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Lord McIntosh of Haringey: My Lords, I simply do not agree with my noble friend that we have reached the point of diminishing returns. In purely financial terms the income from tobacco excise duty is very substantial. While I do not in any way condone smuggling or underestimate the cost to the Exchequer of that activity, nevertheless it is important for both public health and financial reasons that we should continue this policy.
The Earl of Onslow: My Lords, is it not true that the Government believe that if wages are taxed and social costs are imposed on wages on the Continent jobs will come to Great Britain? However, the Government then state that if they tax petrol and tobacco it will have only a beneficial cost. I am a simple fellow. Is it not
self-evident that if a whacking great tax is imposed on tobacco a person will bring a Ford transit van across the channel loaded to the axles with smoke-your-own and say that all of it is for his personal consumption even though that person does not smoke? One does not have to be other than a simple fellow like myself to understand it. Why cannot the Government understand that--or are they not simple? Perhaps they should be.
Lord McIntosh of Haringey: My Lords, the noble Earl is, as he knows, a very subtle fellow. I am astonished to find him arguing from the Conservative Benches in favour of tax harmonisation, as he appears to be.
EU Budget: Erroneous Expenditure
3.26 p.m.
The Earl of Clanwilliam asked Her Majesty's Government:
The Parliamentary Under-Secretary of State, Foreign and Commonwealth Office (Baroness Symons of Vernham Dean): My Lords, the European Court of Auditors annual report presented to Parliament on 17th November 1998, which covered the financial year 1997, estimated that the amount of erroneous expenditure in the EU budget was around £2.8 billion. A small percentage of this sum was suspected fraud, the remainder down to irregularities concerning the payments made against the Community budget. The Committee of the Wise report catalogued a culture of complacency, lack of accountability and in some cases nepotism, which is unacceptable. The consequent resignation of the entire Commission presents an opportunity to make changes to the structure of the Commission and to ensure that the standards of management and public administration in the European institutions are as high as we expect them to be in the national governments of Europe.
The Earl of Clanwilliam: My Lords, I thank the noble Baroness for her excellent intimation that there is a need for a structural review of the operation of the Commission. How many of the 20 commissioners who presided over departments were adversely reported upon by the committee? Can the Minister assure the House that none of those commissioners will be supported for re-appointment by Her Majesty's Government? In addition, do the Government agree that the common agricultural policy is itself a major cause of fraud and corruption and that only a lasting solution and proper reform will lead to a considerable reduction in the budget of the CAP?
Baroness Symons of Vernham Dean: My Lords, the noble Earl raises a number of enormously important points. The report was critical of a number of Commissioners for different reasons. Commissioners Santer, Cresson and Marin were criticised for lax
management of expenditure programmes or departments under their control. It was also critical of Commissioners Cresson, Pinheiro and Wulf-Mathies for favouritism or irregularity in the making of appointments. It will be up to individual countries to decide what to do about re-nomination. The noble Earl is aware that my right honourable friend has made clear what the Government intend to do about the nomination of our own commissioners upon whom there is no taint. The noble Earl also referred to issues related to the common agricultural policy. These matters, together with other important issues related to the structural funds and financial matters of great interest to all of us, will be discussed at the meeting in Berlin on 24th and 25th March.
Lord Thomson of Monifieth: My Lords, I declare a somewhat ancient interest as one of Britain's first commissioners 25 years ago. Is the Minister aware that I find particularly painful the findings against the present members of the Commission of nepotism and administrative failure to manage their affairs? Is the noble Baroness aware that none of the commissioners was personally found guilty of either fraud or corruption? Is she also aware that I welcome the fact that she spread the net more widely about looking at the institutions of the Community? In declaring a more recent interest as a member of the Nolan committee, perhaps I may ask whether the Minister believes that there may be a strong case for a truly independent Nolan committee of the European Union to consider not only the European Commission but also the European Parliament and the Council of Ministers.
Baroness Symons of Vernham Dean: My Lords, the findings are very painful indeed. My right honourable friend described the report as damning. The noble Lord is quite right that none of the commissioners was found to be personally culpable of fraud or of having gained himself financially from those irregularities.
However, what the noble Lord says is absolutely right. It is no good simply identifying some individuals. We need to consider not only the systemic difficulties but also the ways in which those might be put right. I draw the noble Lord's attention to the fact that the committee of les Sages is due to report again in a few weeks' time to make some recommendations about reform. In the Statement repeated in your Lordships' House by my noble friend the Leader of the House earlier this week, my right honourable friend put forward a number of suggestions about the reforms on a wider basis which should be contemplated for the European institutions.
Lord Mishcon: My Lords, will the Minister be good enough to indicate to the House Her Majesty's Government's policy in regard to the payment of compensation for loss of office where Ministers or members of the Commission are involved who will not be reappointed but who are ultimately responsible therefore for the disgraceful level that has been announced?
Baroness Symons of Vernham Dean: My Lords, commissioners' terms and conditions are set down in
the statutes which govern their employment. The statutes contain generous provision for the end of service remunerations. I have details of those provisions. I do not think it is worth repeating them now. I can send them to the noble Lord if he finds that helpful. However, as the Prime Minister made clear in another place on 17th March, we believe that any commissioner who is found guilty of fraud or misconduct should not receive those remunerations. Indeed, the statute states that in the event of resignation as a result of gross misconduct--what it terms as a faute grave--the commissioner would not qualify.Tax Credits Bill
Brought from the Commons; read a first time, and to be printed.
Health Bill [H.L.]
3.32 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, I beg to move that the Bill be now further considered on Report.
