House of Lords: Future Location

Debate between Earl Howe and Lord Harris of Haringey

Monday 20th January 2020 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. To get back to the serious core of the Question, this issue has been debated many times in your Lordships’ House and, indeed, the other place. I have no doubt that the conclusion reached by both Houses—which was unanimous, incidentally—will be factored into the discussions currently under way.

[Lord Harris of Haringey (Lab)]

The Minister is held in very high esteem by this House and therefore we have enjoyed his responses to these questions, particular given the flimsiness of the contents of the folder in front of him. I notice that he suggested that minds greater even than his might be considering these matters, and that is a point of some substance. Could he tell us whether his noble friend the Lord Privy Seal was briefed in advance of the statements being made about the intention for your Lordships’ Chamber?

[Earl Howe]

I am not aware that she was, but I shall ask her.

Intelligence and Security Committee of Parliament: Special Report

Debate between Earl Howe and Lord Harris of Haringey

Monday 4th November 2019 Lords Chamber

[Earl Howe]

My Lords, these are indeed extremely topical and important matters and I do not depart in the least from the premise that the noble Lord has articulated. In the UK, we have seen no evidence of successful interference in our democratic processes, but we are not complacent. We know that there are those who would wish to do us harm and try to divide us, but I can say without equivocation that that will always be met with a robust response. My right honourable friend the Prime Minister is no less committed to ensuring the integrity of the electoral process than is the noble Lord himself.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister is being very careful in his choice of words. He is conflating the process by which government as a whole has to consider the report, and that includes a process by which the various agencies have the opportunity to ask for various things to be redacted. That is widely understood, so unless the noble Earl is able to confirm that that is not the case, those agencies have agreed what redactions are necessary. Given that, the only item remaining is the Prime Minister’s approval and therefore the only issue is this: has the Prime Minister not had the time over the past fortnight, or is there something in the report which he feels would be embarrassing if put in the public domain now?

[Earl Howe]

My Lords, no. This matter rests entirely with the Prime Minister. Of course, agencies have a role to play but, in the end, it is his decision and he is entitled to take that decision in his own time, in accordance with the security considerations that he perceives in the report.

Metropolitan Police: Use of Section 14 of the Public Order Act 1986

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 16th October 2019 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords—

[Earl Howe (Con)]

My Lords, as I am sure we all agree, it is up to noble Lords to give way to each other. I would not wish to rule between the noble Lords, Lord Harris and Lord Mackenzie.

[Lord Harris of Haringey]

My Lords, as the second Labour contributor to this, may I ask my question? First, will the Minister praise the Metropolitan Police for the fact that, for the first few days of the protest, it was very happy to facilitate legitimate protest even if some of us found it highly inconvenient? Will she also clarify something? She has said throughout that this is an operational matter. I have been in the room when these kinds of things have been discussed. Of course it is an operational decision, but can she tell us whether Her Majesty’s Government expressed a view to the Metropolitan Police on what should happen?

UK Territorial Seas: Incidents

Debate between Earl Howe and Lord Harris of Haringey

Thursday 14th June 2018 Lords Chamber

[Earl Howe]

I would be more than happy to meet interested parties to discuss those concerns. This is an important element in the tapestry of activity on which we depend for maritime security. It is important to emphasise, as the noble Baroness is aware, that we rely not just on aerial surveillance, space-based systems, radar and so on, important as those things are; human intelligence is often important as well. There is now a network of field intelligence officers working for Border Force around the country. I would be happy to take this matter forward with the noble Baroness.

[Lord Harris of Haringey (Lab)]

My Lords, I too am grateful to the noble Earl for the briefing that was provided yesterday. The improvements that have come with the co-ordination activity are welcome, but it is co-ordinating limited resources, as the noble Earl has admitted. He talked about it being intelligence led. Perhaps he cannot share it with us, because it would be difficult, but can he ensure and guarantee the House that he, as the relevant Minister, will have an intelligence assessment of what is actually required to prevent illicit materials, guns, people and so on entering the country, and whether that is sufficient given the resource that is available?

[Earl Howe]

My Lords, Ministers collectively will have that picture presented to them because, as I have explained, it is not just the Ministry of Defence that is involved in this sector. The Royal Navy is deployed, as noble Lords will be aware, very much in a supportive role to many of the other agencies. But I entirely take the noble Lord’s point. He may be interested to know that UK Border Force has introduced into service six new coastal patrol vessels in addition to the five cutters already in service, while continuing to call on a maritime patrol aircraft contract for aerial surveillance. But that is not the end of the story: we are looking at future needs across the piece.

Multilateral Disarmament

Debate between Earl Howe and Lord Harris of Haringey

Monday 28th November 2016 Lords Chamber

[Earl Howe]

I completely take the noble Lord’s point. It is early days to be thinking in those terms, although he is right to do so. It is encouraging that the November IAEA report to the board of governors confirmed that Iran remains compliant with the nuclear-related measures set out in the joint comprehensive plan of action. We welcome the findings of the DG’s report. We praised the IAEA for its progress and continued work on that very challenging task, but no doubt lessons and messages will emerge from that strand of work.

[Lord Harris of Haringey (Lab)]

My Lords, the noble Earl has talked about the need to move towards multilateral disarmament, but there are stocks of fissile material in various parts of the globe. How confident is he that those stocks, which could be turned into nuclear weapons, are sufficiently secure to avoid them falling into the hands of aspirant nuclear powers or, worse still, non-state actors that might wish to possess such materials?

[Earl Howe]

My Lords, that is clearly a constant concern and the noble Lord is right to raise it. Against that background, the UK continues to push for the early start of negotiations, without preconditions, on a fissile material cut-off treaty in the Conference on Disarmament. We supported a Canadian-backed resolution at the United Nations first committee on that topic, in October. In this country we have a voluntary moratorium on the production of fissile material for nuclear weapons or other explosive devices. We have not produced fissile material for nuclear weapons since 1995.

Investigatory Powers Bill

Debate between Earl Howe and Lord Harris of Haringey

Report: 3rd sitting (Hansard): House of Lords
Wednesday 19th October 2016 Lords Chamber

[Earl Howe]

We come back to the test of reasonable practicability here. I am about to come on to what the Bill does not provide for on encryption and I hope that this will help the noble Lord.

The Bill does not ban encryption or do anything to limit its use. The Bill will not be used to force providers to undermine their business models, to create so-called back doors or to compromise encryption keys. It will not be used to prevent new encrypted products or services from being launched and it will not undermine internet security.

[Lord Harris of Haringey]

I am very grateful for the detailed exposition that has been given. The Minister says that the Bill will not be used to do those things. Can he confirm that it cannot be used to do those things?

[Earl Howe]

My Lords, some noble Lords have suggested the Bill’s provisions cause a weakening in encryption, which I think is the central point that the noble Lord is getting at. Many of the biggest companies in the world rely on strong encryption to provide safe and secure communications and e-commerce, but retain the ability to access the content of their users’ communications for their own business purposes, such as advertising, as we have heard. These companies’ reputations rest on their ability to protect their users’ data. This model of encryption can, and does, maintain users’ security. I do not think that anyone would dispute that.

Before I come on to the individual amendments, it would be helpful to address a number of specific points that were raised in relation to encryption. There was a suggestion that a company should never be asked to do something that it does not already do. Such an approach would of course, at a stroke, remove our ability to use any of the powers in the Bill, including carrying out any interception of terrorists’ and serious criminals’ communications, because companies do not do this in the normal course of their business.

