European Parliamentary Elections (Amendment) Regulations 2018

Lord Hunt of Kings Heath Excerpts

Monday 22nd January 2018 Lords Chamber

[Lord Swinfen (Con)]

My Lords, I wonder whether my noble friend can help me. I think that I heard him say that the cost of a by-election in Wales is £7 million but that it is very much greater elsewhere—I have a feeling that he gave a figure of either £12 million or £20 million. I do not understand why there is this difference. Can we not learn something from Wales, so that costs can be brought down elsewhere?

[Lord Hunt of Kings Heath (Lab)]

My Lords, we should be told about that one for sure.

The Minister is having an exciting time. On Thursday, he welcomed the President of France to this country on behalf of Her Majesty the Queen. Today he is bringing forward perhaps the only coherent piece of European legislation we can expect from this Government over a long period. However, like the noble Lord, Lord Rennard, I remain to be convinced that it is entirely necessary.

As the Minister explained, under the regulations, when an MEP vacancy arises and it is not possible to fill it within the existing procedure, the party that holds the seat may instead nominate a person to be an MEP, so that a by-election is not required. I can see that, on the face of it, that seems a sensible provision, since a by-election in the short period between now and 2019 might be regarded as a pointless exercise. However, some points need to be made here.

Carillion

Lord Hunt of Kings Heath Excerpts

Monday 15th January 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for repeating the Statement. However, I have to say that it seems remarkably complacent in the face of the catastrophic failure of Carillion. Millions of pounds of public money is threatened, hundreds of thousands of public service users are vulnerable and tens of thousands of jobs are at risk—yet the Government could have ameliorated the crisis. The Statement claims that the Government have been closely monitoring the company since last July—some monitoring. Remarkably, contracts worth £2 billion were awarded during this period, when no fewer than three profit warnings were given by Carillion. Why was that, and why was a consortium of which Carillion was a part so recently given a lucrative deal to work on the HS2 line?

Why did they leave vacant the position of the Crown representative—responsible for helping a company in a situation such as Carillion’s—from August to November during a crucial period of the company’s difficulties? That was surely a gross neglect of their responsibilities to monitor the company? Does the Minister plan an investigation into the Government’s handling of the matter? The Statement refers to the official receiver’s statutory duty to investigate the cause of failure in any company. That will not cover the action of Ministers—and they have their fingerprints all over this debacle. Who will investigate their conduct?

The outcomes of this liquidation will be wide-reaching. Carillion ran 50 prisons, almost 9,000 schools, 200 operating theatres and 11,800 hospital beds. What assurance can the Minister give that none will be affected? The information the Government have released through the Insolvency Service makes no reference to their plans for the ongoing delivery of public services. Will the Minister commit to inform the House about this as soon as possible? Will he act quickly to bring these public sector contracts back in-house?

The Statement says that taxpayers will not bail out this company, but is that believable? The Government have form: there is a pattern of the taxpayer being asked to pick up the pieces of wildly irresponsibly bidding and grotesquely high pay and perks for executives, with the Government using yet more public money, as in the case of the east coast main line, to bail out these failing companies. It is vital that shareholders and creditors are not allowed to walk away with the profits from profitable contracts while the taxpayer bails out loss-making parts. Will the Minister commit to make sure that that does not happen?

Carillion employs almost 20,000 people, with far more in its supply chain. The Minister referred to them, but will he confirm that the pay and conditions of these workers will be the Government’s priority in any financial assistance? The workforce will have turned up today not knowing whether their jobs and pay are safe. Will the Minister commit to doing everything in his power to protect the jobs of those working on public sector contracts? My understanding is that in a compulsory liquidation the contracts of all employees are automatically terminated. Will he say whether that is so? Will the Redundancy Payments Service pay out huge sums for redundancies, arrears of wages, holiday pay and protective awards?

The Minister mentioned pensions. Can he tell us how much the Pension Protection Fund will have to put aside to cover the deficit in Carillion’s defined benefit pension schemes? He also mentioned the supply chain. Lots of SMEs and workers in the supply chain will be threatened, and contracts with large companies are clearly their lifeblood. What will the Minister do to safeguard jobs and workers in Carillion’s supply chain?

The Government are guilty of being too cosy, too incompetent and too profligate: too cosy with the companies; too incompetent in leaving the position of the Crown representative vacant for three months and awarding more contracts to a company that they knew was in severe crisis; and too profligate in handing over public money to the private sector as a result of their dogmatic belief that it should profiteer from our schools, hospitals and public services no matter what its performance.

