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Archive for the ‘Health’ Category

Sunday
Jun 15,2014

Shaz is 15 years old. This is how she tells her story: “When I was 12, I went on a family holiday to Bangladesh. As soon as I got out there were marriage proposals from my cousins. I started starving myself and was brought back. I couldn’t tell anyone. My brother said I was going to marry my cousin from Bangladesh if I didn’t he would kill me.” Shaz’s brother was only two years older than her, and was born and brought up in this country. Today forced marriage becomes a criminal offence. This is welcome and is the culmination of a long campaign by many organisations – including (declaration of interest) the Freedom Charity, whose Board I chair. Forcing someone to marry against their will is abhorrent, and is also widely regarded as a violation of internationally recognised human rights standards. Indeed, Article 16.2 of the Universal Declaration of Human Rights says: ‘Marriage shall be entered into only with the free and full consent of the intending spouses.’ Under the previous Labour government, the Forced Marriage (Civil Protection) Act was passed, enabling victims to apply for court orders for their protection. It became apparent however, that more was needed; which is why we were happy to support criminalisation being included in the Coalition’s Anti-social Behaviour, Crime and Policing Bill during the last parliamentary session.  Labour Peers successfully strengthened the measure as far as the principle of consent for people with learning difficulties was concerned, recognising that for some a forced marriage may take place without violence or threats. The big task remains education. We need to make sure that those at risk understand they have a choice. We need families and communities to understand that forcing someone into a marriage against their will is not just wrong. It is now illegal. Shaz was lucky. She tells how in January of last year: “I was at school when Aneeta from Freedom visited, we all leant about  forced marriage. I knew then I could get help. Freedom got me out. Now I live with my Foster Mum and Dad.” We are now approaching the long summer school holidays – a time when young girls often disappear on long family holidays and are forced into marriages overseas. It is even more important therefore to get the message across that forced marriage is wrong. That is why I, along with Labour colleagues and many others around the country, are marking the criminalisation of forced marriage by being photographed on Monday holding a Twitter-friendly sign saying #FREEDOM2CHOOSE.

Monday
Nov 18,2013

For the past six months I have been chairing the Lords’ Select Committee on the Olympic and Paralympic Legacy. And today, after 33 evidence sessions, hearing from 53 witnesses and taking written submissions from 67 organisations and individuals, we have published our report – with 41 recommendations.

So what are our main conclusions?

The Games themselves were an outstanding success, absolutely vindicating the decision by Tony Blair and Ken Livingstone to back London’s bid, as well as exceeding expectations and confounded the sceptics. That success was only delivered through incredible cooperation between the numerous organisations involved, the host Boroughs and virtually every Whitehall department. Since the Games however, the same political impetus and the imperative of a deadline no longer exist. As a result many aspects of the legacy are in danger of faltering and some have fallen by the wayside. There is a lack of ownership and leadership.

That is why we recommend giving a single Cabinet-level Minister overall responsibility for all strands of the legacy. Only someone with senior clout will be able to bang heads together across different departments, including Education with its role in school sport and funding, Health which is supposed to be getting us all more active and healthier, DCMS with its responsibility for the sports governing bodies – plus all the departments that should be working to deliver the economic benefits not only in London but across the UK.

In London itself, the Office of Mayor should be given unambiguous responsibility for holding and taking forward the vision for East London and the developments in the Olympic Park and the surrounding area.

East London has for over a hundred years contained some of the most deprived communities in our country. Too many still live in poor and grossly overcrowded properties or in temporary accommodation. Unemployment rates are among the UK’s worst and the skills gap means that local businesses cannot find the staff they need. Delivering the Olympics brought forward much-needed infrastructure improvements but making sure that all the potential new jobs and new housing are delivered will require laser-like focus and determination from the Mayor.

There is suitable land for housing in East London but it is not being used. One Borough says that the biggest problem is land-banking. In another, Barking and Dagenham, one site, part-owned by the Greater London Authority, has permission for 11,000 dwellings but only 300 have been built. There is much that the Mayor should be doing.

