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Lord Bach: I am grateful to the noble and gallant Lord for his contribution. As far as command is concerned, I must draw the distinction sharply between ISAF and 45 Commando. 45 Commando has nothing to do with ISAF. We are now talking about Operation Enduring Freedom and Operation Veritas, which are part of the coalition forces in the continuing struggle against Al'Qaeda and the Taliban. They will be under the same command as other British Armed Forces have been in the four or five months of this conflict thus far.

With regard to the timescale, we hope that this tour of duty will last for three months. I make no promises to the House about that. That is the intention as I speak today.

I have no separate knowledge of air support. I suspect that the RAF has played an important role in air support in its most general terms during the course of Operation Enduring Freedom and will no doubt continue to do so. Air support for 45 Commando and the work that they do with their American colleagues, and any other country that takes part, will no doubt be under American escort.

Lord Tebbit: My Lord, first, was the implication of the Minister's last answer that 45 Commando will in fact be under American control but that he could not quite bring himself to use the words?

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Secondly, does he agree that the implication of his Statement is that we have now entered into an open-ended commitment in Afghanistan? Will he say whether the Treasury has entered into an open-ended commitment with the Department of Defense?

Lord Bach: My Lords, let me be explicit. I hope I was fairly explicit previously. Under Operation Enduring Freedom, the command of the coalition forces has been by the Americans from Central Command at Tampa. That continues. It will apply to 45 Commando, as it has to other British Armed Forces that have previously been there. This is not an open-ended commitment, but we are determined that Al'Qaeda and the Taliban should be destroyed in Afghanistan before Operation Enduring Freedom ends. Otherwise, I repeat, what would have been the point of entering into this difficult task in any event?

With regard to questions about Her Majesty's Treasury, the noble Lord will have more experience than I of those.

Lord Gilbert: My Lords, my noble friend has quite understandably said that he cannot give the House any commitment as to how long our troops may find themselves in Afghanistan. However, will he tell us whether Her Majesty's Government have made a decision about the size of our contingent? Will it permanently be capped at the number to which he has referred at the Dispatch Box today, and, if so, have Her Majesty's Government told our allies that?

Secondly, although I understand the Minister's reluctance to identify other countries that have been invited to make contributions to this war-fighting force in Afghanistan, will he at least tell us how many other countries, without identifying them, have been invited to participate?

In conclusion, perhaps I may comment on the remarks of the noble Lord, Lord Hurd. However worthy his objectives, I can think of nothing more disastrous than having British troops sent on a war-fighting expedition being asked to take part in policing operations that are the responsibility of the civil authorities in Afghanistan.

Lord Bach: My Lords, I have no doubt that we have discussed the matter of numbers with our allies, as we discuss everything with them. The number in our ISAF force is presently down on the original number. It makes up part of the total number that I gave in my answer to the noble Lord, Lord King. He asked me for a figure in the round and my figure represented ISAF as well as Operation Enduring Freedom. That is the position so far as concerns numbers.

I regret that I am not in a position to answer the question about who else the Americans may ask to join in.

Lord Gilbert: My Lords, have the Government capped the number of British troops who are going in a war-fighting ro?

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Lord Bach: My Lords, I do not believe that the British Government have, but the decision to send in 45 Commando, with the logistics and other forces that it needs to make it operational, comes to between 1,500 and 1,700. If that is a cap, then they have.

Baroness Park of Monmouth: My Lords, I should like to ask the Minister three questions. First, may we take it that we can now forget any British commitment to the new EU army's plans for Macedonia? Secondly, is there any truth in the press statements that a major training exercise in Canada had to be cancelled? Thirdly, how is that in any way consonant with keeping our troops properly prepared and able to rotate?

Lord Bach: My Lords, the noble Baroness is cleverly trying to lead me down the road to Macedonia, but I shall not be tempted on that. I have enjoyed talking about Afghanistan this afternoon, but I am not going to answer questions about Macedonia. I do not know the answer to the noble Baroness's question, but, with the greatest respect, I do not think that it is relevant to today's Statement. The issue of Canada is relevant. I do not have the answer, but I shall write to the noble Baroness as quickly as I can on that.

Baroness Dean of Thornton-le-Fylde: My Lords, I, too, welcome the Statement and endorse the comments of those who have pledged full support for our Armed Forces in Afghanistan. I should declare an interest as chairman of the Armed Forces Pay Review Body. I have listened to the questions and answers about operational issues. One of the best manifestations of support for our troops is to ensure that their welfare is taken care of. The terrain and climate in Afghanistan are very difficult. Like other Members of this House, I have read the reports about the field accommodation and the quality of the reconstituted food that our troops are receiving. I know that some noble Lords may not regard that as a priority, but I do, having met service personnel. Will the Minister give me an assurance on this important issue, particularly as it appears that, while we may be hoping for a three-month operational deployment, the task may well take longer?