There was a suggestion that equipment interference would do away with the need for these provisions. It will not. Equipment interference is no substitute for having a company’s assistance. Even if it were, there are only a very small number of very clever people who are able to carry out equipment interference. There will never be the capacity to deploy them on each and every operation.

Finally, there was a suggestion that encryption is not a problem for the security and intelligence agencies. The heads of those agencies have repeatedly made clear that ubiquitous encryption is one of the most difficult challenges they face.

I now turn to the individual amendments, because I hope that this will clarify the picture further. Amendment 251 seeks to preclude an obligation to remove encryption from being imposed under a technical capability notice in relation to end-to-end encrypted services. I hope that the points I have already made make clear why the proposed amendment is not necessary and indeed why it is not desirable. As I have set out, the Government recognise the vital importance of encryption. Nothing in the Bill does anything to limit its use, and that of course includes the use of end-to-end encryption. But I have also set out the dangers of creating a guaranteed safe space online for those who would seek to do the public harm such as terrorists and other serious criminals, and I am afraid that that is exactly what this amendment would do. The amendment seeks to make explicit provision in law for there to be certain online services that criminals can use to go about their business unimpeded with no fear of being caught. That is not a position that any responsible Government or, I hope, Parliament could support.

What we must ensure is that the Bill enables us to work collaboratively with individual telecommunications operators to establish what steps are reasonably practicable for them to take, considering a range of factors including technical feasibility and likely cost. Any decision will have regard to the particular circumstances of the case, recognising that there are many different models of encryption, including many different models of end-to-end encryption, and that what is reasonably practicable for one telecommunications operator may not be for another.

As I have already said, this is not about asking companies to undermine their existing business models; it is about working with them to find a solution to ensure both that their customers’ data remain secure and that their services cannot be exploited by individuals who pose a threat to the UK. So in answer to the question put by the noble Lord, Lord Harris, I can confirm that these provisions cannot be used to introduce back doors or undermine internet security.

--- Later in debate ---

[Earl Howe]

We already have a wide range of safeguards which I have listed. I do not see that it is necessary to go down the road the noble Lord is advocating because of the dangers that I have pointed out. These amendments would create safe spaces which I am sure that neither he nor any noble Lord would desire to occur.

[Lord Harris of Haringey]

My Lords, I am enormously grateful to the noble Earl for his detailed response and for reiterating the welcome and voluminous safeguards that are set out in the Bill. They are important and valuable, and they give me confidence about the context of the whole Bill. However, the argument with which he concluded does not quite hold together and there is an elision between different issues. The noble Earl has given an absolute assurance, I think on the basis of a piece of paper that was handed to him, that it cannot be used to require a communications service provider to build a back door or to create one in a future area. But then he said that we must not put in the Bill something that creates a safe space. Either the Government’s position is that this cannot be used to require a company to produce a back door, in which case the safe space exists and presumably the Government are not happy with their own legislation, or it is the case that the Bill could require a communications service provider to build such a back door.

We have already heard from the noble Lord, Lord Evans of Weardale, that what we are trying to do here is balance two national security concerns: the national security concern to prevent terrorism and so on and the national security concern about making it slightly easier for cybercriminals. These are very important issues. If the Government are clear that, as a result of the Bill, a technical capability notice could not require an operator to build a back door that would otherwise not exist, it is important to set that out in the Bill. If we are in a position where techUK says—as it has in the briefing it circulated to me and, I am sure, to other noble Lords—that this is ambiguous, perhaps it is the responsibility of the Government to remove that ambiguity and make the position clear. I do not really want to have to divide the House on this matter, so between now and Third Reading, is the noble Earl prepared to turn the unequivocal assurance he has given that it cannot be used in this way into an amendment to the Bill that will remove that ambiguity?

[Earl Howe]

With the leave of the House, I hope I can help the noble Lord on this because I do not believe that the Bill is contradictory. First, the term “back door” has been used, but I do not think that is a helpful or accurate way of describing the Bill’s provisions. “Back door” is in everyone’s judgment a loosely defined term. It is used incorrectly to imply that the Bill would enable our law enforcement, security and intelligence agencies to gain unrestricted access to a telecommunications operator’s services or systems, thereby undermining the security of those services—to force that to happen. That is absolutely not the case. The Bill enables our agencies to require telecommunications operators to remove encryption themselves, only in tightly defined circumstances: where they have applied the encryption themselves; where it has been applied on their behalf; where it is reasonably practicable for them to remove it; and where doing so is required to comply with a relevant warrant, notice or authorisation.

I come back to the point I made earlier. This is about the Government being able to sit down with companies and reach agreement with them on the basis of what is reasonably practicable, affordable and so on. It would not be responsible for any Government to deny themselves the possibility of doing that and discussing what in all the circumstances is reasonably practicable for the company, and for the company to agree to do it.

[Lord Harris of Haringey]

Again I am grateful to the noble Earl. I do not think anyone here has misunderstood the point that this is not about giving the Government uninterrupted access. It is about requiring companies to create a facility so that if they are asked, after all the suitable warrants have been gone through and all the safeguards have been fulfilled, to gain information and pass it back to the Government. I accept that that is the position and that is what is intended here. However, the Minister has still not been unequivocal on whether technical capability measures could require such a facility to be created, so that, in those circumstances and with all those safeguards in place, something could be done. It is a critical issue that we need to clarify. Otherwise, we do not know where we stand as far as the amendment is concerned. The Minister needs to provide the House and the IT industry with as much clarity as he can on this point, because the danger is that it will become the subject of continual argument.

Were the Bill to be amended by any of the amendments in this group, the Government would still have the option to say that they were minded to serve a technical capability notice on a particular company. That would then trigger a series of discussions, because it is what the Bill provides for, and a communications service provider might come back at that point and say, “Look, we literally cannot do it. We do not have the facility”. However, it is not clear whether the Government could none the less say, “Well, we understand that, but we are requiring you to do it”. The question then is: what is or what is not feasible? I happen to believe that some of the biggest communications service providers in the world have more computing expertise than any nation state. If they are told, “You are legally required to do this”, they could do it; they could find a way of making it happen. We have to be explicit as to what the Government’s expectation is. Are they saying, “No, that is not what we are requiring”, or are they saying, “Well, we might”? If they are saying, “We might”, that clarifies the position, if not helpfully. If they are saying, “No, we are not”, which is what the Minister said earlier, perhaps we could put that in the Bill—if not in the form of words proposed, then in some form of words that the Government could craft between now and next week. That would be a helpful way forward and provide absolute clarity as to the extent to which technical capability notices could be served. If I am not able to get that assurance from him—I appreciate that bits of paper have been flying backwards and forwards between him and the Box—we are in a very difficult position.

[Earl Howe]

I can state categorically to the noble Lord that it is absolutely not the case that the Bill would force a company to insert a back door, thereby undermining internet security. We might ask a company in certain circumstances to decrypt particular data if it was reasonably practicable and feasible for them to do so.