Stratford International has had £1bn of public investment to equip it for high-speed international rail services, but none stop there. It is time that the Transport Department persuaded the operators that at least some of their services should use the facilities, bringing in both travellers and business.

As for the promised “cultural legacy”, the term only appeared twice in more than 500 pages of written evidence and the only tangible thing mentioned by DCMS Secretary Maria Miller was the world tour of the inflatable Stonehenge that she described as “a fantastic way of bringing Britain to life overseas.”

As far as sports participation is concerned, the step-change improvement hoped for did not occur. If anything, the slow steady improvement seen since 2005 has faltered. Facilities at grassroots level need to be improved and we received much evidence telling us that the Coalition’s scrapping of School Sports Partnerships was a big mistake.

Although we hunted for White Elephants among the facilities created for the Games, we didn’t find them. But the unseemly squabbling of West Ham United and Leyton Orient football clubs over the Olympic Stadium was most unedifying. It is important that more effort is made to ensure that this national asset is put to good use with maximum possible community use, including possibly by the club that was unsuccessful in the bid process.

That is the overall lesson of the report: the London Games were a huge success but much more still needs to be done to ensure the nation gets the maximum possible return on its investment.

 

Monday
Jul 29,2013

Two issues today highlight the way this Conservative-led LibDem-supported Coalition Government operates.

Fees of up to £1200 to bring an employment tribunal case are being introduced today.  This is allegedly intended to prevent so-called vexatious claims from being brought.  The reality is that for the first time since employment tribunals were introduced in the 1960s there will be charges imposed to deter those who have been badly treated or exploited by their employers.  The fees discriminate against the weak and the low paid.

Less important, but symptomatic of the way this Government pays lip-service to engagement and consultation are a series of consultation exercises launched in the last few days with closing dates for response at the end of August or in the first week of September.  Good practice would be that consultations should be open for up to three months – five weeks over the peak holiday period is designed to stifle responses.  The consultations cover such matters as pensions fro retained firefighters, the housing transfer manual, and various notices under the Gas and Electricity Acts (and yes, I don’t know what these are about, but they are no doubt complicated and take time to understand their implications).

I am not surprised by the Tories, but I hope the LibDems are ashamed of themselves.

Thursday
Apr 18,2013

A few weeks ago I asked “How often does Boris Johnson speak up for Londoners?”  The answer seemed to be not very much.  I had tabled a question in the House of Lords:

To ask Her Majesty’s Government what representations they have received from the Mayor of London in the last year on (1) health services in London, (2) housing provision in London, and (3) the impact of changes in welfare benefits on the people of London.[HL5797]“

The response I got was as follows:

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham): The Department of Health has held a number of discussions over the last year with the Greater London Authority, London Councils and the Local Government Association about the London Health Improvement Board. We recognise that there is potential for delivering health improvement services on a city-wide basis in London. The London Health Improvement Board has been meeting since July 2011.

The Localism Act conferred on the Mayor of London responsibility for housing, economic development and Olympic legacy in London, in addition to existing responsibilities over transport, planning and the police. Therefore, the mayor is responsible for housing and regeneration policy in London. The Department for Communities and Local Government has regular conversations with the Mayor of London and the Greater London Authority regarding housing provision in London. Over the last year these conversations have focused on a broad range of issues, such as funding and delivery of affordable housing, increasing investment in the private rented sector, getting surplus public sector land back into use and dealing with homelessness and rough sleeping.”

The answer was – as I pointed out –  notable in what it does not say.

There is no indication that the Mayor had spoken up on behalf of Londoners about the state of London’s NHS and the piecemeal closure of services that is taking place all over the capital.

And there was no mention whatsoever in the answer (despite its specific inclusion in the question) of any representations made by the Mayor on the impact of changes in welfare benefits on the people of London.

So I concluded:

“Boris Johnson has made plenty of public statements about not being nasty to bankers and the iniquities of high tax rates but apparently has little to say about the cuts in welfare and housing benefits that hundreds of thousands of Londoners will face in the next few weeks.”

