashes public spending and hikes the VAT rate up to 20%; and then it all gets a whole lot worse ….”
Now, as we listen to George Osborne and Government Ministers softening us up for next week’s Autumn Statement and the acknowledgement that we are heading for a double-dip recession, it is no consolation to realisation that my nightmare seems to be coming true.
The Wall Street Journal reports that:
“British intelligence picked up “talk” from terrorists planning an Internet-based attack against the U.K.’s national infrastructure, a British official said, as the government released a long-awaited report on cyber security.
Terrorists have for some time used the Internet to recruit, spread propaganda and raise funds. Now, this official said, U.K. intelligence has seen evidence that terrorists are talking about using the Internet to actually attack a country, which could include sending viruses to disrupt the country’s infrastructure, much of which is now connected online. The official spoke on condition of anonymity and didn’t say when the infrastructure threat was detected and how it was dealt with.
Terrorists, however, are still more focused on physical attacks that lead to high casualties and grab attention. “For the moment they prefer to cover the streets in blood,” he said.”
I first started raising these concerns more than seven years ago, pointing out in a debate in the House of Lords on the 9th December 2004:
“As a nation, the systems that are essential for our health and well-being rely on computer and communications networks – whether we are talking about the energy utilities, the water and food distribution networks, transportation, the emergency services, telephones, the banking and financial systems, indeed government and public services in general – and all of them are vulnerable to serious disruption by cyber-attack with potentially enormous consequences. Indeed, the Coastguard Service was laid low by the “Sasser” worm in May this year.
The threat could come from teenage hackers with no more motivation than proving that it could be done, but even more seriously it could come from cyber-terrorists intent on bringing about the downfall of our society. “
At the time, I was assured that there was no intelligence to suggest that such a threat was significant. The then junior Home Office Minister, Lord Steve Bassam, now no less a person (if such a thing were possible) than the Opposition Chief Whip in the Lords, said:
“there are also terrorists who would challenge and seek to undermine democratic society using any methods within their grasp. It is not complacent to say this; but perhaps it should be made plain that at the moment they do not appear to be interested in attacking us electronically.”
Of course, in the intervening seven years there has been a burgeoning realisation of an increasing number of cyber-threats and, if there is now intelligence to suggest that international terrorists are thinking in that way, I take no satisfaction from having predicted it in 2004.
What is important is that the substantial resources provided to GCHQ under the Government’s new Cyber Security Strategy, published last week, are used effectively to combat the threat. GCHQ and the other intelligence agencies are to get 59% of the £650 million that the Government has allocated to cyber security over the next three years. It is unlikely that there will ever be much detail published as to how the resources are used, so we can only hope ….
Last Thursday, I reported the debate at the Metropolitan Police Authority about the possible wider use of Tasers in London. There were considerable reservations about this expressed by some members of the Authority (and by some in the public gallery).
I am personally keen that there should be proper consultation and debate on the issue and I do not think the arguments are clearcut.
The use of any weapon by the police has got to be proportionate and appropriate to the risks involved. Any weapon can cause more harm than originally intended.
However, temporarily incapacitating someone with a Taser, so that they can be restrained and arrested, is likely to be better than killing them by shooting a large hole in their chest or head with a firearm.
Nevertheless, putting a 50,000 volt charge through someone should not be done lightly – it is unlikely not to lead to adverse consequences in at least some circumstances. But these risks need to be weighed against the risks of not using a Taser, such as the risks of harm coming to a member of the public or to a police officer by not quickly restraining someone who is running amok.
Therefore, this evening’s piece on the Inspector Gadget blog makes instructive reading. His police force makes Tasers available to all front-line patrol teams, and he offers three recent incidents where Tasers have been deployed as part of routine patrol duties as follows:
“1. The usual call to a ‘male with a samurai sword’ running about in Ruraltown High Street threatening to kill passing members of the public, stripped to the waist (why are they always stripped to the waist?) high on something and very, very violent. TASER crew arrives within 4 minutes, draws TASER, red-dots the man and orders him to drop the sword.
In a miracle of instant recovery, all the man’s mental health and drug issues disappear and he drops the sword. A completely compliant arrest follows with no injuries to anyone.
Previously this would have required shields, large batons, a firearms unit and a long delay during which he could have killed anyone he wanted, including the first police officers on the scene.
