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The hon. Gentleman asked about amendment No. 73. The European Qualifications (Health and Social Care Professions) Regulations 2007 amend the heading of section 44 of the Medical Act 1983. We have changed the reference in the Bill to reflect that. It has no effect on the meaning of the provision. The difference that he highlights is that between a European member state and a relevant European state. A “relevant European state” means a member state of the European economic area or Switzerland. The Swiss have certain treaty rights despite not being members of the EAA, including free
movement of Swiss professionals and the recognition of their qualifications by member states.
Lords amendments Nos. 33 to 36 agreed to.
Mr. Bradshaw: I beg to move, That this House agrees with the Lords in the said amendment.
Mr. Deputy Speaker: With this it will be convenient to deal with Lords amendments Nos. 38 to 47.
Mr. Bradshaw: Amendments Nos. 38, 40 and 41 strengthen the safeguards available for those subject to orders by justices of the peace by placing additional maximum time limits on detention, isolation or quarantine. Amendment No. 38 provides for an automatic review every 28 days where an individual is quarantined, isolated or detained under regulations made using section 45C of the Public Health (Control of Disease) Act 1984. Amendments Nos. 40 and 41 provide for the period of any extension of a measure for detention, isolation or quarantine imposed under an order not to exceed 28 days. There were concerns in the other place that the wording of the legislation could lead to disposal of dead bodies in a less than respectful manner. Amendments Nos. 37 and 39 clarify that where disposal of an infected or contaminated dead body is required, it is by way of cremation or burial. It was also felt that clarification was needed as regards who should be notified when an application for a justice of the peace order is made regarding a dead body. Amendments Nos. 42 and 43 deal with that issue.
Amendment No. 47 ensures that regulations made using the emergency procedure in new section 45R are not subject to the process for making hybrid regulations. That is because the hybrid instrument procedure is a rather lengthy process and would not be appropriate where there is an imminent public health threat. Finally, amendments Nos. 44, 45 and 46 ensure that the first draft of the regulations under sections 45N and 45L(4), which provide for the making of additional provisions in relation to a justice of the peace’s order, are subject to the affirmative procedure.
Anne Milton (Guildford) (Con): I shall start with amendments Nos. 37 and 39, which ensure that dead bodies are disposed of respectfully. The former wording of the clause did not really protect the humane treatment of dead bodies, and I am sure that many in this Chamber would like to think that they will be buried or cremated, rather than disposed of. I would particularly like to thank those in the other place for picking up on this point. Conservatives in the Grand Committee commented that the insensitivity should be addressed, and I welcome those amendments.
Amendment No. 38 makes available a right of review for special restrictions or requirements
“imposed by virtue of a decision taken under the regulations”.
Proposed new subsection (6B) would provide that where the restriction or requirement imposed was isolation, detention or quarantine of a person, the maximum period prior to review, and the maximum interval between reviews, would be 28 days. In addition, the review would be automatic for such measures. I fully support that amendment. In Committee, we had considerable discussion about issues relating to detention. I am pleased to see that the Minister has recognised some of the concerns about safeguards on the power to detain, isolate and quarantine people. The measures will restrict periods of detention, isolation or quarantine under the domestic regulation-making power to a maximum period of 28 days before a review must take place. We do not want a situation where people are held in isolation or quarantine indefinitely at the mercy of a periodic review. I therefore welcome the extra safeguards that the amendment will give to the liberties of those detained.
The automatic review is most welcome, and it will not depend on an application. As I said, considerable concern was raised in Committee about the powers, and I know that organisations such as the National AIDS Trust have particular concerns on the matter. I am pleased that the Minister heeded some of the concerns raised in Committee. There has been a lot of discussion in the House on detention recently, and it is curious in some ways that the measures in this Bill received almost no attention. The powers are quite draconian; they may be necessary in certain circumstances, but we need to ensure that the public are protected.
Amendments Nos. 40 and 41 will amend the Public Health (Control of Disease) Act 1984 to limit the period for which a part 2A order could impose detention, isolation or quarantine of a person to a maximum of 28 days. The amendments will also limit any extension of those measures to no more than 28 days, and provide a power to shorten the maximum periods further by regulation. I am pleased that the amendment will restrict the period of any extension of a justice of the peace order for detention, isolation or quarantine to no more than 28 days at a time. Once again, that will help to safeguard the human rights of those who have been detained, and it will protect the public from any miscarriages of justice. Consequently, I fully support that amendment. There is also a provision to shorten the maximum periods by regulation. If there is an opportunity to do so, and the 28 days is not found to be necessary in practice, I hope that the Minister will take up that option.
Lords amendments Nos. 42 to 47 are largely technical. As someone who has not been a Member of Parliament for very long, I find it disappointing that such technicalities are not ironed out earlier. My hon. Friend the Member for Eddisbury (Mr. O'Brien) said in his remarks on the first group of amendments that much parliamentary time could have been saved by introducing such measures when the detail had been properly worked out.