However, in the interests of fairness, I thought I should seek further clarification in case the omission from the answer was a mistake by civil servants.

After all, this was the Mayor who in October 2010, while he was running for re-election as Mayor, had likened the effects of the housing benefit changes to “Kosovan-style ethnic cleansing“.

I therefore tabled another question in the House of Lords this time more specific that elicited the following response:

Lord Harris of Haringey:

To ask Her Majesty’s Government, further to the Written Answer by Baroness Hanham on 5 March (WA 397-8), what representations they have received from the Mayor of London, separately from the London Assembly, specifically on the subject of the impact of changes to welfare benefits on the people of London.[HL6517]

Lord Freud: We are not aware of any representations received in the past year from the Mayor of London, separately from the London Assembly, on the impact of changes to welfare benefits on the people of London.”

So the Department of Work and Pensions is not aware of ANY representations from the Mayor in the last year.

This demonstrates how little he really cares about what is now happening to many Londoners.

All he was prepared to utter was a single lurid soundbite in one of his rare media interviews. And then nothing.

No attempt to use the formidable statistical and information resources available to him at the Greater London Authority to put the case to his colleagues in Government.  Nothing at all.

Perhaps what it means is that now he has been re-elected he no longer feels the need to represent the interests of Londoners as his focus has moved on to winning over the Conservative MPs he needs for his next objective – to succeed David Cameron as Leader of the Conservative Party.  And not many of those Tory MPs care about hard-pressed Londoners damaged by the Government’ s policies on benefits.

Friday
Mar 29,2013

The House of Lords is now in recess for Easter.

However, forthcoming business for the period after the recess has now been published and on the 24th April the House will be debating the highly controversial “competition” regulations for the National Health Service.  That is likely to be the main business that day.

However, before the main course there is an aperitif: “Consideration of the 5th and 6th Reports for the Procedure Committee”.  The first of these contains some proposals to repeal three standing orders of the House.  The standing orders concerned date back to 1699, 1678 and (wait for it) 1675.  The Committee points out that these orders are now obsolete (in one case they were made redundant by statute over 300 years ago and in another by an Act of Parliament of 1840 – 173 years ago).

So there is no rush then …..

Wednesday
Mar 27,2013

The focus of that Eddie Mair interview was the question of Boris Johnson’s fitness for further office.  There was no real discussion of how well he has actually done in his current job as Mayor of London.

In the earnest spirit of inquiry I recently tabled a question in the House of Lords:

To ask Her Majesty’s Government what representations they have received from the Mayor of London in the last year on (1) health services in London, (2) housing provision in London, and (3) the impact of changes in welfare benefits on the people of London.[HL5797]“

The response I got was as follows:

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham): The Department of Health has held a number of discussions over the last year with the Greater London Authority, London Councils and the Local Government Association about the London Health Improvement Board. We recognise that there is potential for delivering health improvement services on a city-wide basis in London. The London Health Improvement Board has been meeting since July 2011.

The Localism Act conferred on the Mayor of London responsibility for housing, economic development and Olympic legacy in London, in addition to existing responsibilities over transport, planning and the police. Therefore, the mayor is responsible for housing and regeneration policy in London. The Department for Communities and Local Government has regular conversations with the Mayor of London and the Greater London Authority regarding housing provision in London. Over the last year these conversations have focused on a broad range of issues, such as funding and delivery of affordable housing, increasing investment in the private rented sector, getting surplus public sector land back into use and dealing with homelessness and rough sleeping.”

The answer is notable in what it does not say.

There is no indication that the Mayor has spoken up on behalf of Londoners about the state of London’s NHS and the piecemeal closure of services that is taking place all over the capital.  I doubt whether the remit of the London Health Improvement Board covers the configuration of health services in London and I have asked another question to clarify this.