2. A disqualified driver, known for violence against police officers, bailed out of a stolen vehicle after a pursuit. Armed with a 2 ft long iron bar in one hand and a knife in the other, he became cornered by the two policemen from the pursuing vehicle. Red-faced, drunk, very angry and screaming death threats, a stand-off ensued which without TASER would have taken hours to resolve (remember, the public don’t like it when we pile mob-handed onto one man). The TASER crew arrived within a few seconds and red-dotted him in the chest.
Another miracle occurred. Right in front of the police officers eyes, a complete change in character. Weapons dropped, hands behind the back and a compliant arrest.
3. My own patrol officers end a siege without calling for tactical response units and bringing the whole town to a halt for hours by using TASER on a male who is clearly intent on cutting his own throat, while at the same time threatening t0 stab any police officer or paramedic who approaches him. All this in the isle of a busy local supermarket.
In this case, TASER was fired at the man. He was immediately incapacitated and arrested without any injury to anyone. In the past, this could have been another Kingsbury or it could have taken hours and hours of negotiation, maybe even a fatal shooting by police.”
His accounts also accord with the experience in the Metropolitan Police, where – in more limited circumstances – Tasers have been deployed, and reported through monitoring arrangements to the – shortly to be abolished – Metropolitan Police Authority: in these cases too often the appearance of the red dot on someone’s chest (indicating the laser sights of the Taser) has been sufficient to persuade someone otherwise presenting a risk to themselves, members of the public or police officers to calm down and relinquish their weapon.
Inspector Gadget concludes in typical – but telling – style:
“Refusing to let us have TASER in case we shoot the wrong person is like refusing to let us have cars in case we run someone over, boots in case we kick someone in the head or a first aid kit in case we give the wrong treatment. On my team we take the deployment of TASER very seriously. I haven’t even heard the team joke about it.”
I spent part of yesterday evening at the official opening of The Grange building at Middlesex University’s Hendon campus. The £80 million building and its facilities are hugely impressive and must be some of the country’s best for the creative arts, and include:
The creativity that these have already spawned were on display throughout the building.
Over the last few years, I have watched the whole Hendon campus develop and grow, so that it is now an enormous asset for London and the country, nurturing and unlocking the talent of its students – who go on to become some of the best paid graduates emerging from the country’s universities and to make their contribution to the UK’s future prosperity.
The Metropolitan Police Commissioner, Bernard Hogan-Howe, is reporting to the last ordinary meeting of the Metropolitan Police Authority before it is due to be abolished in January.
This is the first (and possibly the last) time that the Authority has had the opportunity to discuss the remarks made by the Commissioner on LBC when he announced that he had asked for a review of the availability of Tasers for officers called to violent incidents like the one in which four officers were injured in Kingsbury on the 19th November. According to the Commissioner, he discussed the attack and possible responses with the Mayor and MPA Chair, Kit Malthouse AM (in a break from his paternity leave) before his scheduled LBC interview and his specific remarks were in response to a phoned-in question from a Met firearms officer.
The Commissioner pointed out that he was simply “reviewing the options” and that there would be “full discussion” before any final decisions are taken. What is not clear is how and where such discussion will take place after the MPA is abolished.
In the meantime, members of the Police Authority raised substantial concerns and issues about wider use of Tasers. At least, the Commissioner recognised that this was not an operational decision for him alone and that there needed to be wider public consultation and that ultimately the Authority would need to take a view. Of course, after 16th January, the Authority will be the Mayor and the MOPC.
What is probably the final ordinary meeting of the Metropolitan Police Authority is in session and Deputy Mayor Kit Malthouse AM, Deputy MOPC Presumptive, is NOT in the Chair (he is on paternity leave). Instead, Reshard Auladin, the Deputy Chair, is presiding over what is hardly going to be a quiet somnolent meeting of the Authority.
Apart from the usual items on the agenda, like the Commissioner’s report (will he mention Tasers?), there is also the “Policing London Business Plan” that will lead to a lively (and political – given the approaching Mayoral elections) debate on the gap in the Met’s budget, the Mayor’s instruction to keep police numbers up without the money to do it (apart from £30 million that the Mayor is transferring to the Met from the Fire Service budget, about which the Fire Brigades Union threatened demonstrations outside the MPA meeting), the cutbacks in Safer Neighbourhood Teams and their sergeants etc etc. And the report of the MPA’s Civil Liberties Panel on the DNA database (topical with the Government’s plans to remove potential rapists and others from the database) is also to be discussed.