[Lord Stunell (LD)]

My Lords, I thank the Minister for repeating the Statement. The collapse of the second-largest construction company in the country and a major provider of public services across the country is cause for concern and regret, not least for those employed by that company and those who depend on it because they are part of a long supply chain in many different industries, particularly the construction industry. The official receiver has been appointed and the Statement says that one of his duties will be to hold an inquiry. Can the Minister say something about the status of staff and employees working on public sector service provision and those working on private sector contracts? What is their future? What do the Government intend to do to protect them?

There is, of course, anger on the part of many of those working for and with the company that the warning signs were not quickly followed up by the Government after the alert in July—not least that a Crown representative was not appointed when good practice and ministerial guidelines say that that should have happened. I hope that the Minister will say something about that. If the official receiver’s inquiry does not cover such issues, I will certainly join the noble Lord, Lord Hunt, in calling for a wider inquiry.

In view of Carillion’s role in delivering numerous large-scale infrastructure projects, what are the implications of its collapse on those projects and their timetables, and what impact may it have on the Government’s industrial strategy? We should bear in mind that construction and construction training were key elements of that strategy and that many apprentices are employed not just by Carillion but by those in the supply chain, whose continuing apprenticeships are clearly at risk. Can the Minister help us on that? What are Ministers doing to minimise damage to public services and the capacity of the construction industry? Subcontractors face a very difficult time. It is one thing to say that contracts can be transferred to their partners—for instance, on HS2—but what about the backlog of unpaid bills that Carillion will owe them? Will that be coughed up by their new partners? Is that part of the deal that was arranged when the partnerships were set up, or is it more likely that the subcontractors will be expected to bear the loss?

Finally, what does the Minister have to say about the governance of that company and the way that the warning signs were there? Even the chairman has some form from times past. What exactly do the Government believe is the right governance structure for a major contractor for public services so that in future there will be protection for the public, for employees and for the country?

Intergenerational Fairness in Government Policy

Lord Hunt of Kings Heath Excerpts

Thursday 26th October 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, at times I have felt a little lonely today. None the less it has been an absolutely fascinating debate, and I congratulate the noble Baroness on it and on the way she opened it. I commend noble Lords who have spoken because of the tone of our debate. We have had a forensic analysis of some of the huge challenges facing us if we accept the premise of an intergenerational crisis on fairness, but there is a conclusion among noble Lords that we are not talking about warfare. Every day, we see so much support, caring and co-operation between the generations and that is what we have to build on as we develop policies in the future.

The noble Baroness, Lady Smith, was right to draw attention to what is a real conundrum: the short-term political horizon versus the need sometimes for long-term planning and decision-making. She mentioned climate change, which was a very good example, but clearly noble Lords have mentioned other examples in domestic policy where, for instance, we see proposals that might impact some of the benefits that older people receive but then get short shrift. The Government’s experience in relation to the funding of long-term care in the last election—which mirrored our own experience of when Mr Cameron attacked us for the “death tax” in 2010—does not always encourage politicians in terms of proposing policies which they deem to be in our interest in the long term.

The noble Lord, Lord Wallace, wondered whether we should have a Select Committee on this matter, and I think that is worth suggesting. It did strike me that, on climate change, through thick and thin, there has been a general consistency over many years now. I wonder whether having the Committee on Climate Change—a statutory advisory committee to Government —has been helpful. I wonder whether that is some kind of model we might think about in dealing with some of these very difficult issues.

Clearly, the demographics show us that we will have a growing number of older people in our population. Many of them have benefited from the benefits that noble Lords have mentioned and which they now question. Certainly the last Labour Government presided over a halving of the number of pensioners in poverty, not least through the introduction of pension credit. But our health and social care system is under considerable strain. Every year, the number of patients requiring treatment is going up, and there is clearly a huge problem. Our hospitals are unable to discharge patients because of the lack of care, community and care homes—we debated that this morning. So far there has been precious little idea about how we will meet this ever-growing problem, which we know will be with us for at least 30 years.

