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Lord Turnberg: I shall comment briefly on the amendment and I have to mention my special interest as a past chairman of the Public Health Laboratory Service.
I understand why noble Lords have raised the amendment. Zoonoses are very serious diseases. They are quite common—more common than we think—and we have to take them seriously. The HPA—and its predecessor the PHLS—certainly takes the matter seriously and spends much time dealing with such
examples as SARS and Asian flu that the noble Lord, Lord Clement-Jones, mentioned; and the agency has teams specifically set up for them. There is no doubt that they are important, that the HPA is involved and takes them seriously.The real question is not whether the HPA takes the matter seriously or is involved, but how it can best work with other agencies such as Defra that are involved in animal health. Does the amendment encourage the solution that we seek? Will there be better working, a closer relationship and better co-ordination between the HPA and Defra? I am not sure that the amendment will achieve that aim. Should we not be looking at other ways of achieving that, perhaps by some mandatory arrangement for the degree of co-operation and co-ordination that the amendment seeks?
Earl Howe: I support the amendment. The challenge is particularly great with regard to those infections that are asymptomatic in animals but cause overt disease in humans. Chief among those are some of the more serious food-borne pathogens. Surveillance of both wild and companion animals, as well as livestock, is essential, if such hazards are to be predicted and controlled. The key to that is good collaboration between public health doctors and the veterinary profession. Vets are an under-utilised resource in disease surveillance. In my view, vets have a crucial part to play in ensuring that the new agency is capable of meeting its preventive responsibilities to the full.
But a joined-up approach of this kind is perhaps not as simple as it might appear. As the House of Lords Select Committee noted last year, the extent to which surveillance of animals takes place is usually determined by the economic impact of a disease on animal health rather than its potential to damage human health. That means that an organism which does no harm to an animal might not attract the kind of surveillance effort that in a wider context it deserves. Campylobacter has no economic relevance to agriculture whereas it has a considerable impact on human health. There is therefore a critical need for medical and veterinary personnel in adequate numbers to collaborate, under the agency umbrella, in an integrated approach to those threats, not only at a laboratory level but at a surveillance level on the ground.
4 p.m.
Lord Warner: It is already clear that it has always been our intention that the HPA should be concerned with zoonoses. It would be impossible to disagree with virtually all the remarks made by noble Lords in this mini-debate.
But the HPA already has that responsibility within its remit under the terms of the Bill as presently drafted. I have checked that with parliamentary counsel, who assure me that "infectious disease" already covers zoonoses, so the amendment is not necessary to ensure that the HPA has authority to operate in the area.
The HPA already has plentiful powers under the terms of the Bill to secure information to enable it to do its job. As its predecessor bodies were also active in this area—for example, in work on foot and mouth disease and BSE—so it has been contributing to international efforts to combat avian flu. That is another example which shows that it is already active and obtaining information.
I draw the Committee's attention to Clause 5, which requires mutual co-operation between the HPA and relevant bodies. So there is already provision in the Bill to ensure that the HPA co-operates with all relevant bodies.
Zoonoses are already included in the term "infectious diseases". The HPA is already active in that area and the Bill places a duty on it to co-operate. As to the concerns expressed by the noble Lord, Lord Clement-Jones, about whether it will always do this work as part of its planned work programmes, the agency will have to agree its work plans in relation to its budget with the Department of Health. Therefore, we can formalise those arrangements in the work plans to be agreed with the HPA. There will be no problem in regard to a mechanism to ensure that it takes an active part in the area. Neither the chairman nor the chief executive, who have been listening to the debate from the end of the Room, will be in any doubt whatever of the Committee's views on the subject.
As to another point made by the noble Lord, Lord Clement-Jones, there is nothing to stop the HPA from generating income from a variety of sources when carrying out work for a non-traditional health body. We shall come on to that income-generating power later in our discussions.
Against that background, the Bill already adequately meets the concerns expressed by Members of the Committee, and I am not sure whether the addition of the words would improve its provisions. When I consulted parliamentary counsel on the matter, he advised that the inclusion of a reference to a particular example of infectious disease could have the effect of casting doubt on the scope of the generality of "infectious disease". Unqualified, it is actually broader than qualified.
Lord Clement-Jones: I thank the Minister for that reply and in particular, speaking as a lawyer, for the sui generis sting in the tail known to all lawyers as somewhat spurious on occasion. Nevertheless, it was a very useful coda—a warning signal that we should not further amend the already immaculate clause—which was very salutary. His reply was carefully considered, and I thank Members of the Committee who took part in the debate. I am very pleased that the senior executives from the HPA are present today to hear the debate. Clearly, there is the intention—it appears from what the Minister said that the draftsmen certainly intended it—that zoonosis is included within the remit of the HPA.
A number of points have been made that give me slight pause for thought. There may be ways in which we want to bring back some of the substance of the debate on Report, for the simple reason that the noble
Earl, Lord Howe, made a very important point about the relative priorities in the matter and the relative impact on the animal world and on human health. That made quite an impact on my thinking on the matter.A second point, which derives from what I said earlier, concerns the whole issue of accountability. Of course, if the matter is within the remit of the HPA, that simply makes it primus inter pares—we have been bandying Latin and Greek words around in this debate—with the other agencies dealing with zoonosis. It does not necessarily put it in pole position. When we come to the likes of avian flu and SARS, there may well be—I shall not be totally adamant about it—a good case to put the HPA in the leading role, and give it the accountability and responsibility for dealing with such matters.
