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Lord Ashley of Stoke: My Lords, is my noble friend aware that, despite what she says, most national health hearing aids are old-fashioned? I note that the Government have set up a working group to act on this, and that is welcome, but can my noble friend assure the House the review will not drag on for too many years? All the facts are now known and well established. The private sector raced ahead using modern technology and far superior hearing aids are available because of the use of that modern technology. The National Health Service could obtain the benefits of those aids by mass production and the cost-savings of large-scale economy, yet it is not doing so. Can we please get a move on and
have a commitment from the Government that they will introduce digital aids on the health service? The cost will be minimal.
Baroness Hayman: My Lords, my noble friend makes a number of points. Perhaps I can reassure him on the first; that is, the review that is taking place of both hearing aid and audiology services will not be dragged out. I hope that it will report later this year. I recognise that great advances are on the horizon, particularly using digital technology. We must explore those. However, we must be certain that they are safe, effective and give value for money before including them in the NHS range. My noble friend is right to pinpoint the role of the NHS Supplies Authority as a bulk purchaser. In that regard there will be opportunities in the future for driving down the price of what is, at the moment, expensive new technology.
Lord Clement-Jones: My Lords, can the Minister confirm whether or not she believes that there is adequate price competition in the market for digital hearing aids? If not, is there a good case for referral of the manufacturer of digital hearing aids to the Office of Fair Trading?
Baroness Hayman: My Lords, this is a new technology. It is being introduced at the moment mainly in the private sector. We will have to see how that market and pricing within that market develop. The NHS Supplies Authority has started to look at future provision of hearing aids and one element of its investigations will cover analysis of digital hearing aid technology, including the cost considerations in that regard.
Lord Jenkins of Putney: My Lords, is my noble friend aware that a large number of people of modest means are obliged to pay £500 or more, which they can ill afford, in order to acquire a satisfactory hearing aid which meets their requirements? The old-fashioned type will not deal with many of the problems from which people suffer. Is it not more urgent than is generally appreciated for people to be enabled to acquire a hearing aid at a reasonable cost--or, indeed, without cost--on the National Health Service as soon as possible?
Baroness Hayman: My Lords, I certainly agree with my noble friend that this is a serious issue and one that affects a great number of people. But as I said in my earlier reply, we should not think that there is simply one old-fashioned, outdated hearing aid available. Over the past four years there has been substantial updating in the range of hearing aids available, including in-the-ear aids, high-frequency aids and mini aids. Also, the type of hearing aid provided by the NHS is a matter for the clinician concerned. If it is clinically necessary for the patient, it is possible for a hearing aid outside the normal NHS range to be prescribed.
Baroness Carnegy of Lour: My Lords, since the price of newly invented hearing aids inevitably reflects the cost of development, does it not stand to reason that
to buy large quantities of newly invented digital hearing aids--provided their success is proven--would rapidly reduce their price? Should not the Government look at the matter in that way? There is no question but that digital hearing aids are infinitely more useful?
Baroness Hayman: My Lords, I alluded to the possibility of bulk purchase by the NHS Supplies Authority driving down the price of what is at the moment expensive new technology. We must recognise that there is a need to evaluate the technology and to conduct trials to see exactly what enhanced benefits there are--for example, against the existing advanced programmable analogue aids--when considering large numbers of users. That is not to say that digital technology does not offer great possibilities of advance. We need to look at how it will be cost-effective and of benefit to patients. Also, we need to look at how the price may be brought down.
Lord Annan: My Lords, does not the Minister agree that the noble Baroness, Lady Carnegy, is entirely right when she says that digital aids have been tested and tried time and again? There is therefore no need to have large exploration and a programme designed to delay any decision on this.
Baroness Hayman: My Lords, the review is not designed to delay a decision. We are looking carefully at what exists. As I understand it, there are needs for other technology in addition to the aid itself--the calibration mechanisms and so forth. It is important that we recognise this and look carefully when considering use by large numbers of patients at what are the additional and cost benefits. That is work we are now taking forward.
Baroness Pitkeathley: My Lords, is my noble friend aware that in the recent Royal National Institute for Deaf People survey 51 per cent. of those hard-of-hearing who were surveyed said that they would not take consultation about the matter for fear that they would be prescribed a hearing aid and did not want to wear one? A further 21 per cent. said that they did not believe anything could be done about their deafness. Does not my noble friend agree, therefore, that a campaign of public awareness as to what can be done to alleviate hearing problems would be beneficial?