And there was no mention whatsoever in the answer (despite its specific inclusion in the question) of any representations made by the Mayor on the impact of changes in welfare benefits on the people of London.

Boris Johnson has made plenty of public statements about not being nasty to bankers and the iniquities of high tax rates but apparently has little to say about the cuts in welfare and housing benefits that hundreds of thousands of Londoners will face in the next few weeks.

I wanted to seek further clarification from the Government by asking:

“Further to WA 5797, does the absence to a reference to representations from the Mayor of London in respect of changes in welfare benefits on the people of London mean that there were no such representations”

but have been told that that would be against the rules.

Instead, I have asked again what representations the Government has had from the Mayor specifically on the subject of impact of changes to welfare benefits on the people of London.

I await the answer, but I expect I know it already: Boris Johnson is more concerned about the very wealthy and about big bonus bankers than those who have to rely on what is left of our social security system.

 

Tuesday
Mar 26,2013

There are a few politicians who are so well-known that they are referred to a almost universally by their first names. Maggie Thatcher was one; John Major and David Cameron are not. It seems to be a requirement for those who become Mayor of London – think of the Ken and Boris show.

Jeremy Hunt clearly thinks he is part of that select band. His introduction to the Government’s response to the Francis Report on the events at Mid-Staffordshire Hospital is signed with a rather inappropriate flourish simply by him as “Jeremy”.

Perhaps this is intended as a subtle signal that he is available either as a replacement for the Prime Minister or as the next Conservative Mayoral candidate……

Monday
Mar 18,2013

This morning the Public Accounts Committee published a coruscating report on the continuing problems that HM Revenue and Customs have in answering the telephone.

On Saturday thousands marched through North London to protest at changes in the services offered by the Whittington Hospital.

What links these two events?

The answer is a former car parts company, Unipart, that now sells its services in promoting “efficiency” to public bodies.

Unipart advised HMRC on their processes.

Unipart advises the Whittington Hospital on how to cut its costs and shed staff.  One of the major proposals management there is implementing is to change the way in which the public can “interface with” the Hospital.

Excessive delays in answering the phone by HMRC are serious, but they are not usually life-threatening.

Answering telephone calls from patients and their relatives in a hospital may be.

The danger is efficiency proposals that work well in an industrial setting may not be suited to a public service on which the lives and well-being of people depend.

Friday
Jan 11,2013

Yesterday afternoon I initiated a short debate in the Moses Room of the House of Lords on the biological threats facing the United Kingdom, specifically I was asking “Her Majesty’s Government what arrangements they have in place to protect the residents of the United Kingdom against biological threats; and what measures they are taking to promote the international regulation of biological weapons and to ensure that security standards are sufficient in laboratories engaged in biological research around the world.”

The National Risk Register has in its top tier of risks facing the UK major natural hazards, such as a flu pandemic, but also includes as a serious threat in that top tier of risks a biological attack by terrorists.

As Lord Tony Giddens pointed out later in the debate:

“There are three sets of factors which make biological threats far more menacing than they were for previous generations. The first of these … is work in scientific laboratories that is designed to unpack the basic building blocks of nature but which can have spin-offs of a dangerous kind. … Secondly, there is the disruption to or destruction of the world’s ecosystems, releasing pathogens from their normal hosts. The process is normally known as zoonosis and it is one that is fraught with implications for human beings. Thirdly, … we have globalisation which can transmit pathogens almost immediately from one side of the world to the other.”

But the other big change that I had highlighted was the speed of technological advance that has taken place in the last ten or fifteen years in respect of genetic manipulation and as I explained:

“viruses are very simple. They are simply a capsule, often with perhaps 10 or 12 genes within them. The changing of just one gene within a virus can have a very profound effect on what that virus does: how easily it is transmitted, the extent to which it can be transmitted from an animal to a human being or between humans, and the consequences for the organism that is infected.