Lord Bach: My Lords, I am grateful to the noble Baroness, who plays an important role. Of course welfare and accommodation are crucial, even more so in hostile terrain such as Afghanistan. I can give her the assurance that she is seeking.

Lord Mayhew of Twysden: My Lords, is it not essential that the operation is funded by the MoD, with full indemnity from Her Majesty's Treasury? I have not given the Minister notice of this question, but perhaps he can answer it anyway. Is it not the case that counter-productive penny-pinching in the recent Gulf exercise, in which Challenger tanks were sent to the desert without desert air filters, has been found to have

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resulted in significant damage to their engines, for which spares are being delayed, with consequential harm to our ability to deploy those vital units?

Lord Bach: My Lords, the Treasury has not been lacking in the war against Afghanistan. The noble and learned Lord will know that there was a debate in the other place on defence funding last week. Extra money has been paid out of the consolidated fund to cover the money that was expended by the Ministry of Defence in relation to Afghanistan. The figures are available. I do not believe that there has been any penny-pinching on Afghanistan. I speak on behalf of the Government, not just on behalf of the Ministry of Defence.

Lord Mayhew of Twysden: My Lords, what about the future?

Lord Bach: My Lords, the noble and learned Lord is pressing me on the future. My view is that the Government will make sure that the important decisions that I have restated today will be properly funded.

National Health Service Reform and Health Care Professions Bill

House again in Committee.

6.14 p.m.

Earl Howe moved Amendment No. 42:

    After Clause 2, insert the following new clause—

Strategic Health Authorities shall have in place systems of surveillance to—
(a) monitor changes in the health of members of the public within the area of the Strategic Health Authority; and
(b) identify trends arising from the activities of the Primary Care Trusts within the area of the Authority."

The noble Earl said: One of the major questions begged by the Bill is its implications for public health. Public health doctors, including directors of public health, will have to transfer from existing health authorities to PCTs. Strategic health authorities will each have a doctor with responsibility for public health, but not necessarily experience in that discipline. The precise way in which the roles and responsibilities at each tier of the NHS will work together is as yet unclear. My purpose in tabling the amendment is to ask the Government to clarify their plans in this extremely important area, on which they have rightly placed a great deal of emphasis.

So far, the plans for NHS reorganisation have not yielded up any clear operational guidance on how the three essential elements of public health—planning, surveillance and service delivery—are to be run and co-ordinated. Ministers have referred in outline to public health networks, but there has been no indication of how such networks will relate to the statutory entities within the NHS. I am worried that, if

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the PCTs are to be charged with shouldering the lion's share of planning and delivering health protection and health improvement to local communities on top of what is already a huge and in part unfamiliar remit as providers of health services, we could be in a serious situation.

I am also worried that in some strategic health authorities there may be no one with the expertise of a public health doctor and that the person with responsibility for public health will not have the necessary independence that the role demands.

We then look to the regions. Regional directors of public health are to be created. Those directors will address the wider determinants of good health in the regions and will co-ordinate the design of the new public health networks. The new role for regional offices and regional directors of public health lacks a great deal of clarity. In particular, there is concern that the staff working to those offices will be working as employed civil servants, not as professional independent advocates for patients, as consultants work in the NHS.

In their recent document, Getting Ahead of the Curve, the Government have proposed a new national agency,

    "to act as a source of national expertise and to provide key services at national, regional and local level in a range of specified areas of health protection".

My noble friend Lady Noakes will have more to say about national co-ordination of public health when she speaks to Amendment No. 99 later. I am not at all clear how the functions of this new agency—yet another new agency—will differ in practice from the functions of the public health networks. How will the agency relate to the regional directors of public health and the strategic health authorities? Where will accountability lie for the success or failure of public health services? It appears at the moment to lie nowhere.

As far as we can understand it, the approach to public health in this reorganisation is piecemeal. It needs to be cohesive. At the least, we ought to have a codified plan from the Government setting out how public health services are to be delivered through the various local and national bodies, as well as a clear idea of where the duties and responsibilities lie. I did not necessarily expect to see anything on the face of the Bill in that regard—although that would have been a bonus—but it is regrettable that at this very late stage in the planning for a far-reaching reorganisation of the health service there is still almost no detailed knowledge within the NHS of how precisely and in practice the priorities for public health are to be addressed across the country. I beg to move.

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