[Lord Harris of Haringey]

My Lords, I understand that that is the case; that is, if they have the encryption key—we will not use “back door”; we will find another form of words—and the capability to do it, and it is not too complicated and all the relevant warrants are in place, yes, they will do that. As I understand it, most tech companies are perfectly understanding of that and willing to do it. The question is whether, if the Government were presented with a situation they were concerned about, they could say to one of the biggest communications service providers in the world, “We are asking you to build something which is not there at the moment, but we’ll provide that facility for those circumstances that might arise in the future when we’ve gone through all the relevant warrants and so on”. I am looking for an assurance from the Minister that that is not sought here, because of the dangers that we have already discussed. If he wishes, I can reiterate the question to give the Minister the opportunity to read the piece of paper that has just arrived.

[Earl Howe]

Of course, a technical capability notice can require a new capability to be built; that is what they are there for. If it was neither practicable nor feasible, they would not have to do it. The problem here is that it is very difficult to generalise, because any decision about these things would have to have regard to the particular circumstances of the case. As I said, there are many different models of encryption, including many different models of end-to-end encryption. Any decision has to recognise that what is reasonably practicable for one telecommunications operator may not be for another. That is why I have referred repeatedly to the need for the Government and industry to have that easy interchange which they do at the moment. It is important to emphasise that these powers already exist in law today. We should not do anything that undermines the basis for the constructive discussions that we are having.

[Lord Harris of Haringey]

The Minister reminds us that the ideal arrangement is one of easy interchange and discussion—I understand that that carries on and works very well. He is right to say—this is why the wording of the current legislation is ambiguous and therefore a problem—that building a technical capability could mean simply putting in a piece of equipment, which means that, at the point at which the Government ask, having gone through all the voluntary processes, it is quite a straightforward matter to provide the information that the Government have legitimately and lawfully requested. That is one definition of technical capability.

What I want to know is whether “technical capability” could apply to a very secure end-to-end encryption process which no communications service provider could break but where, if they devoted thousands of person hours in California or wherever they operate from, they could develop something which might do that. If that is what the Bill is saying, we need to know.

[Earl Howe]

That would not be reasonably practicable in that particular example.

[Lord Harris of Haringey]

I accept that it would not be reasonably practicable; it would also be very expensive—as I understand the Bill, the Government would have to pay for it and I am sure that technical experts in California or wherever might be very expensive. If that is the case, and if it is not possible to write it into the Bill—I would have thought it could be—it would be helpful for the Minister to write and make very clear what the Government’s intentions are in that regard and confirm that such circumstances are precluded by the Bill. If the Minister is prepared to do that, I am prepared not to press the amendment to a vote.

[Earl Howe]

I think I have made the Government’s position as clear as I possibly can and I am not sure what I can do to amplify the remarks I have already made. While I want to be as helpful as possible to the noble Lord, I am struggling to see how a letter from me would make the position clearer.

[Lord Harris of Haringey]

I understand the Minister’s dilemma and I am sure that a letter from him to me would have far less force than the words appearing in Hansard. I appreciate that the courts can look at the debates in Hansard to try to interpret them. However, I ask that the Minister spends the next few days just thinking about some further modification to the Bill to make sure that this ambiguity, which I think genuinely exists—because techUK tells me so—is cleared up. On the basis that I am sure he will spend his waking hours between now and next Monday thinking about precisely these matters, I beg leave to withdraw the amendment.

Investigatory Powers Bill

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 13th July 2016 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords, first, I should draw attention to my interests in the register on policing and counterterrorism matters. Secondly, I should make clear that my starting point on the Bill is that it is important that the developing gaps in access to communications data are addressed to protect the nation against all sorts of threats.

In any set of counterterrorism or counterespionage measures, or whatever else it might be, you have to look at the balance and weigh the benefit to the nation in protecting its citizens by having those powers against the potential downside or consequences of exercising them.

When we come to the question contained in this group of amendments—essentially about enabling or requiring companies to break the apparent encryption—we have to look carefully at the potential downsides presented by this. The first downside, or danger, is that by enabling this to happen—by creating the mechanism and requiring companies, as my noble friend Lady Hayter said, to make new arrangements so that encryption can be broken—you create a back-door mechanism. This would be available not just to the forces of good—those who are trying to protect all our security—but to cybercriminals and those who would do us ill. Therefore you need to weigh clearly what you are trying to do against whether you are creating something that will make it easier for criminals and those who would do us harm.

The second element is the extent to which what we do in this country sets a precedent that will be seized in other countries, whose interests may not be the same as ours or as positive as ours towards their citizenry. If we create that precedent, what is to prevent Governments in other countries saying that they want the same powers and therefore doing the same? That test has to be applied to quite a number of the measures in the Bill. As I say, my starting point is that I want the state to be able to fill the gap in its access to communications data that is emerging and opening up. However, I want to hear from the Government a clear explanation of why in this set of cases the benefits outweigh the potential disbenefits.

[Earl Howe]

My Lords, a number of amendments here separately seek to remove the encryption provisions from Part 9 or propose modifications to them.

I will begin with Amendments 92, 102 and 103, which propose removing the encryption provisions from Clauses 226 and 228. If these are anything other than probing amendments, I have to say that they are irresponsible proposals, which would remove the Government’s ability to give a technical capability notice to telecommunications operators requiring them to remove encryption from the communications of criminals, terrorists and foreign spies. This is a vital power, without which the ability of the police and intelligence agencies to intercept communications in an intelligible form would be considerably diluted.

Let me be clear: the Government recognise the importance of encryption. Encryption keeps people’s personal data and intellectual property secure and ensures safe online commerce. The Government work closely with industry and businesses to improve their cybersecurity. However, law enforcement and the intelligence agencies must retain the ability to require telecommunications operators to remove encryption in limited circumstances—subject to strong controls and safeguards—to address the increasing technical sophistication of those who would seek to do us harm.

Encryption is now almost ubiquitous and is the default setting for most IT products and online services. If we do not provide for access to encrypted communications when it is necessary and proportionate to do so, we must simply accept that there can be areas online beyond the reach of the law, where criminals can go about their business unimpeded and without the risk of detection. That cannot be right.

These provisions simply maintain the current legal position in relation to encryption and go no further. They retain the ability of law enforcement and the security and intelligence agencies to require companies to remove encryption that they have applied, or that has been applied on their behalf, in tightly prescribed circumstances. It would not—and under the Bill could not—be used to ask companies to do anything that it is not reasonably practicable for them to do.

The safeguards that apply to the use of these provisions have been strengthened during the Bill’s passage through Parliament. First, the “double-lock” authorisation process now applies to the giving of notices, which means that a judicial commissioner must approve the Secretary of State’s decision to give a notice. The Secretary of State must also consult the relevant operator before a notice is given. The draft codes of practice, which were published alongside the introduction of the Bill, make clear that should the telecommunications operator have concerns about the reasonableness, cost or technical feasibility of any requirements to be set out in the notice—which includes any obligations relating to the removal of encryption—it should raise them during the consultation process. Furthermore, the new privacy clause in the Bill requires that regard be given by the Secretary of State to the public interest in the integrity and security of telecommunications systems when deciding whether to give a technical capability notice.

--- Later in debate ---

[Lord Harris of Haringey]

My Lords, can the Minister clarify for me—I am sure that other noble Lords have got to the point precisely—that the requirements that the Bill seeks to create will apply only where a service provider has offered a service which most people might assume is secure and encrypted but has built in an existing arrangement which allows it to access it? Would it apply only in those circumstances? If that is not the case, perhaps the Minister could explain in what other circumstances it might apply. Can he further tell us whether there is an expectation in the Bill that, where a service provider is developing a new service, it must ensure that it has the facility to access what the user would assume are encrypted data?