In fact, in 2001 the Journal of Virology published a research paper that demonstrated a whole number of ways of modifying the mousepox virus. This new virus was so effective that it overwhelmed the immune system of the test mice, causing massive liver failure and eventually killing the subjects. That reaction occurred even if the mice had been vaccinated against the mousepox virus. That was a legitimate scientific experiment—an effort to control the mouse population in Australia—but it demonstrated that a quite small change in a single gene with comparatively simple techniques could have major consequences.

These techniques are becoming more straightforward and all sorts of legitimate research is taking place in these areas around the world. Some of this could have the consequence of rendering a vaccine ineffective; some of it could confer resistance to therapeutically useful antibiotics and antiviral agents in pathogenic organisms; it could increase the virulence of a pathogen, or make it easier for that pathogen to be transmitted; or it could perhaps alter the range of hosts for that pathogen. A whole number of things are now technically possible that were not easily doable 10, 15 or 20 years ago. Entirely legitimate research on genetic manipulation and modification is of course going on all over the world for entirely benign purposes.

The question that I want to pose is: how well regulated around the world is that research? How confident can we be that other countries are applying the sorts of restrictions that we would wish to see? Some pharmaceutical companies may have an interest in carrying out experiments and developing their techniques in countries where the regulatory regime is far less intense than it might be in our own country.”

Biological weapons are outlawed under the Biological Weapons Convention, which has been signed by virtually every country in the world.  However, as I pointed out:

“although countries have said that they accept that they should not be developing biological weapons, the world has not set up what we might consider to be any effective system for monitoring compliance or verification. Some of the biggest and most powerful countries—the United States of America, for one—are extremely dubious about setting up any external system to monitor their own compliance and do not necessarily see the need for a supervisory body.

The US, for example, clearly has no official bioweapons capability but has constructed a huge research base, in many different centres around the United States, under the National Biodefense Analysis and Countermeasures programme. That is undertaking, no doubt quite properly, genetic research, development and testing. However, if the United States says, “We are not happy with our compliance with the Biological Weapons Convention ever being tested by anybody else”, it is very difficult to see how that could be enforced on other countries.

Scepticism also persists about whether Russia’s offensive bioweapons capabilities have been completely dismantled. There are, I think, five Russian military bioweapons facilities which remain closed to outside inspection. Many of the officials linked to their current defensive programme are the same officials that developed Soviet offensive capabilities during the Cold War. There is a question again about how secure those facilities are, particularly as we know that regimes change and that certain parts of the world become less stable as things move forward.”

I also warned that:

“There is clearly a risk that stocks of materials developed for one purpose could be misused or fall into the hands of terrorist groups or, potentially, rogue regimes.”

And concluded as follows:

“In responding, can the Minister first say what is being done to improve supervision of these matters? Secondly, what is being done to regulate the security of scientific establishments, including those that hold stocks of pathogens? It all ends with a fundamental question. We are at risk, as a nation, from a pandemic of whatever sort and from whatever origin, whether naturally or unnaturally occurring. Are we really satisfied that our emergency and health services are able to withstand that?”

The Minister who responded was Lord Wallace of Saltaire who acknowledged that:

“This is an important subject, and both a domestic and international one. We are concerned with the potential of a terrorist attack and the very distant potential of a global state attack. … We are also concerned with the possibility of accidental release from badly secured laboratories.”

Being a LibDem Minister he could not avoid taking the opportunity to snipe at his Conservative Coalition colleagues, saying:

“This is an area of domestic and international overlap. I would not discourage noble Lords from pointing out, as we deal with the intensely emotional issue of the defence of British sovereignty from European and other interference, that this is one of many areas where you cannot have entirely different British and foreign issues. We have to have international co-operation and, as far we can, regulation.”

He did confirm that:

“The Government are deeply committed to protecting the United Kingdom from biological threats. That requires us to have strong measures at home and co-operation abroad.”

but warned that:

“There is resistance to a strong international compliance programme … it is not simply from the United States, let alone from the American pharmaceutical industry, but from a range of other countries that I will not go through. For many of them it is a question of sovereignty and, for one or two south Asian countries, of suspicion of the West. There are limits to what we can achieve and we have to work as far as we can through education, co-operation and providing assistance. I also note that we are working with our partners inside the European Union through the establishment of centres of excellence with regional centres around the world to build this level of co-operation.”