On the other hand, in our debate today we have had some very concrete suggestions about a way forward in many of these areas. It would be wrong to be negative by thinking that we are in such a state that there is no way through. I warmed to the suggestion of the noble Lord, Lord Best, that in relation to the imbalance in housing, the concept of rightsizing in accommodation and help-to-move packages—which would then release housing stock—deserves attention. Particularly because of the way he presented it, that could be seen as an incentive to older people, rather than a cutback in their benefits, or putting their home ownership under threat because of care bills. I agree with the noble Baroness, Lady Stowell, that one of the very difficult issues is how, for instance, we could release equity in people’s homes or ensure that the distribution of housing stock was more equitable than it is.

Certainly, the housing situation is bleak: the waiting list for council accommodation is long; housing rental costs for young people are high; and the number of home owners under the age of 25 has halved. Your Lordships’ Economic Affairs Committee said that the root of the crisis in housing is in the restriction of land supply and of the planning system, the failure to replace council houses bought under the right-to-buy scheme and the lack of incentives for private companies to build more affordable homes. None of this is insurmountable; it needs the political will. I hope that we can see housing rise much more to the top of Governments’ priority order in the next few years.

The noble Lord, Lord Willetts, referred to the issue of young people’s expectations. The fact is that the younger workforce will be earning less than their parents’ generation in comparison and younger people are increasingly reliant on their parents and grandparents for support. Alongside that, the world of work has become much more insecure, with fewer full-time and reliable jobs. We have seen an explosion in part-time jobs and, in particular, insecure work, such as the introduction or development of zero-hours contracts. All of these lead to a very insecure position for many young people. The noble Lord, Lord Bird, asked where the new industries are, and that is a very good question, as was his second question: where is the investment coming from to invest in those jobs which provide the kind of stability and satisfaction that we need to see?

Education and skills are very important. I do not want to go into this debate about tuition fees, save to say that the noble Lord, Lord Willetts, has received a gentle push-back from noble Lords. I particularly warmed to the comments of the right reverend Prelate the Bishop of Salisbury that, however you define student loans, to many young people they are a debt—a psychological barrier. I was also interested in what the noble Baroness, Lady Stowell, said about our parents’ attitude to debt. We are in a position where, in a sense, the Government embrace debt and tell young people that it is a good thing—I wonder whether that is wise.

There are so many experts here on pensions, but I agree that the position is precarious. Having a son whose employer is now putting 1% into the pension scheme makes me feel such anguish about what those people will get when they retire in terms of a decent pension package. The noble Lord, Lord Filkin, talked about its precariousness. On the other side, the noble Lord, Lord Bird, talked about unleashing the power of pension funds in order to invest in the kind of infrastructure that we will require. I cannot help feeling that on pensions we have a huge amount of unfinished business.

Clearly, there is no magic wand to wave. But we could adopt a coherent set of policies to help young people in relation to housing, education and greater security at work. This does not need to be at the expense of the chipping away at hard-earned protections for older people. Of course we face hard decisions about public expenditure, the role and level of taxation and the distribution of public finances, and some tension is inevitable, although the noble Lord, Lord Turnbull, indicated that we have some flexibility, which I hope that the Government will listen to, given the distinguished experience that he brings to your Lordships’ House.

The key message from this debate is that we would like the Government to focus more on intergenerational fairness. I agree with the noble Lord, Lord Wallace, that it is a debate for the whole of society. I also agree with the noble Lord, Lord Tugendhat, that, building on the experience of 2017, the more that younger age groups vote, the better. I, too, would go for votes at 16, and I suggest to the noble Lord, Lord Young, that, having encouraged so many more young people to vote, it is a great pity that the electoral register that his Government are so determined to bring in will not reflect that increase in young voters’ interest in elections.

Government-commissioned Research

Lord Hunt of Kings Heath Excerpts

Wednesday 28th June 2017 Lords Chamber

[Lord Young of Cookham]

The noble Baroness has rightly summarised the recommendations made by Sir Stephen Sedley. Basically there are two problems, one of which is the availability of research and the other its accessibility. On availability and putting it in the public domain, Sir Tom Scholar, the Permanent Secretary to the Treasury, has recently written to all Permanent Secretaries reminding them of the protocol which obliges them to put research into the public domain as soon as possible. On ease of access—finding the data—the Government Digital Service is sharpening its navigational and taxonomy tools in order to make it easier for users to find the information they need.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that the House is reassured by the noble Lord’s response. He mentioned two problems, but surely the third is that much of this research shows that government policies have little basis in evidence and, therefore, departments are not keen to allow it to be published. Is he aware of the debate in relation to pharmaceutical companies and the publication of research that has not worked? There has been a big change in attitude by a number of the companies and they are now committed to full transparency. Given the sensitivity of those companies, I would have thought that the Government could take the same approach.