[Earl Howe]

The answer to both questions is that it depends on what is reasonably practicable for the communications service provider. The power will apply usually to encryption that the provider has applied or has been applied on its behalf. If there are other circumstances where it would apply, I will take advice and write to the noble Lord, but we come back to what is reasonably practicable for the company. It is why the Government maintain a dialogue with communications service providers to ascertain what is practicable and what is not, and what would be cost effective and what would not be. However, broadly speaking, the noble Lord was right.

[Lord Harris of Haringey]

I am sorry to press the point, but I need to understand it. I understand the Minister’s answer in respect of the requirement applying where it is reasonably practicable because the encryption arrangement has been applied by the service provider, but is he saying that there is an expectation that in building new services a service provider should create something where it is technically possible for it to undermine that encryption? If so, that would raise a very different point which is important to clarify. Is the service provider required to make it technically practicable in future services as it develops them for this to be allowed?

[Earl Howe]

It might be, but it might not be. Again, it depends on what is reasonably practicable in the particular circumstances. Those circumstances might vary from provider to provider and from situation to situation, so it is not possible for me to generalise about this, but I will take further advice and write to the noble Lord about it.

--- Later in debate ---

[Earl Howe]

I was certainly not implying that the Government wished to ban end-to-end encryption; in fact, we do not seek to ban any kind of encryption. However, there will be circumstances where it is reasonably practicable for a company to build in a facility to de-encrypt the contents of communication. It is not possible to generalise in this situation. I am advised that the Apple case to which the noble Lord referred could not occur in this country in the same way.

[Lord Harris of Haringey]

Is the Minister therefore saying the Government’s expectation is that service providers will in future ensure that it is reasonably practicable for them to access those communications? If that is the case, I think that he is raising a whole new group of issues.

[Earl Howe]

The Bill is clear that any attempt to obtain communications data must be necessary and proportionate, or it will not be permitted. It is crucial that the Bill provides a robust, legal framework which means that the law is consistently applied correctly. That is why we are introducing the double lock involving judges signing off warrants for the most intrusive powers, which means that the Secretary of State’s decisions, other than in the most urgent cases, will be independently scrutinised before warrants can be issued. I come back to the central point here, which relates to encryption: we do not think that companies should provide safe spaces to terrorists and other criminals in which to communicate. They should maintain the ability when presented with an authorisation under UK law to access those communications.

NHS: Financial Tariff for 2015-16

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, no, Choose and Book will not be affected, although NHS England has plans to update it to make it a much richer and more informative system.

[Lord Harris of Haringey (Lab)]

My Lords, given the appalling performance of ambulance services—certainly in London, and, I suspect, in the rest of the country—what steps are the Government taking to ensure that the tariff means that people will receive the emergency call-outs that they would expect on the basis of the funding that should be being made available?

[Earl Howe]

This is part and parcel of the discussions going on at the moment. There is a balance of interests here—above all, the interests of NHS patients, but within the system, the interests of those who hold the budget and the interests of those who provide the service. The risks relate, on the one hand, to affordability, and, on the other hand, to financial and service stability, and the need not to sacrifice quality in the process.

NHS: Health and Social Care Act 2012 Reforms

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 22nd October 2014 Lords Chamber

[Earl Howe]

I agree with my noble friend that the integration of health and social care services has a major part to play in making the system more efficient across the piece and more effective for the patient. That is why we are introducing the better care fund, which, at a local level, will channel at least £3.8 billion into pooled budgets to deliver that integration.

[Lord Harris of Haringey (Lab)]

My Lords, if the system is quite as wonderful as the noble Earl suggests, will he explain why so many people are waiting so much longer in accident and emergency departments and why so many young doctors completing their GP training decide to leave the country and practise overseas rather than participate in the grotesque mess that this Government have produced?

[Earl Howe]

I take issue with the phrase “grotesque mess”. If the noble Lord cares to look at the figures, he will see that waiting times are low and stable, MRSA and C. diff infections are at record lows, mixed-sex wards are down by 98% and the number of people waiting a long time for treatment is massively reduced. Yes, we know that many A&E departments are under pressure but many are coping. The work that we are doing, including channelling more money into the system for this winter, should, we hope, relieve the worst of the problems.

Health: Local Healthwatch Funding

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 19th March 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

The Government have made no assessment. We welcome transparency in funding for local Healthwatch—something we called for in response to the Francis inquiry report—and Healthwatch England’s findings are a helpful contribution to that. We remain of the view that local authorities are best placed to decide local funding arrangements based on local needs and priorities, which is why the funding made available to them is not ring-fenced for a specific purpose.

[Lord Harris of Haringey (Lab)]

So the noble Earl is telling the House that £10 million—almost a quarter of the money that his department allocated for local Healthwatch—has disappeared midway through the Department for Communities and Local Government to local government and not reached local Healthwatch. Was that not predictable and predicted? Why do the Government not now recognise that providing a local voice for the users of the health service is critical to the development of the health service and ensure that the funds are channelled through Healthwatch England for it to commission local services? If they cannot do that because it would require legislation, perhaps the Government could publish an indicative statement of what each local authority ought to be spending on local Healthwatch.

[Earl Howe]

My Lords, I would say that it is not the role of the Government to dictate what local authorities should be doing. It is up to local authorities to make judgments about what are the needs and priorities of their areas. I would also say that there cannot really be any direct comparison between the money made available by central government and the funding provided to local Healthwatch. It is not the case that £10 million has somehow disappeared. It is, rather, that councils have made local funding decisions which mean that £33.5 million was invested in local Healthwatch last year. What matters here is the transparency. That is what we very much welcome. It enables local Healthwatch to hold local authorities to account for their funding decisions and thereby, perhaps, influence them to give them a bit more money if that is required.

NHS: Clinical Commissioning Groups

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

There are two elements to consider here. One is the target allocation, which is what NHS England is currently working on, and the other is the actual allocation—the money given to individual areas. The task for NHS England will be to decide how quickly or slowly to move from current allocations to the target. The key will be not to destabilise any NHS area in that process.

[Lord Harris of Haringey (Lab)]

I do not think the noble Earl answered my noble friend Lord Hunt’s Question about the discussions that have taken place between the Government and NHS England on this topic. Will he tell us what steer the Government have given on these matters?

[Earl Howe]

We give no steer. As I said to the noble Lord, Lord Hunt, the principles on which NHS England should operate are clearly of concern to Ministers—namely, equal access for equal need, the need to take account of health inequalities in an area, and not destabilising the NHS. We also believe that NHS England should be transparent in whatever it does. Those are legitimate concerns for Ministers, but we do not seek to steer NHS England in any particular direction.

NHS: Clinical Commissioning Groups’ Funding of Treatment

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 12th November 2013 Lords Chamber

[Earl Howe]

They can appeal to the clinical commissioning group itself in the first instance under what is known as an individual funding request. That request has to be considered rationally and transparently. If the request is turned down, the reasons must be published.

[Lord Harris of Haringey (Lab)]

My Lords, 55 years ago—

--- Later in debate ---

[Lord Harris of Haringey]

My Lords, 55 years ago, I had my tonsils removed on the National Health Service. Had that not taken place and I now needed that procedure as an adult, according to figures from the Royal College of Surgeons I would be extremely unlikely to have them removed in the area in which I live—Haringey—but 22 times more likely to have the same procedure carried out in the Isle of Wight. Can the Minister explain why this Government’s arrangements facilitate that extraordinary postcode lottery, which means that there is no equity of treatment across the National Health Service?