His basic message was:

“There are some real problems here … this is a very complex area.”

And he concluded  - rather strangely for a Government Minister – with:

“I shall finish by saying that we need to keep on challenging our Government and even more so other governments.”

We?!

So I suppose those of us who took part in the debate were being told: keep on nagging us and maybe we (the Government) will finally take this as seriously as it deserves.

If you want to read the full debate it is here.

Thursday
Nov 22,2012

Last night in the House of Lords (in between the debates on the Justice and Security Committee which led to the Government’s proposals on so-called secret courts being savaged) there was a debate on the regulations that set out how the Chair and members of the committee of Healthwatch England are to be appointed as a sub-committee of the Care Quality Commission.

The regulations are controversial because the subservience or apparent subservience of Healthwatch England to the Care Quality Commission undermine the independence of Healthwatch England as the national body representing patients’ interests – particularly as part of its job in the future may be to raise, on behalf of patients, questions about how the Care Quality Commission has carried out its functions.

The Minister’s response was pretty unimpressive – essentially that the initial appointments made to Healthwatch England were so good that there would never be any problems in the future.

You can read the full debate here.

My contribution was as follows:

Lord Harris of Haringey: My Lords, I am pleased to have the opportunity to follow the noble Baroness, Lady Jolly, on this Prayer. She has highlighted the weakness in the Government’s position. I am confident that the people who have set up Healthwatch England are of good will and that they intend and wish it to work; that Anna Bradley will be an excellent person as chair of Healthwatch England; that the outgoing chair of the Care Quality Commission is committed to making it work; and that the chief executive of the Care Quality Commission is committed to making it work. I even believe that Ministers in the Department of Health are committed to making it work.

The problem is that we are provided with a framework of regulation which does not guarantee that in future. One or two appointments down the road, with a new leadership of the Care Quality Commission and, perhaps, with different Ministers at the Department of Health, how will those things be ensured, especially if budgets remain tight and Healthwatch England starts to be effective and makes criticisms which are difficult for Ministers-or, worse still, in this context, for the Care Quality Commission? That is when those problems may arise.

That is why, when the Bill was passing through this House, there was so much concern about the importance of independence for the Healthwatch structure. My concern is that, given that the legislation has passed, this is a wasted opportunity to make it stronger.

One of the lessons that is expected to come from the Mid-Staffs inquiry relates to independence. The report is expected to identify the systemic failure of organisations to focus primarily on the needs of the patients of that hospital. Because each was looking at its own area, nobody was taking the step back to say, “How does this work from the point of view of patients?”. That is where Healthwatch should come in and be influential: to cut through the complicated organisational structures which the Health and Social Care Act has bequeathed to the NHS. That is why the simple issue of how it preserves its independence is so vital.

When the Bill was going through Parliament, the noble Earl held a meeting to discuss how Healthwatch England should work. He made the point that there would be valuable synergies from Healthwatch England being located within the Care Quality Commission. He did not stress, but it was clearly part of the equation, that there would also be some useful cost savings associated with that. The cost savings could be achieved in a whole variety of ways. It would be possible to have an agency agreement whereby some of the back office functions were provided by the Care Quality Commission or any of the plethora of structures that the Health and Social Care Act has bequeathed to the NHS. Similarly, because the duty of co-operation exists, you would hope that those synergies could be activated without the need for the Healthwatch organisation to be subservient to the Care Quality Commission. It would have been possible in these regulations to create a structure which, while preserving the general framework of the Act, would ensure that there was independence.