[Lord Young of Cookham]

Sir Stephen Sedley made it clear that:

“There is no recent evidence of the indefinite suppression of research”.


The problem he identified was not suppression but delay. On medical research, the Chief Medical Officer, Professor Dame Sally Davies, told the inquiry that the systems in place now support publication and said:

“Although a decade or more ago there may have been more of a problem with research being delayed, clearer guidance and publication frameworks in place today mean there isn’t a major problem anymore”.

Surrogacy

Lord Hunt of Kings Heath Excerpts

Wednesday 14th December 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, welcome the initiative of the noble Baroness, Lady Barker. I endorse her praise for Baroness Warnock’s outstanding work, which led to the legislation which the noble and learned Lord, Lord Mackay, took through the House. I very much hope that he will speak more often in the gap in future because his contributions in this area are always so welcome.

The noble Baroness, Lady Barker, spoke compassionately and persuasively in favour of updating the law to deal with some of the problems she identified. The noble Lord, Lord Faulks, illuminated the problems arising from a case where the children were left in limbo. However, as the noble and learned Lord, Lord Brown, said, this, of course, is not the only problem. The report of Surrogacy UK, which was endorsed by Baroness Warnock, sets out very clearly some of the challenges that we face with the current law. The report concludes that,

“the time is ripe to embark upon reform of surrogacy law”,

and makes it clear that the current law is,

“out of date and in dire need of reform”.

I will refer to three areas that the report identifies. First, it states:

“Our recommendations for reform centre on the welfare of surrogate-born children and on realigning the law with their best interests”.

Secondly, it states that,

“the principle of altruistic surrogacy in the UK”,

must be guarded. Thirdly, it states:

“The law must recognise the correct people as parents of children born through surrogacy”.

I also draw the House’s attention to the three recommendations the report makes to the Government. First, it states:

“The Department of Health … should … publish a ‘legal pathway’ document for intended parents and surrogates”.

That is a very interesting and important recommendation. Secondly, the report states:

“The Department of Health should produce guidance for professionals in the field”.

Thirdly, the report states:

“Surrogacy should be included in schools’ sex and relationships education”.

Perhaps the Minister, in responding, will say whether the Government have considered those three specific recommendations and are prepared to take them forward.

The noble and learned Lords, Lord Mackay and Lord Brown, and the noble Viscount, Lord Craigavon, emphasised their desire for the Law Commission to undertake a review. It has undertaken a consultation and the noble Viscount, Lord Craigavon, said that it is monitoring this debate. We appeal to the Government to refer this matter to the Law Commission.

If the Law Commission option is not taken forward, will the Government then be prepared to undertake their own review of the law? It is clear that, one way or another, we need this issue taken forward. The work needs to be done carefully but at a pace. I hope that the Minister will give us a positive response tonight and I look forward to her comments.

NHS: Congenital Heart Disease

Lord Hunt of Kings Heath Excerpts

Wednesday 14th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

I do not want to go into issues relating to specific hospitals but I emphasise that no decisions have been made. Where it is decided that changes need to be made, these will be managed carefully and will be carried out in partnership with current service providers, patient groups and advocates. Decisions are likely to be made in the summer but there will be no change on the ground until at least 2018. The public consultation will give everyone a chance to put forward their views and to discuss the plans further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness says that she will not discuss individual hospitals but, in the end, Ministers are accountable. Will she confirm that the reason given by NHS England is that the Brompton does not meet its specification, which insists on same-site locations for all children’s services? Can she confirm that one of the hospitals not threatened with closure has multi-site locations, and will she also confirm that the Brompton has one of the best outcomes in the country?

[Baroness Chisholm of Owlpen]

I am not going to be drawn into discussing specific hospitals and I have given my reasons for that. However, I will say that the statement made in July by the Royal College of Surgeons and the Society for Cardiothoracic Surgery said:

“We fully support these standards. NHS England must ensure that the standards are applied for the benefit of patients, by ensuring that expertise is concentrated where it is most appropriate. The proposals put forward by NHS England today should improve patient outcomes and help address the variations in care currently provided.