But the meeting has started with a question submitted by Samantha Rigg-David on behalf of the United Families and Friends Campaign about the procession down Whitehall on Saturday 29th October in remembrance of those who have died in custody or state care and what the Campaign says was the disproportionate, aggressive and degrading treatment the families received from the Police after the procession had handed in a letter to 10 Downing Street. Shortly after the 29th, I had heard about the incidents referred to in the question and had asked for a briefing from the Met about what had happened. I never received a response, so the answer to the public question is the first time that the Met has given their version of events.
That version was rather different to that of the questioner. However, the Commissioner gave an undertaking personally to review the CCTV material of the incident and to communicate directly with those involved. Surprisingly (given the fact that similar events have been organised over the last thirteen years), it was suggested that there had been a failure of communication between the organisers of the demonstration and the police.
What is not clear is how easily such issues will be aired and pursued once the MPA is abolished.
Yesterday also saw the first discussion of the role of HealthWatch during the Committee Stage of the Health and Social Care Bill. HealthWatch is the proposed new structure to represent the interests of patients and the public in the new NHS. It is potentially hugely important, as patients will need a strong voice to protect their interests. However, the Government is proposing that the national body, HealthWatch England, should be constituted as a sub-committee of the regulator, the Care Quality Commission, and that local HealthWatch organisations should be run by local authorities (even though they will be responsible for some of the social care services that HealthWatch will be monitoring) without any protection of their budgets.
This is what I said on the subject:
“My Lords, I apologise to my noble friend Lord Patel if he in any sense felt beaten up by me. I absolve my noble friend Lady Wheeler from any involvement in that process. I also apologise to the long-suffering officials in the Government Whips Office. If my robust style is mistaken, they should really see what I am like when I am angry.*
I added my name to a number of amendments in the various versions of this group. I also proposed Amendment 305. If the noble Baroness whom I believe is replying to this debate is planning to highlight any technical flaws in that amendment, I should point out that I drafted it myself. Therefore, it no doubt does contain a number of technical flaws. But the purpose of the amendment is to assess the feeling within the House and the strength of feeling in the department about the extent to which it is important that HealthWatch England and healthwatch organisations at local level should be independent.
The principle underlying this group of amendments is straightforward-the centrality of the voices of patients and users in the NHS. That voice must be, and must be seen to be, independent of the various provider and regulatory interests. That is what underpins all of the different amendments.
I find it difficult to understand how the Government will oppose the amendments. They keep telling us that the voice of the patient and the user will be central to all these arrangements. They say that that is their intention. But they must be aware, because everybody else is, of the cynicism and doubt that is being expressed around the country about this whole package of NHS changes. Therefore, they should be able to reassure patients and users that their voices will be heard at every level within this complicated restructuring that will take place. That is extremely important.
What is more, it will be important for that voice to be seen to be independent. Members of the public will be concerned about what is happening. They will worry whether their doctors, who that they do not fully understand as being part of commissioning groups, will somehow be making judgments about their care, influenced by financial interests. They will want to be assured that they can go somewhere for proper advice and support, and that that place will genuinely be independent of all of those interests.
A huge expectation is now being placed on local healthwatch organisations. They are expected to provide that independent advice and information, to be able to monitor the nature of the service at local level and to be able to comment on the various changes that are taking place and on the proposals that are coming from the plethora of commissioning groups, senates and goodness knows what else we are going to have. They are going to be there to make recommendations. So, there will be enormous expectations on behalf of the public as to what these groups are going to do. Similarly, the national body, HealthWatch England, will have enormous expectations upon it. That is why it is so important to get these arrangements right. The
proposals for HealthWatch England and local healthwatch are an advance on what we have at present in terms of LINks. There is no question about that-they are a step forward. The record of successive Ministers and Governments in terms of patient representation in the NHS is not very good. This is a step forward from where we are at the moment. So, let us try to get it right. Why not deal with what are comparatively small issues in terms of how the system works?
The trouble is that, at the moment, the arrangements that the Government are proposing are flawed in two key respects: first, on the issue of independence, as the noble Lord, Lord Patel, has already indicated; and secondly, in terms of the resources available. Let us consider for a moment the position of HealthWatch England as a sub-committee of the Care Quality Commission. That might be a very neat way of not increasing the number of quangos by one; it may be that was the sole motivating feature. However, the reality is that it dangerously compromises the independence that I talked about as being so important. Often, HealthWatch England will have to say, on behalf of local healthwatch organisations, that the regulator should be doing something, has failed to do something or has been inadequate in the way that it has done that. In the last few weeks, we have seen the Minister’s colleagues in the Department of Health making quite critical comments about the way in which the CQC has fulfilled its remit. If Ministers are saying that-and Ministers are, after all, the paymasters of the CQC-what is it going to be like for those people whose remit is to raise these issues but are themselves subordinate to that regulatory body? It is going to be a real conflict and a very difficult position for them. The nature of that relationship-the fact that they are a mere sub-committee and are subjected to all of the panoply of arrangements that go with that-is going to be seriously limiting.