If we look at the regulations that we have before us, we see a number of flaws. First and foremost, for example, is the size of the Healthwatch England committee. Potentially, this will be a committee of as few as six members. I appreciate that in the initial instance it is larger than that, because people of goodwill are trying to make this structure work. However, in three, four or five years’ time there may not quite be the same atmosphere or there may be a feeling that the wings of Healthwatch England need to be clipped back. In any event, with six to 12 members it is going to be extremely difficult to ensure that there really is the geographical diversity that is necessary; the coverage of all the many major areas of special need that exist as far as health and social care is concerned; and proper recognition of ethnicity and gender within that. Again, the initial membership has provided a reasonable attempt to achieve that diversity, but where is the guarantee of that in the future?

I know there is a feeling that small boards work well. The noble Baroness, Lady Cumberlege, who is not in her place on this occasion, has talked to us glowingly about the value of having small, dynamic boards to run organisations but this is a different sort of organisation. It is supposed to be one that represents the generality of the interests of patients across the whole country and which derives its authority from what is happening in local Healthwatch organisations around the country-the 150-odd local organisations that will exist. It is therefore not appropriate to have a small board in such a case, as it is not the same sort of structure.

Then we have the rather strange arrangements for the appointment process. In the first instance, the chair of Healthwatch England has to get the approval of the chair of the Care Quality Commission before appointments can be made. The future arrangements are that the chair will make the appointments directly but let us be clear: the chair of Healthwatch England is a Secretary of State appointment and has the potential to be the poodle of the Department of Health. I have been in the position of being in charge of the organisation representing patients and I remember successive Secretaries of State, from two parties, making attacks on the organisation because we were being effective and raising issues that were uncomfortable.

Under those circumstances, can we be satisfied with a future arrangement whereby the Secretary of State solely makes the appointment of that individual, who then appoints all the other members of the Healthwatch England committee? In the initial stage, you have a double lock where the chair of the Care Quality Commission gets involved but in future you will have someone who might be appointed as a poodle or to muzzle the watchdog nature of Healthwatch England appointing individuals who are, no doubt, like-minded. That is why the arrangements are strange.

We then have the provision for suspending members, which is set out here. Presumably, the suspension is different from disqualification but the Secretary of State may dispense with the chair of Healthwatch England for a variety of reasons, which includes,

    “failing to carry out those duties”.

Who is going to determine what those duties should be? Essentially, we are being told that the Secretary of State will decide what he or she thinks is appropriate for Healthwatch England to be carrying out. Again, the chair then has similar powers in respect of individual members. I make a specific request of the Minister: that in his reply he spells out absolutely that it will not be appropriate for either the chair or the members of Healthwatch England to be suspended from their membership if they are pursuing their interpretation of what is in the interests of patients and their organisations, and the people that they represent.

Because of the requirement saying that the chair of Healthwatch England must be a member of the board of the Care Quality Commission, we are inevitably creating that subservient relationship. Will the chair of Healthwatch England be subjected to, in essence, the collective responsibility of the members of the board of the Care Quality Commission? There have been recent issues with the membership of that commission’s board, where the chair has taken a different view about what the role of individual members should be. That has led to conflict and serious problems.

Let us pan forward a few years: if the chair of the Care Quality Commission does not like the approach being taken by the chair of Healthwatch England, are they then able to say, “You are not fulfilling your duties as a member of the board of the Care Quality Commission because you are not abiding by the collective responsibility of that board’s members. I am therefore asking the Secretary of State to remove you from office and suspend you because you are not fulfilling your roles”? Even if that does not happen we will have, as my noble friend Lord Collins said earlier, the appearance of potential conflict of interest. Ultimately, how are the public going to have confidence in a structure where it looks to them as though the leadership of Healthwatch England is subservient to the Care Quality Commission, one of those important agencies about whose effectiveness it may have to make criticisms?

We should remind ourselves that the aim of all this is to enhance the collective voice of patients in the NHS. You will succeed in doing that only if the public at large have confidence in the structures that you have created. If you build into them the appearance of subservience and potential conflicts of interest, you are weakening that voice. That cannot in any way be in line with what either your Lordships would expect to see from this, or indeed with what I believe Ministers’ intentions to be as far as Healthwatch England is concerned.”