It is fundamentally important that specialist surgical centres are large enough and treat patients regularly enough to develop full expertise to treat all conditions. It’s vital they are properly staffed to provide on-call rotas and teams have the time to create a supportive environment where new techniques are shared and future specialists can learn”.

--- Later in debate ---

[Baroness Chisholm of Owlpen]

The noble Baroness makes a very good point. This has been fiercely debated since the publication in 2001 of the damning report into the high death rates among babies undergoing heart surgery at Bristol Royal Infirmary. The last time plans were put forward, in 2011, it led to a bitter fall-out, pitting hospitals against senior health bosses, and two years later the proposals were scrapped, with NHS bosses being told to look again. That is why we are now trying to go forward, so that we can cover both adult and children’s services.

[Lord Hunt of Kings Heath]

My Lords, may I offer some advice to the noble Baroness? It is quite clear that, in the end, the Government will not agree to the closure of the Brompton, because that has been the decision on numerous occasions since 2001. Why not just pull the consultation? It is not going anywhere, my Lords.

[Baroness Chisholm of Owlpen]

We do not yet know that it is not going anywhere. A public consultation is coming forward, and the Brompton is not the only hospital concerned; it concerns a lot of hospitals all around the country. It is fair that it should go to a public consultation. Everybody will then have a chance to put their views, and that is going to be the way forward.

Care Quality Commission Review: Deaths in the NHS

Lord Hunt of Kings Heath Excerpts

Tuesday 13th December 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for repeating the Statement and take this opportunity to offer my condolences to the noble Lord, Lord Prior, on the death of his father.

The circumstances of Connor Sparrowhawk’s death were shocking and I pay tribute to his family, who fought so hard for justice and to ensure that other families do not have to go through what they did. The findings of this report are a wake-up call: relatives shut out of investigations, reasonable questions going unanswered and grieving families made to feel like a pain in the neck, or that they would be dealt with better at a supermarket checkout. This is totally unacceptable and we therefore strongly welcome the recommendation of a national framework and the specific measures which the Secretary of State has outlined. I assure the Minister that we will work with her and the Care Quality Commission to support the establishment of such a framework in a timely fashion.

Families and patients clearly should not be forgotten in the process. Will the Minister pledge that families and carers will be equal partners in developing the Government’s plan for implementing the CQC’s recommendations? Does she agree that those who work in the NHS show extraordinary compassion, good will and professionalism but also that when something sadly and tragically goes wrong, it can often be the result of a number of interplaying systematic failures? A national framework will therefore provide welcome standards and guidance across the service.

Does the Minister recall that the previous Labour Government set up the National Patient Safety Agency, based on airline experience, which was responsible for monitoring patient safety incidents, including medication and prescribing error reporting? Does she also recall that the agency was scrapped under the Health and Social Care Act 2012 and will she acknowledge that this decision was a mistake? Can the Minister tell me what happened to the national reporting and learning system which the NPSA had developed to do the very work that she has outlined in the Statement today?

I was interested in the Minister’s comments about the Secretary of State not setting any targets for reducing reported avoidable deaths. I understand the reasons—it is a sensible approach—but it is one thing for the Secretary of State to say it and another for the different multilayered sections of bureaucracy to understand it. Can she assure me that the Secretary of State will make it clear to the various regulators that targets are not to be set? Equally, I agree with her point that seeing an increase in the number of reports of potentially avoidable deaths may well be a sign of care getting better rather than worse. But explaining that to the media and the public will be a challenge. Can she tell me that that will be a priority for the Government when these reports are published?

For a national framework and the proposed measures to succeed, investment will be necessary as well. Can the Minister confirm whether hospitals will receive extra funding to carry out the additional requirements that the CQC has recommended? Crucially, will this include safe staffing levels? The House will know that hospitals across England are suffering chronic staff shortages, leaving doctors and nurses overstretched. To go back to the mid-Staffordshire inquiry, Sir Robert Francis called for safe nurse staffing levels to be published by NICE. But when NICE attempted to do that, it was blocked by the Government. Will the Minister now commit to NICE publishing safe staffing levels, as recommended by the Francis report?

We saw reports over the weekend that the bed shortages in England have got so bad that seriously ill patients with eating disorders have to travel to Scotland for treatment. This is leaving some of the most vulnerable in our society hundreds of miles away from their homes. If the Government are interested in safety, does the Minister believe that this practice is safe and sustainable?