The group that we are considering is entitled, “Public health protection”, and public health staff will be greatly exercised by the implementation of some of the powers. The number of public health staff working in the NHS has more than halved in the past 10 years, since the Government came to power. In 1997, there were 3,000-odd key non-consultant public health staff, including nurses,
nursing assistants and other key public health support workers. By 2006, that figure had fallen to 1,362—a 57 per cent. cut.
As the amendments point out, public health staff are crucial to implementing some of the powers and ensuring public safety, yet a 57 per cent. cut in staff means that they have less time to exercise those powers. Indeed, in 2002, Derek Wanless served a warning on the Prime Minister that a failure to tackle public health challenges would contribute to an extra cost of up to £30 billion a year by 2022. The Prime Minister’s failure to tackle them forced the Government’s chief medical officer Sir Liam Donaldson to raise the alarm last July that the country was following the Wanless report’s worst case scenario. He noted:
“There is strong anecdotal evidence from within the NHS which tells a consistent story for public health of poor morale, declining numbers and inadequate recruitment and budgets being raided so solve financial deficits in the acute sector.”
Obesity rates, sexually transmitted infections and substance misuse are all rising. Indeed, since 1997, the proportion of boys aged two to 15 who are either overweight or obese has increased by 33 per cent. I recognise that the Bill contains provisions to do something to address that problem through weighing and measuring children. However, the statistics are shocking. The position has been exacerbated by the Government’s abandonment in 1999 of the Conservative Government’s targets of reducing obesity rates in the general population to 6 per cent. among men and 8 per cent. among women.
Figures have recently been produced on sexually transmitted infections. Since 1997, cases of syphilis have increased by 1,654 per cent. Cases of gonorrhoea have increased by 44 per cent., of chlamydia by 148 per cent., of herpes by 17 per cent., of genital warts by 17 per cent. and of HIV by 11 per cent. The Minister may laugh, but I doubt whether it is a laughing matter for those suffering from a sexually transmitted disease or those involved in public health protection who are trying to deal with the problems, which are not only serious but increasing.
Mr. Siôn Simon (Birmingham, Erdington) (Lab): Surely the hon. Lady is stretching the facts to make a rather cheap partisan point. All the percentages that she cites are recorded increases, which have been recorded because of the massive extra resources that the Labour Government have put into the NHS, unlike the Tories, who systematically bled it dry and almost destroyed it.
Anne Milton: I thank the hon. Gentleman for his intervention. It is interesting that he makes a party political point to knock me for making a party political point. I do not think that he will find that the increase in syphilis is down to extra recording. Syphilis has been recorded for quite some time. The issue is nothing to do with recording. To have sexually transmitted diseases at those levels in this day and age is very serious, and the issue is all about public health protection. On substance misuse, since 1997 the number of alcohol-related deaths has increased by 40 per cent. and the number of young people receiving treatment in hospital as a result of alcohol misuse has risen by 33 per cent. Smoking rates have fallen far more slowly since 1997 than in earlier years. In 2005, 24 per cent. of the adult population smoked, compared with 27 per cent. in 1998.
5.30 pm
Mr. Simon: Will the hon. Lady give way?
Anne Milton: I will give way one last time, but the hon. Gentleman failed to make an adequate point last time, so I hope that he will make one this time.
Mr. Simon: I am grateful to the hon. Lady for giving way again, but she failed adequately to respond to my point, so I will make it again, even more clearly. Is she seriously saying that if we greatly expand the number of health care professionals, as we have done, they will not inevitably produce, de facto, an increase in the number of recorded cases?
Anne Milton: I am indeed going to suggest that. Perhaps the hon. Gentleman should have listened to my point that public health staff have been reduced—not increased—by 57 per cent. I suggest that he check those figures and write me an apology tomorrow, because I am right.
Furthermore, health inequalities are crucial. Public health staff are the key to doing something about the rising rates of sexually transmitted infections, substance misuse and obesity. Although the inequality gap in circulatory disease mortality has declined and is on track to meet the target, the latest health inequalities figures show that the inequality gap in the infant mortality rate has not reduced by a sufficient amount to meet—
Mr. Deputy Speaker: Order. I am reluctant to stop the hon. Lady, but she must ensure that she relates her remarks specifically to the Lords amendments that we are discussing.
Anne Milton: Thank you very much, Mr. Deputy Speaker. The Lords amendments before us are grouped under the heading “Public health protection”, and that is what we are talking about. We are talking about the duties placed on public health staff to detain and isolate people, and to protect the public.
Let me finish by saying that health inequalities can be changed by public health staff. The inequality gap in the infant mortality rate has not been reduced by a sufficient amount to meet the target. The inequality gaps in male and female life expectancy at birth have both increased since the baseline. If current trends continue, the target will not be met. The inequality gap in cancer mortality has declined since the baseline, despite a slight increase in the last period. The minimum requirements for the 2010 target have already been met. However, that is irrelevant, as the meaningful outcome measure is the five-year survival rate.
Although I welcome the Lords amendments, they place yet more duties on public health staff, who are struggling to meet the already onerous burden imposed by the rising rates of substance misuse and sexually transmitted infections, and, more worryingly than anything else, particularly from this Government, by the rising inequalities in health.
Lords amendments Nos. 38 to 47 agreed to.