I am aware that the CQC is making enormous efforts to try and demonstrate their good faith in all of this. I am sure that the individuals involved have good faith as far as this is concerned. However, we are here considering legislation that will set those arrangements. Once those arrangements are set, the good will of the individuals who may be trying to make it work at the moment may not persist-not because those individuals will change their minds, but because, over time, those individuals will move on and others will take their place. Budgetary and other pressures on the CQC will rise. The feeling that they do not like being criticised by a body that is technically subordinate to them will increase. That is why that arrangement does not work.
There is an even stronger argument as to why local healthwatch organisations should not be subordinate to principal local authorities in their area. The Government’s flaws here are flaws twice over. Not only are they imperilling the independence of local healthwatch organisations by saying that-even though they are supposed to be independent-they are creatures of the local authority, the funds will be provided by the local authority and many of the facilities may well be provided by local authority but, because the funds will not be ring-fenced, it will be far too easy for local authorities to start to apply the screws if they do not like the criticisms that come from it.
A major conflict of interest is being created. HealthWatch cannot be accountable to, and at the same time funded by, local authorities because the bodies which commission and provide the services are the local authorities in many instances. However, the Government are saying that HealthWatch can advise members of the public about those services. How can HealthWatch organisations be funded by the same bodies that are commissioning and providing those services? This is precisely the area where the confidence of members of the public and of individual patients is so important. They have to go for advice to a body which is funded by the people about whom they wish to take advice. That hardly looks independent or satisfactory. If HealthWatch is made accountable to local authorities as the Bill proposes, the public will, frankly, have no confidence in that and all the efforts that the Department of Health and the Government have made to try to create a better structure will be wasted. That resource will be wasted because the public will not have confidence in these arrangements.
There is also a failure to protect the funding. I do not know how many hot coals Ministers in the Department of Health had to crawl over to get £60 million out of the Treasury for HealthWatch. I am not suggesting that the Department for Communities and Local Government is any more evil than any other government department, but if you hand the funding to that department, which then hands it on to individual local authorities without a label saying, “Not only is this money to be used for HealthWatch but it cannot be used for anything else”, my experience as a former council leader tells me that you cannot guarantee that the money will be used for the purpose that you wish.
I spoke earlier about localism and said how wonderful it was that the Government should devolve responsibility for this issue. However, it is not a wonderful example of localism if you expect something to happen, you pass the money on and then you are shocked if the money is not used for that purpose. If you want the money to be used for a particular purpose, you have to label it and ring-fence it. However, the Government will not do that. They say that they cannot do that as it would be inappropriate in the spirit of localism.
“I have spent 30 years as a senior business professional and business consultant and it is ludicrous to set an organisation targets to be funded by set criteria and then reduce those funds by 65 per cent. This makes a mockery of the organisation’s ability to carry out its public remit”.
There is a technical point here. The Department of Health has presumably secured these funds through the comprehensive spending review. Who will own those funds the next time that the comprehensive spending review is negotiated? Will it be the Department
of Health or the Department for Communities and Local Government? If it is the Department for Communities and Local Government, how will it rank given its other priorities which have nothing to do with HealthWatch? If it is the Department of Health, how will it answer the question from the Treasury, “How do you know that this money is being spent in the way that you intend?”. It will not be able to answer that question, as I suspect that the correct answer is that the money will disappear. LINks already have huge concerns about the resources question.
The other element of this concerns what sort of patient representative mechanism we want. Do we want something which is top-down or something which comes from local organisations? The amendment that stands in my name seeks to establish an arrangement whereby local healthwatch organisations have ownership of the national body which speaks in their name. I believe that that is essential. Even if you created HealthWatch England as an independent structure without the problems of it being a tool of the regulator, you will still not get the necessary buy-in at local level unless local organisations feel that they are part of it and have a say in its organisation. I speak as someone who was director of the Association of Community Health Councils for England and Wales for 12 years, and I know how important it was for the member organisations to feel that what we were saying as the national body reflected-not to the letter, but reflected-what they felt was important as local organisations. If you do not have that mechanism, if you do not have that process built into the legislation, I am afraid that you will create a gulf between the national body and the local bodies. That is surely unsatisfactory.