[Earl Howe]

My Lords, what the noble Lord calls the postcode lottery is, as he knows, nothing new. That is why Sir Bruce Keogh, the medical director of the NHS, has commissioned a project to engage professional bodies, particularly the Royal College of Surgeons, to develop clinical commissioning guidance, in particular, where there is unwarranted variation in the rates of elective surgical intervention. They are currently looking at 28 common types of surgical intervention with more topics under development, and commissioning guidance will ensue from that work stream.

Health: Local Healthwatch Organisations

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 5th November 2013 Lords Chamber

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of the number of local Healthwatch bodies whose budgets are less than the amount that has been allocated to the relevant local authorities for that purpose.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government have made no assessment. We believe that local areas are best placed to make funding decisions to ensure that local needs and circumstances are best taken into account. In total, we have provided £43.5 million to local authorities for funding Healthwatch this year. We believe that transparency on funding is important. We will be requiring each local Healthwatch to publish the funding it receives from local government in its annual report.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the noble Earl for that response. I am, however, amazed that he says that he has no direct information on this matter. Is he aware that at least 23 local Healthwatch organisations have budgets lower than those of their predecessor organisation and that one of them—the one covering the Mid Staffordshire area—has a budget 19% lower than its predecessor LINk organisation? Are the Government nonchalant about how this money is being spent and about how patients are to be represented at a local level because they want to ensure that there is no vociferous view from patients about the scandalous way in which local health services are deteriorating as a result of both the top-down reorganisation that this Government have imposed and the real-terms cuts in budgets that have taken place?

[Earl Howe]

No, my Lords. As the report from Robert Francis identified, the patient voice has to be at the heart of the health and care system, and Healthwatch plays a crucial role in supporting that as the new consumer champion for health and social care. It is very easy to get fixated on the amount of money that is going into Healthwatch. One additional consideration could be the investment that a local authority may be making in other areas to ensure that the voice of service users and the public is heard—for example, through the voluntary and community sector. Surely what matters are the outcomes that are achieved for service users and the quality of those services.

Emergency Services: Paramedics

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 15th May 2013 Lords Chamber

[Earl Howe]

My Lords, the London Ambulance Service has advised that the article in the Sunday Times was slightly misleading, in that the two members of staff who attended that particular patient were student paramedics in their third and final year of training and so were sufficiently qualified to work unsupervised. It is inaccurate to call them “unqualified”. The issue in this case was that, despite their qualifications and experience, the crew did not act in accordance with their training or the procedures that were laid down. That has been acknowledged by the London Ambulance Service, which has said that it believes that the failings are not reflective of the hundreds of ambulance staff who provide a high level of patient care to Londoners every day.

[Lord Harris of Haringey]

My Lords, the Minister has suggested that, on the issue raised by the noble Baroness, Lady Gardner of Parkes, it is really down to the management of ambulance trusts to make all those decisions. There is widespread concern around the country about the delays in ambulances reaching emergency cases. For example, I am told that the police now find that they are the first responders and end up having to take people to hospital. Is this a problem with the management of ambulance trusts or is it about the level of resources being made available by commissioners for emergency services and ambulance services?

[Earl Howe]

The noble Lord is quite right that certain areas of the country have seen unacceptable delays in ambulance response times—I am aware of two trusts in that regard. However, this is not an issue around a lack of trained paramedics. Projections by the Centre for Workforce Intelligence show that there is a secure supply of paramedics until 2016. The College of Paramedics has stated that training posts on courses are always filled and, currently, 900 ambulance technicians are training to become paramedics. We are seeing an increase in paramedic numbers, which is encouraging.

Health and Social Care Act

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 5th March 2013 Lords Chamber

[Earl Howe]

I intend to meet some of the royal colleges, and I have met one already. I do not feel that a full-scale consultation is appropriate because the Government’s policy has not changed. It is the wording of the regulations that has given rise to anxiety. I therefore think that, having taken on board, as I hope I have, all the concerns that have been raised, a clarification of the regulations is all that is necessary and there is no need to consult on the policy yet again.

[Lord Harris of Haringey]

My Lords, is it not the case that the Government have form on producing regulations that are virtually incomprehensible as far as the lay reader is concerned, particularly in respect of these health service changes? We had the incident with Healthwatch only a few weeks ago. Even though there is a short timescale, is it therefore not imperative that there is proper consultation to make sure that whatever emerges reflects the very fine and helpful words that the Minister has given us this afternoon? Will he also tell us whether Ministers ever read these draft regulations before they are laid before the House?

[Earl Howe]

My Lords, it is my intention to issue an invitation to noble Lords to join me in a meeting so that we can discuss these matters. I am very happy to do that over the coming days. The answer to the second question is yes. We read these regulations in conjunction with the Explanatory Memorandum and the line-by-line interpretation that we have also published in this case which make it crystal clear that these regulations do no more and no less than reflect the law and the Government’s policy. However, others have chosen to misinterpret the regulations, and that was something that I could not predict.

NHS: Private Companies

Debate between Earl Howe and Lord Harris of Haringey

Monday 11th February 2013 Lords Chamber

[Earl Howe]

I can tell my noble friend that the Government intend to lay these regulations shortly.

[Lord Harris of Haringey]

My Lords, it is gratifying that the private sector will be expected to pay corporation tax. However, can the Minister tell us how the private sector will make an appropriate and proper contribution to meet the needs of a full and broad range of training within the NHS, given that in some instances it will not be providing a full range of services?

NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 5th February 2013 Lords Chamber

[Lord Harris of Haringey]

The noble Earl has been extraordinarily helpful in telling us what Regulation 36 is meant to mean. My first question is: why does it not say that, as opposed to producing a formulation? Your Lordships are used to this sort of stuff. If every noble Lord who has spoken in this debate apart from the noble Earl has found it difficult to follow, I find it difficult to see how people around the country are going to be able to interpret this with the clarity with which the noble Earl has provided us.

Secondly, the noble Earl then said what local Healthwatch organisations can do. He said that they can campaign provided it is evidence-based and draws upon the opinions of local people. Who is to decide that? Is it, for example, the local authority, which might not like the campaign that is being mounted? Is it then going to say, “Well, you are not actually speaking on behalf of the communities you claim to be”?

[Earl Howe]

The noble Lord’s first point is a fair one. I was coming on to address it as it is quite clear that at least part of the wording of these regulations has seemed complicated and unfathomable to many noble Lords. I have to acknowledge that that is the case.

To address the noble Lord’s other point, we are talking about the difference between being a genuine voice for local people and simply being an adjunct of a political party. Local Healthwatch organisations should not be swayed or influenced by the activities of any political party. They must act independently. The only influence that matters to them is that of local patients and the public in seeking ways to improve the quality of care for people.

In that sense, the regulations tie down a local Healthwatch no more and no less than any other social enterprise. The wording of the regulations has been constructed in a very similar manner to the wording applied to other social enterprises in regulations. Regulations 36(1) and (2), against which so many missiles have been hurled this evening, are designed simply to reflect the standard community benefit test.