Mr. Bradshaw: I beg to move, That this House agrees with the Lords in the said amendment.
Mr. Deputy Speaker: With this it will be convenient to discuss Lords amendments Nos. 49, 50, 63 to 65, 90 and 91.
Mr. Bradshaw: Lords amendment No. 50 introduces a new clause into the Bill to amend section 164 of the National Health Service Act 2006, which allows the Secretary of State to authorise any primary care trust or other person to exercise the functions of determining authorities in relation to the making or varying of a determination on the remuneration for those providing NHS pharmaceutical services. There is corresponding provision in the National Health Service (Wales) Act 2006.
The Government have repeatedly given a commitment, both in the public consultation and during the passage of the Bill, that the Secretary of State would continue to set the fees and allowances for the national elements of the community pharmacy contractual framework. However, we recognised the concerns raised during the passage of the Bill in this House and the other place that that might change in future. Amendment No. 50 addresses those concerns by ensuring that if, in future, a decision were made to appoint primary care trusts or other persons as determining authorities for the remuneration of those providing pharmaceutical services under section 126 of the National Health Service Act 2006, that may be done only through regulations. There are also a number of related consequential amendments as a result of amendment No. 50.
Mr. Stephen O'Brien: I welcome the opportunity to debate this group of amendments. I am sorry that we did not receive any clarification on the health in pregnancy grant in another place. I must express my concern about amendment No. 48, and by extension, amendment No. 49. On the previous group of amendments, the Minister chose not to make any response whatever to my hon. Friend the Member for Guildford (Anne Milton), who made an outstanding contribution. I am sorry if we are delaying his teatime, but we hope to get some responses on this matter, as this is our last opportunity to get the Bill right.
All the amendments now being proposed were initiated by the Opposition, supported by other Opposition parties, even as far back as the Committee stage in the House of Commons, but we are only now debating the proposals, to which the Government have at last acceded. The Government therefore have a serious duty not only to account for their conduct on the Bill but to ensure that the necessary clarifications are in place. They will have no further opportunity to do so, as no ping-pong is anticipated with this Bill.
Amendment Nos. 48 and 49 will, as the explanatory notes somewhat euphemistically put it, allow the Department for Work and Pensions and Her Majesty’s Revenue and Customs
“to share information to help develop and refine policies for pregnant women.”
Can the Minister clarify what kind of data he envisages being shared? This proposal seems to add further confusion to the health in pregnancy grant. I will not detain the House by rehearsing the important and extensive arguments that we had in Committee—columns 455 and following—or in the other place, which showed clearly how little thought the Government appeared to have put into this measure, how little evidence it was based on, and how desperately Ministers seemed to be covering up for the Prime Minister’s ignorance, after he told the House from the Dispatch Box that nutrition was most important in the last months of pregnancy—Government reports confirm that that is not the case—and that this measure would assist that, for which there is little evidence.
Angela Browning: As a member of the Public Accounts Committee, I am trying to imagine what effect this measure will have on our proceedings. Representatives of Her Majesty’s Revenue and Customs appear regularly before the Committee, and I cannot imagine the kind of questions that I would put to the permanent secretary to find out how HMRC had aided the nutrition of pregnant women. Is that really HMRC’s responsibility?
Mr. O'Brien: I dare say that many of us would like to be a fly on the wall, if not in the Public Gallery, of the next PAC meeting when my hon. Friend will have a chance to put precisely that question. It will be interesting to hear what answer is given, in view of the expected responsibilities. It is extraordinary to find ourselves in this situation, not least when the health in pregnancy grant has been tested by having gone through such a lengthy process in both Houses. By his own admission, the Minister found much of the debate on that grant somewhat frustrating. We support it in principle, but we do so on the basis of evidence that it is indeed in the early weeks of pregnancy, and often the time before conception, that is most important for the health—in the broadest possible definition—and the health care of women either just pregnant or seeking to become pregnant. How that will be understood in the rather clinical world of the PAC, I do not know. Like my hon. Friend, I remain fascinated and I remain to be convinced.
Angela Browning: Does my hon. Friend share my astonishment that although the Government conceded many points in Committee and have introduced many changes, this very issue—the pregnancy grant—was one of the core elements of the Bill, which was quite flawed, yet the Government appear not to have made any substantive changes to it? Does he share my concern that they have failed to address the problems in this crucial part of the Bill?
Mr. O'Brien:
I really do, which is why amendments Nos. 48 and 49 rightly raise this issue at this stage of our proceedings. The Government have sought to skate over what they know to be a patent embarrassment, and a patent inability to produce evidence, because they know that the evidence is not there to back up the Prime Minister’s statement from the Dispatch Box to a full House that nutrition was most important in the “last months of pregnancy”. The Prime Minister cannot undo those words or, as Hillary Clinton would say, “unspeak” them, as they are there on the record. It is
difficult to have an explicit debate on a subject which was kicked off on the wrong basis by the absence of evidence for a prime ministerial opinion.
We have not pinned down the function of the policy. On 6 December 2006, the then Chancellor of the Exchequer, now the Prime Minister, said:
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