Baroness Hayman: My Lords, my noble friend makes an important point. Large numbers of people see hearing loss as a normal part of the ageing process about which nothing can be done to help. Indeed, they have an idea that hearing aids are a cumbersome and old-fashioned mechanism with which they do not want to be involved. It was in order to raise public awareness that the Royal National Institute for Deaf People launched a campaign last year to encourage people experiencing hearing loss to speak to their GP. The Secretary of State was happy to launch that and 39,000 GPs were alerted to the importance of being aware of the problems of hearing and of referring patients for appropriate audiological tests and treatment.
Access to Justice Bill [H.L.]
3.9 p.m.
The Lord Chancellor (Lord Irvine of Lairg): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved, That the House do now again resolve itself into Committee.--(The Lord Chancellor.)
On Question, Motion agreed to.
House in Committee accordingly.
[The PRINCIPAL DEPUTY CHAIRMAN OF COMMITTEES in the Chair.]
Clause 12 [The Criminal Defence Service]:
Lord Kingsland moved Amendment No. 145:
The noble Lord said: Amendment No. 145 has a simple purpose. The noble and learned Lord the Lord Chancellor has, in his Bill, introduced the novel concept of a criminal defence service. The amendment seeks to ensure that before the defence service is established, full consultation takes place with all interested parties. I shall say no more about this amendment now because I know that my noble friend Lord Windlesham wants to speak to it. I beg to move.
Lord Windlesham: I am grateful to my noble friend Lord Kingsland for that brief introduction by way of moving the amendment. We should make no mistake that the amendment to Clause 12 on the introduction of a new criminal defence service represents a landmark in the development of criminal policy. The clause establishes by statute for the purpose of protecting the interests of individuals "involved in"--words to which we shall return later--
The new criminal defence service will, we should note, be an entirely separate service from the community legal service which was discussed earlier in Committee. I refer to Clauses 5 to 11. Although initially--that word is important--both services will be run by the legal services commission as set out in Chapter 6, paragraph 10 of the White Paper, I should like to suggest that the establishment of a criminal defence service goes much further and may have more profound effects on procedural justice in future than the overhaul of the system of paying legal aid, which is what brought the issue before the House in the first place.
The proposed service is not simply a novelty; it was entirely unforeseen until the publication of the White Paper, Modernising Justice, which appeared virtually simultaneously, within 24 hours of the First Reading of the Bill. From the comments made in a letter to the editor of The Times by the then chairman of the Bar, and later confirmed by the Law Society, there was no prior consultation with, nor any notification to, those two professional bodies.
The noble and learned Lord the Lord Chancellor has the reputation of a man in a hurry. The reform of legal aid is an issue where perhaps a degree of haste was not overdue--it has been a bugbear of successive governments for many years--but what was the reason for that lack of prior consultation? At Second Reading I asked for an explanation, but received no reply from the Minister of State when he wound up the debate.
Those Members of the Committee who were present at Second Reading will remember that very little was said about the criminal defence service either by the Lord Chancellor in opening or by the noble and learned Lord, Lord Falconer of Thoroton, when he replied, apart from the highly charged exchanges on the fear that employed lawyers in criminal proceedings might be less independent than under the present arrangements. Nobody was more eloquent in advancing that argument than the noble Lord, Lord Hutchinson of Lullington, whom we are all pleased to see in his place this afternoon.
Perhaps I may repeat those questions now: why was there no prior consultation? Was the CDS a last-minute idea? Were arguments raised against it within the Government, and, if so, what were they? Was it a fear of hostile reaction? Were the spindoctors unhappy--surely not--or was it more likely that it was just a misjudgment of the proper way to approach legislative change?
In replying to my noble friend Lord Kingsland on an amendment to Clause 9 last week, the Lord Chancellor confirmed that it was his practice to consult on major innovations. Nobody can question that this is a major innovation. The amendment provides an opportunity to explain why consultation in advance of publication of the Bill did not happen in this instance; but it goes further than that. The amendment looks to the future and not to the past. By accepting that there should be consultation with the Law Society, the General Council of the Bar, and with other providers of existing legal services, once the Bill has become law--that is, after the event, but before the new service is set up--the Government would have a graceful way of making amends for their failure to consult earlier.
The Lord Chancellor: Clause 12(1) imposes a duty on the commission to establish, maintain and develop the criminal defence service to protect the interests of people involved in criminal investigations and proceedings. The amendment would postpone that duty arising until consultations had taken place and would make all subsequent activity by the commission to maintain and develop the criminal defence service subject to consultation with the legal profession and others.
