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Baroness Cumberlege: As the noble Baroness said, these are difficult issues. When we were considering the content of the Bill we considered carefully whether we wished health authorities directly to employ medical practitioners. The present position under existing legislation is that health authorities can only employ medical practitioners to provide general medical services in exceptional circumstances where other arrangements are unable to secure adequate provision of services in the area. In effect, it is to deal with a crisis in local services.
In the new piloted arrangements which the Bill seeks to introduce there is a clear distinction between the role of health authorities and potential providers of personal medical services. That is crystallised in the contractual nature of their relationship. The health authorities are on one side of the contracted purchasing services; medical practitioners are on the other providing those services. We decided that the virtues of this arrangement and giving both sides a context in which they can discuss and agree what services are specifically required and how most effectively they are delivered were best served by maintaining that distinction in all circumstances. We foresaw difficulties for both health authorities and potential providers under piloted arrangements if health authorities could in effect become both purchasers and providers. It would be difficult for them to appear even handed in the process of allocating contracts if they were one of the potential providers. But even more seriously, if successful, it would compromise the health authority role in monitoring the contract and ensuring that patients got the best deal out of the arrangements.
The current capacity for direct health authority involvement under existing legislation would remain. If a pilot got into serious trouble, for example, and an adequate provision of services could not be maintained, a health authority could protect the interests of patients by employing GPs directly. We believe that it provides for clearer lines of management and accountability for services if direct health authority employment remains, as now, in a fall-back capacity.
Baroness Hayman: I am grateful to the Minister for those helpful remarks. It is helpful to know that in exceptional circumstances it would be possible for a health authority to take up these schemes. It would be a shame if we excluded the possibility of these more imaginative schemes being covered while the more basic and straitjacketed schemes under general medical services were covered. I shall look at what the noble Baroness has said. For the moment, I beg leave to withdraw the amendment.
Earl Russell rose to move to resolve, That this House calls on Her Majesty's Government to withdraw the Child Support (Miscellaneous Amendments) (No. 2) Regulations and lay amended regulations omitting Regulation 9.
The noble Earl said: My Lords, this Motion, if carried, would request the Government to delete Regulation 9 from the Child Support (Miscellaneous Amendments) (No. 2) Regulations. I have two different reasons for moving the deletion of Regulation 9. First, I believe that what the Government are doing is in itself quite seriously mistaken. Secondly, I believe that in terms of normal procedure in this House what they are doing is--and I choose my words carefully--unusual.
The previous law provided that when a benefit penalty--now 40 per cent. of benefit--was imposed on a woman who did not co-operate with the Child Support Agency, that penalty, which is itself heavy enough, could be suspended--and I say suspended, not remitted--if that person was already subject to a large and serious number of deductions from benefit. That is what is now withdrawn. I think the Government are mistaken because they are creating a very heavy burden on the women concerned and therefore also on their children. They are in fact in danger of infringing the basic principle of social security, which is, "Don't let poor Nellie starve".
In November 1996, 1.7 million people had more than one deduction from benefit. I shall run through some figures which may be familiar to the Minister because they have been quoted in the other place; but they are good figures and they bear repeating. The average--I am not dealing in exceptional cases, this is the average--deduction from benefit is £11.99 for electricity; £10.49 for gas; £4.90 for rent arrears and
Put on top of a deduction like that--an extra 40 per cent. deduction from gross benefit--one is not going to be left with very much. I do not understand how people are meant to make a honest living on that figure. The Minister is in fact leading them into temptation. We know whose office that is and it ought not to be the office of the Government. So my first objection is simply that this is too heavy: it infringes the basic principle of social security that people ought to be able to live.
If I know the Minister's line of argument he is going to come back to this with a fairly standard set of arguments about why is this the business of the taxpayer. It is the business of the taxpayer because if any taxpayer is that badly off he ought not to be paying taxes at all. It is in the interests of the taxpayer that those who go out of work--I believe that that has happened to 8 million people since the last election--should not waste away, but should be able to resume work at some future date. So I believe that the taxpayer has a concern for keeping his fellows alive. He has that concern as a matter of self-interest as well as of altruism. So I believe that the taxpayer, if he refrains from starving women and children, may be doing so in his own interest.
I come to the circumstances of this change. The old system, the provision for suspension whose disappearance I so much regret, was first agreed to by the Government in response to an amendment moved by the noble Lord, Lord Carter--and I have given him notice of what I am doing today--to the Child Support Act 1995. The Minister's acceptance of that provision introduced this power to suspend in order to reduce benefit directions in cases of hardship.
On that occasion the noble Lord, Lord Carter, remarked, perhaps just a little smugly that it shows what one can do when one sets out to improve a Bill rather than mortally to wound it. Yes, it does. Appeasement does not work and it has not worked on this occasion either.
That measure was brought into effect by regulations introduced in December 1995 and came into force as recently as January 1996. So this concession has been withdrawn after merely 10 months in operation. It is that which I describe as "unusual". If one is to withdraw a concession that quickly, without casting doubt on the original concession itself, one needs to have a pretty strong reason. I have looked carefully at what Mr. Mitchell said in another place on 11th December. If I have understood him correctly, he says that he is withdrawing the concession simply because a lot of people used it. It is not open to abuse, but open to use.
If the Government had understood the reasons why this concession was asked of them and when they so generously agreed to it, they would have expected that a lot of people would take advantage of it. They would
The Government are also getting themselves into a real moral panic about people not collaborating with the agency. But I explained to them in 1991--and everything that has happened since confirms it--that one simply cannot find an economic incentive which is strong enough to make a woman co-operate when she is determined not to do so. I told the Government in 1991 that by believing that they could do it all by economic incentives they were missing so much. The repugnance in many cases to resuming negotiations is an emotional one. One might starve them before one makes them overcome it. So I believe that attempting to make life more difficult for the women concerned is not going to achieve the desired effect however severely it is done. I warned the Government of that and I believe that experience bears me out.
It may be that they have good reasons for this. I know the Minister of old as an honourable opponent and I am pleased to be opposite him. But when future historians read these exchanges--
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