NHS: Accident and Emergency Services

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

My noble friend makes some important points. As a general point, it is important to say that each ambulance service should plan to provide appropriate resources to meet local demand, because demand varies according to where you are in the country. Planning assumptions in meeting that demand should take into account the likelihood of severe traffic congestion. Plans of that kind may well include resources in addition to traditional ambulance provision, for example, using rapid response vehicles and motorbikes as well as utilising staff such as community paramedics or emergency care practitioners.

[Lord Harris of Haringey]

My Lords, how many accident and emergency departments in London does the Minister expect to close in the next four years? If he does not know the answer, can he say who is responsible for that and how they are accountable for making a strategic judgment across London about the level of accident and emergency services?

[Earl Howe]

The premise behind the noble Lord’s question is that it is automatically worse to have fewer A and E departments in an area. I beg to disagree with that premise. In serious or complex cases, the noble Lord will know that patients need to access exactly the right care, so it is often better and safer for them to travel further to see specialists in major centres than to go to a local hospital. Although it may be closer, it may not have the right specialists, the right equipment or sufficient expertise in treating patients with their condition. The prime example of that has been stroke care in London, where 32 centres were reduced to, I think, eight and there has been a dramatic reduction in the number of deaths following admission.

National Health Service (Clinical Commissioning Groups) Regulations 2012

Debate between Earl Howe and Lord Harris of Haringey

Tuesday 16th October 2012 Lords Chamber

[Earl Howe]

My Lords, the question I was asked was about the officers of local authorities, and I hope I have clarified that. A member of a local authority is an elected councillor, of course, and is debarred from a governing body, as we have discussed. If the noble Lord, Lord Harris, will allow me, I will write to him on the point.

[Lord Harris of Haringey]

Paragraph 5 of Schedule 4 refers to:

“An employee of a Primary Care Trust”.

[Earl Howe]

That is what I have just clarified. The heading of that schedule is:

“Individuals excluded from being lay members of CCG governing bodies”.

As long as they are not a lay member, they can serve.

[Lord Harris of Haringey]

They may be excluded from being a lay member, but one of the lay members is defined as someone who has,

“knowledge of the local area”.

However, if by chance they happen to be a part-time employee of any local authority in the country, they are excluded, and I want to know why that is. Why not leave it to the good judgment of the local people?

[Earl Howe]

My Lords, these regulations lay down the minimum membership of a governing body. It is open to CCGs, in their constitutions, to widen the membership of the governing body if they wish. I will follow this up in writing to the noble Lord.

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Monday 12th March 2012 Lords Chamber

[Earl Howe]

My Lords, no Government have routinely made risk registers available. This is a matter of principle. It is not just that the issues associated with the Health and Social Care Bill have been extensively aired—as I said, they have been—but it is a point of principle whether a risk register that is integral to the formulation of policy should be published.

The tribunal agreed with our assertion that the strategic risk register should not be published but disagreed when it came to the transition risk register. Our difficulty is that the case that we made for both documents, which are of a similar structure and have similar content, was based on essentially the same arguments, which makes it extremely difficult to make a decision on whether or not to appeal the decision. I hope, as I say, that the tribunal will give its reasons for the judgment as soon as possible so that we can determine the right way forward.

[Lord Harris of Haringey]

My Lords, surely this is not about the routine publication of risk registers but about the publication of a risk register for a specific Bill in front of your Lordships’ House and Parliament that is causing extreme concern in the country. Why is it not possible on an exceptional basis? I believe that no less a person than Simon Hughes—if such a thing were possible—has advocated to the Government that the risk register should be put into the public domain so that Parliament can look at the implications properly.

[Earl Howe]

My Lords, I beg to differ with the noble Lord; this is an issue about routine release. I think I am right in saying that the department has received several dozen requests to release the risk register. If this were to become routine, as some people appear to wish it to become, policy formulation in any department would become virtually impossible.

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Monday 13th February 2012 Lords Chamber

[Lord Harris of Haringey]

My Lords, is not the point that the contractual obligation that the Government are proposing would in effect be triggered only by the reporting of an incident to the CQC? Is it not also the case that the contractual obligation that the Government are talking about would not apply to primary care?

[Earl Howe]

I will move on to primary care in a moment, but I do not agree with the noble Lord at all on his first point. What we see happening from a contractual requirement is a process of culture change taking the form of conversations between management and clinicians about the fact that this was something that the organisation had to focus on. I do not agree that it will arise simply by reason of reported incidents.

As I said, any disagreement that I have with the noble Baroness is not out of any difference of intent; it is because of a difference of opinion about what we feel would work. Her amendment would require the Secretary of State to act with a view to securing that any CQC-registered organisation providing healthcare was required—we should perhaps log that word—to take all reasonable steps to ensure that a patient or their relatives were informed of a serious patient safety incident.

The key points here are around a requirement in relation to CQC-regulated healthcare. Any requirement must come with enforcement, otherwise it is not a requirement. The amendment as drafted would extend to providers of purely private healthcare—that is, non-NHS-funded healthcare—which suggests that any requirement would have to be enforced by the CQC. I and my officials have spoken at length with CQC colleagues regarding this. In response, the CQC has clearly stated that it would not be able to routinely monitor and enforce such a duty. This is not due to attaching less importance to this issue than to the others areas that they regulate. It is the very nature of openness that when errors occur, it is not easy to detect routinely where a lack of openness has occurred. When a patient or their relatives are not told of an error and the incident is not reported, it is often very difficult to discover that there has been a failure by an organisation to be open. The only way to fulfil this requirement would be to verify that openness was happening and, given the very nature of the issue, that would not be possible for a national regulator. It would require it to prove a negative—in this case, that people were not told about something going wrong with their healthcare.

--- Later in debate ---

[Lord Harris of Haringey]

I am grateful to the Minister for giving way again, but I am now genuinely confused about why this is different. His argument seems to be that a contractual arrangement—we will come back in a moment to the question of who that will cover and whether it will cover primary care—would magically produce a change in culture but that a statutory obligation, applying to all providers registered with the CQC, somehow would not. This is not about requiring the CQC to monitor every interaction with a patient; it is about creating that culture change and a clear sense of obligation—you cannot be registered as a provider with the CQC unless you are committed to doing this.

[Earl Howe]

My Lords, I hope that the noble Lord will allow me to remind him very respectfully that we are on Report and not in Committee. I am trying to work through my arguments, which I hoped would have a flow to them, but my flow has been interrupted. I am getting to what I hope he wants me to get to.

I was saying that the amendment would effectively require you to prove a negative—in this case, that people were not told about something going wrong with their healthcare. If they were not aware of the error, they would not be aware that they had not been told about it, and the volume of incidents is such that a single national body could not possibly verify compliance with that requirement.

I know that the noble Baroness advocates that the CQC should not routinely monitor this duty and instead should require organisations only to provide evidence that they encourage openness through having appropriate procedures and policies in place. Unfortunately, what that creates—this point was made by my noble friend Lord Ribeiro—is a tick-box exercise. Organisations can provide all the assurances in the world that processes are in place and therefore they are considered to be compliant, when in actual fact it could be that patients were still not being told about errors in their care. That is not acceptable and would not deliver the culture change that we need. We must have a requirement that ensures that patients are told of errors, not one that pays lip service to this and allows organisations—

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 8th February 2012 Lords Chamber

[Earl Howe]

My Lords, where a service is commissioned by the NHS Commissioning Board—and let us imagine that it is a specialised service—the patient’s recourse should be to the board. However, of course, the board will be represented at a local level rather than only centrally, and we expect that the board will be represented in health and well-being boards and in the discussions that take place there. It would therefore be possible for a patient to address their concerns, in the first instance, to the health and well-being board, which would have the ability and power to communicate directly with the NHS Commissioning Board, if that was felt to be appropriate. However, as I said, the patient would be able to go straight to the board in those circumstances.

