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Lord Wallace of Saltaire: My Lords, before the Minister sits down, as we do have a little time, can she be more specific, if possible, about whether there is any movement on Transnistria and the withdrawal of Russian troops? It seems to us to be important. We have heard a certain amount about whether the EU would play a larger role, including perhaps sending peacekeeping monitors, if that conflict did move towards resolution.
Baroness Symons of Vernham Dean: My Lords, reinforcements have arrived from the Box, fully justifying the number of civil servants who are with us
this evening. I can tell your Lordships that the UK continues to raise with the Russian leadership the need for Russia to remove its troops from Moldova. The UK will not ratify the adapted CSE treaty until Russia removes its troops. Many thanks to officials for running to the aid of their Minister. I hope that that satisfies the noble Lord on that question.University of Manchester Bill [HL]
The petition against the Bill from Kenneth Rohde and Ian David Bell (No.1) was withdrawn. The order made on 11 February last was discharged and the Bill was committed to an Unopposed Bill Committee.
- House adjourned at seven minutes before ten o'clock.
Official Report of the Grand Committee on the
Health Protection Agency Bill [HL]
Wednesday, 3 March 2004.
The Committee met at half past three of the clock.
[The Deputy Chairman of Committees (Lord Tordoff) in the Chair.]
The Deputy Chairman of Committees (Lord Tordoff): Before I put the Question that the Title be postponed, may I remind Members of the Committee of two points of procedure? Noble Lords will speak standing, and the House has agreed that there shall be no Divisions in Grand Committee. Unless, therefore, an amendment is likely to be agreed to, it should be withdrawn.
Earl Howe moved Amendment No. 1:
- Page 1, line 8, leave out "(or any part of the community)"
The noble Earl said: In moving Amendment No. 1, I begin our Grand Committee proceedings by reiterating the general welcome that I gave to the Bill at Second Reading and by making it clear that I approach our debates today in an entirely constructive spirit. I hope that that will become even more evident as we proceed. Where I flag up our genuine concerns, I hope and trust that the Minister will be able to reassure me sufficiently on those matters. I look forward to hearing what he and the noble Baroness, Lady Andrews, have to say.
I must start by apologising to the Minister for tabling what may seem a somewhat oblique and elliptical amendment. It is not my purpose to dissect the meaning of "community", although no doubt that would be an interesting debate were we to have it. I have homed in on,
- "any part of the community",
The agency's ability to respond rapidly to an outbreak of infection—whether from a food-borne organism, a virus transmitted from person to person, or whatever it happens to be—and to monitor what is going on day to day will depend critically on the networks put in place on the ground and on the efficiency with which the information can be communicated up the chain. That may seem a statement of the obvious but there are worries among some of us that the local mechanisms for controlling communicable disease have been disrupted by the recent reorganisations.
Much will depend on PCTs, which, as we know, have their hands full in all sorts of ways unrelated to public health. Many—I am one—feel that PCTs are in any case too small, in terms of population, to have the full range of specialties needed to produce effective health gain and effective local control. Indeed, the consultants in communicable disease control—the very people who know most about the day-to-day business of health protection—have been removed from the PCTs and relocated into the Health Protection Agency. The direct involvement of those individuals with the local arms of the NHS and with environmental health departments of local authorities has thereby been done away with.
I strongly question the wisdom of that. Although one can produce a lot of good arguments for overarching structures, staffed by professionals, those overarching structures can work only if there are people with both the skills and the authority on the ground to get things done as they should be done.
Whoever is charged with those day-to-day tasks needs to be monitored, but how will we know whether or not they are doing a good job? In theory, the strategic health authorities are there to performance-manage. I am not the only one who regards strategic health authorities as too large and too distant to have the knowledge of what can effectively be done at ground level. In the main, they are not staffed with grass-roots experts on health commissioning and delivery. That, combined with the fragmentation of commissioning and delivery, will prove a serious barrier to driving up standards in public health.
We will drive up standards only by having clinically-led service improvements, speciality by speciality, across wider perspectives than single hospitals or single PCTs. Medical management should find ways of recreating the necessary integration of hospitals and PCTs in that sense. Unless that happens, the laudable aim articulated for the agency in the clause—that it should have, as it were, fingertip control at a local level—cannot be fulfilled properly.
It is not clear to me how communicable disease consultants will link up with PCTs. Other than in emergencies, there is no clear command structure. Even then, as I shall say later on, there are all kinds of grey areas. I have heard it said before that if we look at this country's record of infectious disease control, it is only because we have had extremely competent people dealing with it that that we have got by without a major epidemic. In other words, we have got by despite the system, not because of it.
We are in danger now of making the system a good deal less joined-up than before at local level. It would be very helpful if the Minister could tell the Committee something about the day-to-day practical arrangements—the allocations of responsibilities for lines of command and so on—that will overcome the structural shortcomings to which I have referred. I beg to move.
The Parliamentary Under-Secretary of State, Department of Health (Lord Warner): The words which are the subject of the amendment were put in to make it clear beyond peradventure that the HPA may
undertake functions in relation to not only the population as a whole, but particular localities—as it will do in its support for primary care trusts in England—and in respect of other sections of the community, such as children or workers in a particular area.The noble Earl perhaps understated the capacity of the SHAs to monitor the work of PCTs. There are, after all, 28 strategic health authorities and 303 PCTs, a ratio of about 10 to one or 11 to one, which is not a huge span of control in terms of monitoring activities. Certainly we are not looking for a command-and-control model between the HPA and communicable disease consultants.
It has always been our intention that the agency should play a hands-on role in supporting local services in England. The consultation exercise carried out before the Special Health Authority was set up showed that we needed to explain more clearly—it may be the cause of some of the problems—that the role would be active and not simply advisory. Misunderstandings about that have caused some concern and I can understand why the noble Earl is probing the issue.
Certainly the agency has worked closely with local NHS bodies since its establishment as a special health authority to achieve a clearer understanding of its role in relation to local services. It has been negotiating memorandums of understanding and putting them in place with primary care trusts. Those have been based on a standard model. I should be happy to show the noble Earl the standard model if it would help him. That standard model allows adjustments to take place to take account of local variations, but it will introduce a pretty standard set of arrangements for how the HPA will relate to people locally. Further work is in hand to refine the memoranda of understanding for future years.
There will always be the issue of what balance of the resources available to the HPA is allocated to local and national issues, but the HPA's plans, which have been discussed and agreed with the Department of Health, project it, broadly speaking, spending just over 20 cent of its total resources in 2004–05 on local and regional services. So there is a clear intent to identify a chunk of resources that is committed to local areas.
I think I mentioned at Second Reading that the agency had identified 10 key gains. One of the 10 key gains that it has committed itself to achieving states:
- "from Cumbria to Cornwall, the same high standards of response to an outbreak or incident".
So what we have is a pragmatic solution in which there is a clear allocation of resources by the HPA to the work of local and regional services; a pretty standard memorandum of understanding, but one tweaked to take account of local circumstances, as is right; and a commitment by the agency as one of its key priorities to produce a more standardised response where there are local control or infection incidents, so that it can respond around the country in a consistent way. That strikes me as a considerable improvement on what existed previously. I do not underestimate the contribution made by consultants on communicable diseases, but we had a less consistent service. The existence of the agency offers improvements in that area. I hope that that provides some reassurance to the noble Earl.
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