In conclusion, the CQC has called for the issues addressed in its report to be a national priority and for all those involved in delivering safe care to review the findings and publish a full report. The Opposition absolutely agree with that. Action is needed. We welcome the recommendations and we stand ready to work with the Government to ensure that these issues are no longer ignored.

[Baroness Jolly (LD)]

My Lords, I, too, thank the Minister for repeating the Statement and echo the condolences offered by the noble Lord, Lord Hunt of Kings Heath. I declare my interests as set out in the register. I am chair of a learning disabilities charity caring for adults across England.

We welcome the findings of this report but are saddened that we should need one. However, we welcome its publication and recommendations and hope that they will be taken forward and acted upon as a matter of urgency.

I am going to talk about families, governance and learning good practice from unexplained death inquiry processes. In the report, the Secretary of State said:

“The lesson of Mid Staffs, Morecambe Bay and indeed other injustices like Hillsborough is that when families speak out we must listen”.

Surely another lesson is that a trust, or even a regulated care setting run by a charity or the private sector, should reach out to the family first after the family member dies in an unexplained way. We recognise that the emphasis in the report on the importance of including and listening to families in investigations is extremely important, but is this not what common decency should require and families expect, and should this not already be happening?

The situation at Southern Health NHS Foundation Trust reflects what is known across the sector: that whether we like it or not, mental health and learning disabilities are always considered after acute and community services. As long as I can remember—and my involvement with the NHS began at the end of the 1990s—commissioners thought of them last and there was certainly nothing approaching parity of esteem. Now, at least for mental health, we have parity of esteem, and we should have processes in place that are as good and as robust as in all other NHS settings. The chair of the trust should work with the CEO to make sure this happens and a named non-executive director on the board should have ownership of the process. Sadly, this situation is nothing new. Trusts have struggled with this for years and it has to be kept on the agenda. I mean this literally as well as figuratively. It should not be relegated to a subcommittee; it should be on a full board meeting agenda by default.

I commend the processes adopted by Mersey Care NHS Foundation Trust. In such circumstances as we have been discovering, it carries out a review within days, very quickly, while all the involved staff are still in post and details are not forgotten—and, of course, families are involved.

Any good unexplained deaths investigation or complaints system should always have an element of learning built into it. This should be shared within the organisation and also within the sector, and there should be a process to make that happen. Processes currently seem to be ad hoc. Standards and definitions should be standardised into a common framework, as indicated by the report.

I have three key questions for the Minister. First, will the Government consider extending the recommendations of this report to regulated residential settings where those with a learning disability or a mental health condition are being cared for? Secondly, the report outlines the need for a national framework. Will the Minister outline who will co-ordinate the work outlined in the report and who might be involved, and indicate its expected completion date? Finally, will the framework contain recommendations about sharing good practice within the organisation and the sector?

House of Lords Act 1999 (Amendment) Bill [HL]

Lord Hunt of Kings Heath Excerpts

Committee: 1st sitting (Hansard): House of Lords
Friday 9th December 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I wonder if I might follow the noble Lord, Lord Cormack, because he spoke a great deal of sense, in terms both of the debate that we had about retirements and the impact of the noble Lord’s amendment today. I remind the noble Lord, Lord Trefgarne, that I was the Government Whip on the 1999 House of Lords Bill and I well recall our debates. Like the noble Lord, Lord Cormack, I accept that the noble Lord has raised a point of principle which it is quite right for us to debate. Of course, we are nearly 18 years on from that Bill and much has happened in the meantime.

The noble Lord is a very distinguished Member of your Lordships’ House. It is clear that he disagrees with the principle of my noble friend’s Bill. Why on earth did he not challenge at Second Reading or put a Motion down and let the House come to a view? Why is he engaging in a clear filibuster not just in the context of the point that the noble Lord, Lord Cormack, has made about this House but at a time when we are very likely, depending on events, to be debating hugely important issues around Brexit? Does he really think it sensible to set a precedent that filibustering is to be allowed in your Lordships’ House? I would caution him against that activity. I hope that when he comes to wind up he will explain what he is doing, why he has not allowed his amendments to be grouped and why he is not allowing the House essentially to come to a view on the principle.