Moved, That the Bill be further considered on Report.--(Baroness Hayman.)
On Question, Motion agreed to.
Earl Howe moved Amendment No. 47:
After Clause 18, insert the following new clause--
(" .--(1) The Secretary of State may by regulations--
(a) extend the duty in section 13, or
(b) extend the functions of the Commission for Health Improvement, or any of them,
to any independent hospital.
(2) In this section "independent hospital" means premises--
(a) within the meaning of "hospital" given by section 128(1) of the 1977 Act;
(b) which are not a health service hospital within the meaning of the 1977 Act nor any other premises maintained or controlled by a government department or local authority or any other authority or body instituted by special Act of Parliament or incorporated by Royal Charter; and
(c) which are used or intended to be used for the provision of health care within the meaning of this section,
but excludes--
(i) any premises used, or intended to be used solely or predominantly, for the reception of and the provision of nursing for persons suffering from any sickness, injury or infirmity;
(ii) any sanatorium provided at a school or educational establishment and used, or intended to be used, solely by persons in attendance at, or members of the staff of, that school or establishment or members of their families;
(iii) any first aid or treatment room provided at factory premises, at premises to which the Offices, Shops and Railways Premises Act 1963 applies or at a sports ground, showground or place of public entertainment;
(iv) any premises used, or intended to be used, wholly or mainly--
(a) by a medical practitioner for the purpose of consultations with his patients;
(b) by a dental practitioner or chiropodist for the purpose of treating his patients; or
(c) for the provision of occupational health facilities,
unless they are used or intended to be used for the provision of treatment by specially controlled techniques as defined in section 21 of the Registered Homes Act 1984 and any regulations made thereunder;
(v) any premises used, or intended to be used, wholly or mainly as a private dwelling; or
(vi) any other premises excepted from the definition of a "nursing home" for the purposes of section 21 of the Registered Homes Act 1984 by regulations made thereunder by the Secretary of State.").
The noble Earl said: My Lords, this amendment is a reformulation of a number of separate amendments tabled in Committee, but in a less prescriptive form. Its purpose is to permit but not oblige the Secretary of State to extend both the duty of quality and the remit of the commission for health improvement to the independent sector.
In Committee the Minister made some helpful comments on the issue. She recognised that the regulation of the independent sector was an issue of importance which needed to be addressed. She confirmed that the Government were committed to consulting on it and suggested that the right time to look fully at the subject would be after the Select Committee in another place had reported. If I do not misrepresent her, she wanted to avoid a straightforward transposition of the structures and systems in the Bill on to the private sector without first listening to the views expressed from all quarters.
That for me is a position with which it would be hard to disagree. However, the concern which some of us had in Committee was that the Health Bill represents an ideal opportunity--and probably the only legislative opportunity for some time--to make provision for regulating the private sector. If we do not take this opportunity, we could be kicking the issue into some very long grass.
My noble friend Lord Skelmersdale suggested the obvious way to get round the dilemma: to insert enabling powers into the Bill allowing the Government to apply as many of their clinical governance provisions as seemed to them appropriate to the independent sector at some point in the future. One of the remarks I hear on occasions is that the independent sector does not want to be regulated. If that were once true, it is true no longer. As I mentioned on the last occasion, the independent sector has already responded extremely positively to the Government's quality agenda on a voluntary basis. A lot of work has been done under the auspices of the private practice forum of the Academy of Royal Medical Colleges. There is, I believe, a real recognition in the sector that quality in the delivery of healthcare should apply across the board as a matter of principle in independent hospitals and the NHS; and that the regulatory framework supporting that should not be subject to any artificial barriers or boundaries.
There is, after all, a considerable day-to-day overlap between the two sectors. A high proportion of the doctors and consultants who work in the private sector also work for the NHS. Many NHS patients are treated in private hospitals. NHS hospitals treat private patients. In fact the extent to which the private sector now shoulders the burden of elective surgery across the country as a whole is not often appreciated. The estimate I have been given is about 15 per cent. of all waiting list type treatments. For some procedures such as hip and knee replacements and heart bypasses, the figure is probably nearer one in four. It is as important for patients to know how well doctors are performing in their private practice as anywhere else, and to know that the highest possible standards are being followed in private hospitals.
I know from personal experience of two excellent private hospitals, one brand new and one well established, which are struggling to achieve recognition, that private insurance groups require hospitals on their preferred lists to demonstrate certain standards. I believe that the amendment would help those hospitals to demonstrate such standards.
The other criticism is: "The NHS should not be regulating the private healthcare sector". That is a complete misreading of the proposal I am advancing. The Government are establishing two brand new bodies: the national institute for clinical excellence; and the commission for health improvement, at either end of a continuum of clinical guidance. At one end we shall have NICE producing guidance for doctors on the treatments that work and those that do not. In the middle we shall have local clinical governance arrangements in hospitals, GP practices, and so on. We shall have the professions and the colleges overseeing those arrangements. At the other end of the continuum we shall have the commission for health improvement in the role of inspector and auditor. It cannot make sense to exclude from that national framework a significant part of this country's healthcare providers.
Indeed, we need to remind ourselves that the Secretary of State has the duty to promote the health of the nation. That does not mean the health of only those who happen to be treated under the state system, but the health of everyone. It means that he has a responsibility for the totality of healthcare delivered in this country by whomever it is delivered. Anything less than that and the patient will be short-changed.
It is not my intention to force the Government to act now or to prescribe a set of clinical governance arrangements which do not fit. The amendment deliberately allows for flexibility. I believe that it is a sensible proposal; it is a proposal that is in the interests of patients and I commend it strongly to the House. I beg to move.
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