[Lord Harris of Haringey]

I appreciate that this is very bad manners, given that I missed most of the debate. The Minister has just said—although perhaps I misinterpreted him—that the NHS Commissioning Board will have a representative on every local health and well-being board. If so, how will those individuals be known or accountable? Is that not the most extraordinary bureaucracy? He seems to have made a most extraordinary statement.

[Earl Howe]

My Lords, we are at Report stage and I hope that the noble Lord will forgive me if I do not reply at length. The point I was seeking to make was not about representation on the board but involvement in the health and well-being board’s wider deliberations. It is entirely open to a health and well-being board to invite a member of the Commissioning Board to be a permanent member, but I am not saying that we are prescribing that.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Baroness, Lady Thornton, has spoken to Amendments 10 and 52, which, as she has said, would remove altogether the autonomy duties on the Secretary of State and the board. The noble Lord, Lord Harris, asked me what the problem is that the Bill is trying to solve in this regard. The duty is intended to promote a culture of fostering local autonomy rather than to outlaw specific practices; but without a focus on autonomy, it is possible that the mandate from the Secretary of State to the board or the framework document from the board to CCGs could impose disproportionately burdensome requirements on the system. The Government believe that local operational autonomy is essential to enable the health service to improve the outcomes of care for patients, provided that autonomy is within the framework of clear ministerial accountability.

The noble Baroness will be aware, because I have said it before, that we are aiming to free those closest to services to take decisions that are right for patients, free from central micromanagement by either the Department of Health or the NHS Commissioning Board. The amended duties, with the caveat that the interests of the health service take priority, achieve the right balance between autonomy and accountability. Without the clause, a future Secretary of State could choose to ignore one of the fundamental principles of the Bill, which is that those closest to patients are best placed to take clinical decisions. Without the clause, a future Secretary of State would be free to use his extensive powers to micromanage the NHS. The autonomy duty is a necessary part of the Bill, placing a duty on the Secretary of State to consider the expertise of those in the health service while recognising that there will be circumstances—

[Lord Harris of Haringey]

My Lords, the noble Earl seems to be saying that you cannot trust your own Secretary of State not to micromanage unless they are effectively forbidden from doing so. We have all talked of the Secretary of State’s accountability to Parliament. Surely the principle is that an accountable Secretary of State will be under enormous pressure from Parliament not to micromanage. If it is such a central issue of policy, Secretaries of State should simply be told not to do it, rather than requiring an Act of Parliament.

[Earl Howe]

I challenge the noble Lord to think of one Secretary of State, with the distinguished exception of my right honourable friend Mr Lansley, who has not succumbed to the temptation of micromanaging the NHS. No Secretary of State has been able to resist that temptation because, frankly, Parliament expects them to do it. That is what the system has expected of the Secretary of State. This is a burden on commissioners and clinicians, and, in the end, it does not well serve the interests of patients. It is all very well for the noble Lord to say, “Well, just stop”, but the system encourages it and the duties on the Secretary of State are there to encourage it.

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 8th February 2012 Lords Chamber

[Lord Harris of Haringey]

I just want to make sure that I understand the point that the Minister is making. Let us compare two localities in London. I mentioned Tottenham, so compare that with, say, the residents of Totteridge. They are very different socioeconomic groupings with very different health outcomes. What is the mechanism for addressing health inequalities between Tottenham and Totteridge? Who will be responsible for addressing inequalities between areas that are just a few miles apart but which have very different characteristics and very different social outcomes? The health and well-being boards are borough-based. Tottenham is in the London Borough of Haringey and Totteridge is in the London Borough of Barnet—neighbouring boroughs that are very different in composition. What will be the overarching structure that addresses those inequalities?

[Earl Howe]

Localism lies at the heart of our approach to these issues. Although I have no doubt that conversations and comparative analyses will take place between different health and well-being boards and different local authorities, in the end it is the responsibility of health and well-being boards to look to their catchments. As I said, the outcomes that are published, both in terms of the NHS performance and public health and social care, will in themselves incentivise improvement, if the local authority and the health and well-being board work together as they should. This is a joint enterprise between public health, social care and the NHS.

We shall no doubt experience the effect of comparative work between local authorities once the early implementer groups have bedded down and begun their work. Both the board, however, and the Secretary of State will have duties in relation to inequalities. They overarch everything that happens and I suggest that that will ensure that a system-wide and strategic approach is taken, for example, through setting objectives in the board’s mandate in relation to inequalities. These could feed down very easily to CCGs through commissioning guidance issued by the board. I hope that that gives the noble Lord a summary, or at least a flavour, of how we envisage this working.

--- Later in debate ---

[Lord Harris of Haringey]

May I just clarify? Will there be nothing between the board at national level? Will it look right across the country and say, “We will address these inequalities”? Will there be nothing, for example, at the London level, to address inequalities between different parts of London or will it simply be driven nationally? That is a recipe for not necessarily making the best decisions in particular areas.

[Earl Howe]

The noble Lord will know, because the NHS Commissioning Board authority has published its proposals, that the board will be represented sectorally. There will be field forces in all parts of the country. My vision of this, and that of Sir David Nicholson is that in the areas in which the board operates it will take a view across a region and look at how outcomes vary between local authority areas. The board will be very powerfully placed to influence the kinds of inequalities that the noble Lord has spoken of. It is important for noble Lords to understand that the board will not be a collection of people sitting in Leeds. The majority of its staff will be a field force. I hope that that is helpful.

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Thursday 19th January 2012 Lords Chamber

[Earl Howe]

I do think that the objections that the Royal College of Nursing has raised have very little to do with the Health and Social Care Bill. They are much more about what may or may not be happening in certain hospital trusts, which are matters that, in general, the Bill does not affect.

[Lord Harris of Haringey]

My Lords—

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Monday 7th November 2011 Lords Chamber

[Earl Howe]

I agree with the noble Lord. In fact, the GMC sets out in its Good Medical Practice the following:

“If a patient under your care has suffered harm or distress, you must act immediately to put matters right, if that is possible. You should offer an apology and explain fully and promptly to the patient what has happened, and the likely short-term and long-term effects”.

Therefore, the noble Lord is quite right: this would apply whether a doctor was treating an NHS patient or serving in a private capacity.

The noble Baroness, Lady Hollins, asked—

[Lord Harris of Haringey]

I am grateful to the noble Earl for giving way yet again on this perhaps longer than expected debate. Although we have clarity about the duty placed by the General Medical Council on individual doctors, which is obviously helpful, the noble Earl gave us an example from the United States where in essence it is not that doctors conspire to keep material from the patients but that the management of the institution finds different ways to get round the duty to report an incident. The reason for saying that a very clear duty needs to be placed on them is management cover-up, which so often takes place when things go wrong.

[Earl Howe]

That is exactly why I referred to the need for a culture of openness rather than encouraging a situation in which we simply try to catch people out when they are not open. The amendment tabled by the noble Baroness looks to me like yet another way for people to get into trouble, rather than a way in which an organisation can take ownership of things that go wrong, encourage openness and look in-house to put things right. That is my fear about the amendment.