Since becoming Lord Chancellor on 2nd May 1997, I feel that I spend half my life consulting people. If I am "a man in a hurry", certainly the extent of the consultations which I undertake operate as a considerable brake upon that. I believe wholly in full discussions, consultations and piloting before changes are introduced. Looking back over the past year or two
The examples of consultation and discussion that I could give are legion and will grow as we move further along the road to reform. With respect to the noble Lord, I believe that his amendment is based on a misunderstanding of what the Government are about in their reforms of the way in which we secure defence services and how they intend to proceed. The amendment appears to assume that we are on the verge of a revolution when in fact we are already in the midst of continuing evolution of which the changes under the Bill are only a part. I dare say that the noble Lord, Lord Windlesham, is right that this is a landmark, but it does not begin to represent a revolution. The Government have reached the conclusion that in all areas of legal aid they need to become more active in securing services for those who need them rather than simply being reactive and paying lawyers' bills when they come in once a service has been provided; hence the shift over time to contracting or other means of better ensuring that the services are of good quality and value for money in protecting the interests of criminal defendants.
As my examples of recent consultations and discussions indicated, we are already proceeding well along this road as regards criminal legal aid. For example, limited contracting is possible under the current statute. In June last year the Legal Aid Board started a pilot scheme to develop contracts to provide criminal advice and assistance, including at the police station and in the magistrates' court. The Government's aim is that all advice and assistance in criminal matters should be provided under contracts by the year 2000. Contracts for representation in the youth courts will begin to be piloted next month. As the pilot proceeds,
Meanwhile I hope to make much faster progress on very expensive criminal cases. Again, my department is currently in discussion with the Bar and the Law Society about the prospect of one-off individual contracts in such cases. However, the current powers to contract are limited and are not appropriate to a system where we expect contracting to become the predominant but not necessarily the only means for securing criminal legal services for defendants over time.
Matters of principle or major changes will need to be the subject of discussion and consultation as we develop the scheme. But the purpose of the Bill is to allow us to go further down the road towards contracting. Perhaps I may explain to the noble Lord that there is not going to be any sudden realisation of a grand plan to be unveiled and foisted on the legal world on the day we implement the Bill. In most respects the organisation and types of services available on day one of the new statutory regime will be no different from what they were on the last day of the current regime.
Perhaps I may take as an example one of the matters raised in our discussions in Committee; namely, how contracting will affect the Bar. At present we have a graduated fee scheme covering trials in the Crown Court of up to 10 days. That will still be there when this Bill comes into effect and in all likelihood it will last until the year 2003. Therefore, depending on what progress we make with the Bar in our discussions on contracting directly with it for its services, that scheme could remain in place for some years. In some types of cases it may remain indefinitely. In that time it might even be extended in its coverage.
This is a practical and incremental strategy and to my mind it is the right way forward. It gives us time to consult as we go. It is no big bang on which there must be some specific consultation exercise. The way in which we are proceeding will ensure that we can pilot new arrangements rather than chancing our arm with major untested changes without piloting and discussion.
I am at pains to emphasise to the noble Lord that there is not, and there is never going to be, a wholesale, redesigned system on which to consult specifically. I take the opportunity to reassure the Committee about that. While I am in no doubt that contracting will play an ever larger part in securing defence services in the future and that there may well be a place for a salaried element in the provision of criminal defence services--we shall discuss that later today--the upshot of what I am saying is that it is not possible to consult on the establishment of the criminal defence service as an entity precisely because there is no fixed grand plan on which to consult. However, we shall need to debate, discuss and consult on key elements and important changes as we go. Indeed, the passage of this Bill and our discussions in Committee on it are providing just such an opportunity.
I believe in proper consultation. As I said at the outset, I believe I spend about half my time engaged in it. If we are going to achieve real progress in improving defence services, consultation will be a vital, ongoing aspect of the reforms. To my mind the amendment as it stands points to the difficulty of enshrining this in law. The amendment not only seeks to make consultation a precondition of imposing a duty on the commission to establish the criminal defence service. It would also make it a precondition of maintaining and developing it, a task that holds out the prospect of really undefined and uninterrupted consultations stretching continuously into the indefinite future.
I apologise for detaining the Committee but I hope that on the basis of what I have said the noble Lord is reassured and that he will be able to withdraw the amendment.
Page 8, line 17, after ("shall") insert (", after consultation with the Law Society, the General Council of the Bar and such other providers of existing legal services as its proposals may affect,").
"criminal investigations or criminal proceedings".
Those words come in Clause 12(1).
3.15 p.m.
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