[Lord Dykes (CB)]

My Lords, I support the two previous interjections. I thank the noble Lord, Lord Cormack, for many years of toil, with others, in the modernisation and reform group which he has led. I came into this House in 2004. I have always regarded myself as a friend of the noble Lord, Lord Trefgarne, and he of me—we know each other well. I regard the noble Earl, Lord Caithness, as a man of great wisdom and as a hard-working and diligent Peer—in fact, we are all effectively full-time working Peers nowadays, which counts for a lot. However, I beg the noble Lord, Lord Trefgarne, as a friend, to reconsider pressing these amendments, with the damage that they will do to the reputation of this House. I ask him to think again and to bear in mind the suggestions that have been made already by people with more authority than me in these matters, hoping that he and the noble Earl, Lord Caithness, will have the courage and wisdom to respond.

--- Later in debate ---

[The Earl of Caithness]

It is true, my Lords. Some 33% or 34% of those appointed are ex-politicians. We are a pretty good dumping ground. The appointment system has also failed us in that only 22% of appointments were women.

I am sorry that my noble friend Lord Cormack is going—I need to refer to him again. He is coming back; wonderful. Our average age now is 69 to 70. I took my seat here when I was 21. Where are the youth represented in this House? We have only two Members under 39, and 29 under 50. I do not think that is a good recommendation for an appointment system.

It seems to me that the best chance of getting into this House in future will be to become an MP. You could possibly increase your chances if you change party as an MP. I have a friend in Scotland who changed from the Conservative Party to the SDP-Liberal party; he was promised a peerage. He did not get it so he changed to the Labour Party. He was promised a peerage, but he did not get it. He is disillusioned with politics now. There is a serious point in there which we need to consider, and I hope it will come up as a result of Monday’s debate.

These words were spoken in 1999: the hereditaries are,

“the ones who sit in the second Chamber not as a result of patronage”.

[Lord Hunt of Kings Heath]

My Lords, will the noble Earl tell the House how hereditaries got here in the first place? Were they elected or appointed by the monarch?

[The Earl of Caithness]

My ancestor was given a title. I cannot remember quite what it was for; I did not talk to him about it. It was 500 or so years ago. That is why I want to get rid of us—but I also want to get rid of the life Peers as well.

Let me continue. The important quote from 1999 is that,

“the House … will be the stronger, the more independent of patronage and the better”,

and:

“I believe without equivocation … that the House of Lords will be better for the 92”.—[Official Report, Commons, 10/11/99; cols. 1200-01.]

Those words were spoken by my now noble friend Lord Cormack, who clearly does not now believe that.

He is not the only former MP to change his mind about this House. On Monday, we heard a very good speech from the noble Lord, Lord Rooker, who admitted that when he was in the House of Commons he was totally ignorant about this House and did not pay any attention to it. I totally concur with that. When I was a Minister in the 1980s, I found that my Secretaries of State were not very conversant with the procedures of this House and found us an irritation—there were then far more hereditaries—but subsequently changed their mind.

Health: Parity of Esteem

Lord Hunt of Kings Heath Excerpts

Monday 28th November 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to wind up for the Opposition tonight and congratulate the noble Lord, Lord Alderdice, on what can be described only as a powerful tour de force. It was a fascinating insight into parity of esteem, as he saw it, in Northern Ireland more generally, which set the context for our debate. Almost all noble Lords have agreed with his proposition that, despite any number of pronouncements, policies and changes in the law, mental health continues to be a Cinderella service. Certainly, my impression of mental health services is that, although they came as part of the health service in 1948, although in the original structures they had their own hospital management committees, which were brought into area health authorities and then district health authorities—and then there was the development of NHS trusts and foundation trusts—and although they were in some cases integrated with those organisations and in some cases were not, they remained invisible throughout. It is a service that continues to be invisible when it comes to the key policy decisions that the Government, NHS England and the regulators make on the health service.

From a managerial point of view it is my impression that, once you become a manager in a mental health service, you stay a manager there—you do not move over. You are not perceived to have the qualities needed to become a leader in a more acute trust. If you look at the NHS people seconded into the department, NHS England or the regulators, you can see how few of them are experienced in mental health services. The noble Lord, Lord Lansley, suggested that this was rather underpinned by the financial system of mental health services whereby, because there is no tariff-based system, clinical commissioning groups tend to negotiate around the tariff and then what is left goes under block contracts to mental and community health services. This puts them at a disadvantage.