The Government’s proposals could make an enormous difference to patient representation in the new NHS, and patient representation is going to be enormously important in the new structure, because I think that many patients will feel disempowered and worried by what is happening. However, those arrangements are flawed unless the Government accept the spirit of the amendments in this group-and unless they accept that HealthWatch, both nationally and locally, should be independent, and that resources should be clearly ring-fenced and clearly identified and cannot be used by bodies that have no interest, necessarily, in patient representation used for other purposes.”
*This relates to a procedural manoeuvre instigated by the Government late the day before that I thwarted.
Yesterday was the seventh day of the Committee Stage of the health and Social Care Bill. In theory this should be the half-way point of the discussions, but the Committee has only got up to Clause 20 and there are another 323 Clauses to go.
One of the debates yesterday centred on the “mandate” (crazy word, crazy Bill) that the Secretary of State will give to the National Commissioning Board (this is the biggest quango in the known universe and it will effectively run the NHS). The “mandate” is essentially the Government’s instructions to the Board, but as they are claiming that they are giving away all responsibilities to the Board (and thereby absolving Ministers from taking responsibility for what happens to the NHS as the budget is cut) the content of this “mandate” is really rather important. How detailed will it be and will it be subject to proper Parliamentary scrutiny?
I am afraid the Government’s attitude brought out the normally-hidden (!) cynic in me:
“My Lords, I confess that I am something of a cynic about some of the proposals in the Bill. I am a great believer in the principle of localism, the local determination of services and local decision-making. Therefore, in principle I would applaud any Government-even this Government-who desire to devolve responsibility for various things to local authorities and, in this case, local commissioning groups.
However, my cynicism kicks in because what I suspect is happening here-I suspect that it will happen in other service areas-is that Ministers are cynically saying, “We are leaving these responsibilities to you, the local bodies concerned. We are very happy for you to make all these decisions. The snag is that we will not provide you with the resources to meet all the expectations that the public, who rely on those services, might legitimately have hoped to be provided. However, we are not taking these decisions. We will not be involved. It is a matter for local determination”. To be honest, I think that is what underpins much of the localism, devolution or autonomy agenda that we are seeing.
However, the experience of all previous experiments of localism is that while Ministers say, “Yes, this is a wonderful idea. We want to do it”, pressure starts to be applied to particular things. They want to have a mechanism whereby they can say, “It is, of course, your decision. However, we want you to make sure that these things happen”. Gradually, the list of the things that must happen gets longer and longer and the list of areas of discretion gets shorter and shorter.
When I saw the proposal for a mandate to be in the Bill, I thought that that was the mechanism whereby on the one hand Ministers will proclaim that they have no involvement in these decisions and say that they are all local decisions, but on the other hand this will enable them to ensure that certain things still happen because they are being subjected, as elected politicians, to pressure to make sure that they happen. That is why the amendment of my noble friend Lord Warner, which would restrict the extent to which this could be done, is very important. If we do not have an amendment of that sort in the Bill, I can tell you now what will happen; every single pressure group, voluntary organisation and lobby will say, “We want included in the mandate”, which is being issued to the national Commissioning Board, “the following service. We will want to see it there.”
For any sensible Minister the simple answer to all this is to write an extremely long mandate that covers all those points rather than sticks to them. If they were
obliged to be limited to just five or six or another small number of issues, that would be extremely salutary. It would stop the creep that would happen. However, I suspect that the Government are not going to say suddenly, “My goodness, the noble Lord, Lord Warner, has come up with an excellent idea. Why didn’t we think of that? We must accept it, of course”, because unfortunately that is not always the way in which government Ministers react. They will stick to the letter of the Bill without those specifications. They will say, “Well, why five? Why not 10? Why not 12? What about three?”. All these different things will be argued as an excuse for not doing it. You will then get the drift and the pressure to say that more and more things must be added.
Amendment 100A is so important because there must be parliamentary scrutiny of what is happening, because this will be the mechanism that drives decision-making in the NHS. It is not going to be a pure version of devolution, localism and autonomy; this is going to be done through the mandate. The mandate is then going to be the most important document that drives the NHS at any one moment. That is why parliamentary scrutiny is essential. Parliament must have the opportunity not just to see it and to know what is being done in the name of the public but to comment, amend, or put forward amendments and have the Government respond to them.
I therefore hope that when the Minister responds he will accept not only the principle of my noble friend Lord Warner’s amendment but the principle of detailed parliamentary involvement in this process in the amendment of my noble friend Lord Hunt of Kings Heath.”
The full debate is here.