The noble Baroness, Lady Hollins, asked whether the consultation that we are undertaking covers whistleblowing. No, the consultation is focused on the duty of candour; whistleblowing is a separate, but linked, issue. Since coming to office, we have, as she may know, taken a number of important steps to promote it in NHS settings.

The noble Baroness, Lady Morgan, asked about the timing of the consultation response. She is right to say that the consultation finishes on 2 January. The government response will follow in due time after that. Unfortunately, I cannot be more specific. I shall be happy to write all noble Lords upon publication of the government response and I encourage noble Lords to take part in the consultation before it closes.

My noble friends Lord Mawhinney and Lady Williams referred to mediation. I take their point. They will know that mediation can mean a number of different things. As part of the proposed contractual requirement, we suggest that providers will have to offer an apology and an explanation and provide further information as appropriate, all in person with the patient, their representative, the relevant clinicians and other hospital or trust representatives as appropriate. That might well involve a mediator. I am all for mediation if legal fees and all the expense and heartache that goes with them can be avoided.

Health and Social Care Bill

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 2nd November 2011 Lords Chamber

[Earl Howe]

I shall, of course, be guided by the Committee. If it is the wish of the Committee that I do not explain the Government’s view, then I will not do so. With apologies to those noble Lords whose questions I am not going to answer now—

[Lord Harris of Haringey]

I appreciate that the noble Earl is moving to a position of not addressing those questions, but it is important that he tells the Committee whether the Government have a fixed mind on these matters or whether they are going to approach with an open mind the discussions that we, in an outbreak of consensus, have agreed should happen and try to build on that consensus. If the views are closed, it raises some very difficult issues for the Committee.

[Earl Howe]

No, my Lords, there are no closed views. That is the reason why I suggested earlier that it was time to reflect and engage in discussions in the spirit of co-operation. I would not have said that if I had had a closed mind to them. There would not have been any point in the discussions. I simply wished to do noble Lords the courtesy of answering their questions and addressing the points that they had made. If noble Lords would rather that I did not do that, then we can make life easier for ourselves. I will certainly write to noble Lords if they would like to inform me afterwards that they wish to receive a letter. If they do not, I will not write. It is entirely up to them. I do not wish to make work for myself unnecessarily.

I have said that I believe the balance of advantage for this Committee lies in our agreeing collectively not to amend the Bill at this stage and I am pleased that there seems to be consensus around that view. I believe instead that it would be profitable for me to engage with noble Lords in all parts of the House, both personally and with the help of my officials, between now and Report to try to reach consensus on these important matters. I would just say to my noble friend Lord Marks that that includes the issues that he has helpfully raised this afternoon. I believe that he is right to associate Clause 4 in particular with the matters that we have been considering. Those discussions can be carried out in an informal way with interested Peers or in individual meetings in the House or my department. There is a place for either type of discussion. My concern is only that it is an inclusive process involving Peers from all sides of the House, and that will include listening to the views of the Constitution Committee should it choose to continue its valuable role.

With that, I hope that no noble Lord will feel cheated by the brevity of my contribution and I shall sit down.

EU: Economy

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 2nd November 2011 Lords Chamber

[Earl Howe]

My Lords, other than for GPs, dentists and pharmacists, where use of the logo is voluntary—although it is very widely used—providers of NHS services are required to display the NHS logo as a sign of their commitment to the NHS patients that they treat. That is fine as far as it goes. However, where private services are also being delivered from the same premises, there are clear rules laid down that the NHS logo must be nowhere near any information about those services and that patients have to be absolutely clear what service they are receiving, whether it is NHS or private.

[Lord Harris of Haringey]

On the basis of that answer, does the noble Earl accept that it is inappropriate for an NHS general practitioner, during an NHS consultation with a patient, to offer their own private, non-evidence-based services instead of an NHS service —in other words, to offer their own private services in the context of an NHS consultation? I speak from personal experience.

[Earl Howe]

My Lords, except in limited circumstances, which must be set out in their contract, primary medical service contractors—GPs, in other words—cannot directly or indirectly seek or accept from any of their patients a payment or other remuneration for any treatment. The prohibition not only relates to treatment provided under the primary medical services contract but extends to any treatment that may be provided to the patient.

Health: Cancer

Debate between Earl Howe and Lord Harris of Haringey

Wednesday 2nd March 2011 Lords Chamber

[Earl Howe]

My noble friend is quite right. It does involve often a number of senior clinicians. The key to diagnosis, however, is to get in early, as I am sure he would recognise. The outcomes strategy commits us to saving the additional 5,000 lives very largely through additional identification of early cancer. In fact, 3,000 of the 5,000 lives that we are hoping to save will be saved, we hope, by earlier diagnosis. A good example of that is that over 90 per cent of bowel cancer patients diagnosed with the earliest stage of the disease survive five years from diagnosis, compared to only 6.6 per cent of those diagnosed with the advanced disease.

[Lord Harris of Haringey]

My Lords—

[Lord Walton of Detchant]

Would the noble Earl accept that this country has had a very proud record in carrying out clinical trials, not least in the field of cancer; and that since the passage of the European directive on clinical trials, the problem of getting ethical approval for multi-centred trials—in a variety of different centres—has become immense? Is he aware of the recent report of the Academy of Medical Sciences, from a committee chaired by Sir Michael Rawlins, which has made a number of crucial recommendations? If accepted by the Government, those would make the performance of these trials very much easier.

Herbal Medicines

Debate between Earl Howe and Lord Harris of Haringey

Thursday 13th January 2011 Lords Chamber

[Earl Howe]

My Lords, I do not have the figures, but I am aware of a notorious case on the continent some years ago involving adulterated herbal medicines, which resulted in very serious illness for a number of women. Since 2005, the MHRA has identified 282 cases where products typically marketed as herbal or traditional remedies have been found to be adulterated with random quantities of pharmaceutical substances.

[Lord Harris of Haringey]

My Lords, would it not be more sensible for the noble Earl to present to the House the scientific and medical evidence that suggests that it is indeed sensible to provide any sort of regulatory framework? In the absence of that scientific evidence, would it not be simpler to make it very clear that it is illegal to make false, unfounded health claims in support of any substances and that, if they contain dangerous materials, the individuals promoting them should go to jail?

[Earl Howe]

That is precisely why we want to consider the possibility of a statutory register for practitioners, to make sure that those who prescribe unlicensed medicines that have been prepared by third parties are fit and proper people to do so. When we make the announcement, as I hope we will shortly, the rationale for it will be set out.

Health: Government Spending

Debate between Earl Howe and Lord Harris of Haringey

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend. He is right to suggest that we should look not at each body individually but perhaps at several across the piece to see whether there is scope for rationalisation in a way that does not detract from the quality of service.

[Lord Harris of Haringey]

My Lords, the noble Earl has frequently argued in this House in favour of there being arm’s-length bodies to protect the patient’s interest in the NHS. Will extra resources be found to enable this aspiration of his—and I am sure, of the coalition’s—to be fully funded?

[Earl Howe]

My Lords, the budgetary implications of our plans are being worked through at the moment but we are clear that we need to have a more powerful patient voice within the system than at present. I believe that that goes hand-in-hand with our agenda for patient choice, greater quality standards and more information being made available to patients to enable them to make choices.