Although structures are not important, there is an issue in relation to both the culture and some of the structural issues which seems to account for the lack of focus on and priority for mental health services. Yet my experience when I chaired an acute NHS foundation trust was that many of the challenges we faced were because of the lack of proper support for patients with mental health problems. In any emergency department there will be a huge number of people with these issues. Unless there are properly based mental health services, working side by side with the acute trust, you end up with people inappropriately cared for in inappropriate places, with their outcomes often getting worse and worse.

The noble Baroness, Lady Hollins, asked the Minister a very good question about the sustainability and transformation plans. She thought that the department should not sign off STPs unless it was satisfied that the principles of parity of esteem were fully embraced within them. That is a very good suggestion which I hope the noble Baroness will agree to consider. I have looked at the names of the leaders of the 44 sustainability and transformation plans. They are clearly eminent people, many of whom I know, so there is no doubt that NHS England has appointed people of high calibre. However, they are mainly chief executives of acute trusts, clinical commissioning groups and, in one or two cases, local authorities—particularly Birmingham and Manchester. Why is this? Why have we not turned to mental health chief executives to lead some of these STPs? In my experience, mental health services often know a lot about the system because their clients impact on so many aspects of the service. If we want to make a real, visible indication that mental health services are important, we should look for leaders from mental health services to lead the sustainability and transformation plans. Even if that does not happen, I hope that both NHS England and the Department of Health will ensure that legal requirements for parity of esteem are applied before they are signed off. More than that I hope it is recognised that, unless you put mental health right at the heart of these plans, the ambitions in them are very unlikely to be realised.

I will briefly come to the question of finance. We know that the Government have ordered the NHS to put more money into mental health services. We have heard from noble Lords about the commitment for £1 billion more for mental health by 2020-21. We also heard from the noble Lord, Lord Prior, only last week, that the spend on mental health in 2015-16 is up by 8.4% on the previous year. He said that,

“there is clear evidence that the money that we have been talking about is getting through”.—[Official Report, 16/11/16; col. 1417.]

Yet most noble Lords who have spoken would say that they disagree that the money is getting through to the front line. I do not know whether the Minister has seen the recent work by the Royal College of Psychiatrists on mental health services for children and adolescents. It points out that 52 CCGs in England are allocating less than 5% of their total mental health budgets to services for children and young people. We know of the horrendous problem of young people having to be sent to places hundreds of miles away from their homes because of a lack of facilities. We have also heard, from other noble Lords, that the money simply does not seem to be getting through to other mental health services. Is the noble Baroness assured of the accuracy of the returns made by the NHS to her department on the sharing out of the mental health budget, because there is a suspicion that there has been a rebadging of existing programmes to massage the figures to make it look as though mental health spending is up when the clear experience on the front line is that services are being squeezed and squeezed?

I do not doubt Ministers’ good intents in regard to mental health and ensuring that parity of esteem is achieved. However, the reality is that on the front line mental health services continue to be discriminated against and services are under great threat. There is great concern that in the major changes we are going to see in the health service in the next two or three years as a result of the sustainability and transformation plans, mental health, far from being at the core of the changes, will once again be treated as the neglected hidden Cinderella service. I hope that the noble Baroness can prove us wrong.

NHS England: HIV Prevention

Lord Hunt of Kings Heath Excerpts

Tuesday 18th October 2016 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether NHS England is informing patients that lifesaving drugs will be denied them if funding has to be made available for pre-exposure prophylaxis (PrEP) for HIV prevention.

[Baroness Chisholm of Owlpen (Con)]

Clinicians can apply for funding for the drugs in question where there is a clinically exceptional or clinically critical need. Each year NHS England receives many proposals for investment in specialised services. Difficult decisions then have to be made on behalf of taxpayers about how to prioritise the funding available.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Baroness. She will know that evidence from clinical trials shows that PrEP can be highly effective in reducing the spread of HIV when given to those who are at most risk. Quite disgracefully, NHS England has sought to avoid funding responsibilities by saying that it is the responsibility of local authorities, at a time when there have been big cuts in the public health budgets of those councils. Even more disgracefully, government sources appear to have briefed the media that if they were forced to fund PrEP, treatments for serious conditions would have to be stopped, including treatments for children with cystic fibrosis. This was deeply unpleasant, caused great offence and may well have added to the stigma faced by many living with HIV. Will the Government assure the House that this will not happen again, and instruct NHS England to fund the drug forthwith?

[Baroness Chisholm of Owlpen]

The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.