We may not be in the right part of the Bill for that; I take the point of the noble Lord, Lord Turnberg. Perhaps such a provision should be a subsection in the clause on the duty of co-operation, stating specifically that the lead role in the area should be taken by the HPA. My words were taken out of my mouth because my response would have been about the detailed work plans, but the Minister addressed that point. That is extremely helpful, and a useful signal for his colleagues when they approve the work plans of the HPA, the budget and so on. Whether that is enough of a signpost for future administrations, I do not know. Again, I wonder whether something in primary legislation to deal with the matter would not be desirable.
The Minister has very helpfully elucidated some of the area, but I am not totally satisfied that we should not go rather further and be utterly explicit. We shall obviously debate the matter on a future occasion but, in the mean time, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Deputy Chairman of Committees: I am not in any way calling order, but I wonder if I might suggest a piece of gentle advice as a Member of your Lordships' House. It has always been my understanding that it is not considered proper to refer to people in the Public Gallery, however distinguished they may be.
Earl Howe moved Amendment No. 3:
- Page 1, line 15, after "Wales" insert "and such other persons as he considers appropriate"
The noble Earl said: In moving Amendment No. 3, I shall speak also to Amendments Nos. 5, 9, 10 and 11. Clause 2(2) allows the Secretary of State and the National Assembly for Wales to confer new health-related functions on the agency, and stipulates that the Secretary of State should consult the Assembly and vice versa whenever either initiates such action. I merely pose the question of whether it is really enough for the consultation envisaged to be interdepartmental in the broadest sense and nothing further. I should have thought that we ought to provide for wider consultation, especially bearing in mind that the
functions that may be conferred on the agency under the subsection could be any functions whatever relating to health.At the very least, the Secretary of State or the Assembly should consult the agency itself, but they might also wish to consult relevant parts of the National Health Service and other government departments or agencies in order to ensure that those materially affected by the change were signed up to it, and that there were no unforeseen logistical complications. I hope that the Minister will look constructively on the amendments, which are in no way intended to fetter the authority of Ministers in England or Wales, but rather to give them the opportunity to listen to the advice of key individuals whose experience and views were relevant and important.
I shall move on to Amendments Nos. 9 to 11, which are of purely a probing nature. However, they raise some issues of importance. Subsections (6) to (12) of Clause 2 bring us face to face with one of the anomalous features of the Bill: the effect on it of devolution. To the extent that the principal functions of the agency set out in subsection (1) are matters that have already been devolved to Scottish or Northern Ireland Ministers, the Bill is unable to say anything at all beyond the fact that it is up to those Ministers themselves to confer the functions on the agency, should they choose to do so.
It is a truism to say, as we often do in our debates, that the hazards of infectious diseases and other public health dangers are no respecters of national boundaries. Quite why we then have a situation in which a supposedly national agency—a UK-wide agency—will find itself performing potentially different roles under potentially different remits depending on which part of the country it operates in is something that only the Minister can tell us. At best, it is an arrangement that is bizarre as well as administratively difficult. At worst, it is positively dangerous.
If the Scottish Parliament were to choose not to confer the same functions on the agency as those conferred under the Bill for England, questions arise on, first, whether the agency would be able to work satisfactorily with such a split personality, and secondly, whether the Scottish Parliament will have the capacity to perform by itself all the responsibilities that it chooses not to pass to the agency. We simply do not know the answer to either of these questions, and they are very important.
If the extent to which the agency is responsible for controlling the spread of infectious diseases north of the Border is in some way less than it is to the south, what risks to the population does that give rise to? The cardinal requirement for protecting the health of the population effectively across England, Scotland, Wales and Northern Ireland is full—not partial—co-ordination, yet this part of the Bill is a recipe not for co-ordination, but for lack of co-ordination.
The contrast between Clauses 2 and 3 could not be more glaring. In matters relating to radiological protection, the agency will operate on a truly nation-wide basis, with a single remit and a single set of functions. That is entirely logical. In stark comparison, when it comes to infectious diseases, that will not happen. I do not believe that Ministers think that if terrorists were to release a quantity of smallpox bacteria in England, the progress of the disease would be miraculously halted at Gretna Green. If they do not believe that, what is the justification for allowing the Scots to opt out of using the agency in a manner that would maximise its effectiveness? I cannot see one.
We then have to consider the phrase in subsection (6):
- "Subsection (1) does not apply to a function to the extent that it is . . . exercisable within devolved competence (within the meaning of the Scotland Act 1998 (c. 46))".
The same questions could be asked about the other functions mentioned in subsection (1). Someone, somewhere, once said, "I think we should be told". Upon the answer depends our entire understanding of what the Bill will empower the agency to do both north of the Border and in Northern Ireland without the say-so of Ministers in either country. Indeed, for all I know, the position may be even more complicated than that. If we take, for example, the function of preventing the spread of infectious disease, we may find that the extent to which that function has been devolved is different in the case of Scotland than it is in the case of Northern Ireland. I do not know whether that is in fact the case, but if so, it is important to be clear about it.
I turn now to what is for me a very obvious point. If any of the functions falling within the scope of subsection (1) are legally speaking devolved matters, there should be no two ways about it: they are devolved matters. Why, then, does subsection (8)(a) state that an order by Scottish Ministers may not be made unless they have first,
- "obtained the agreement of the Secretary of State"?
Whatever answers the Minister may give, one point needs no elaboration: in the context of this Bill, devolution has created a minefield. That fact is much to be regretted given that the Bill presents the country as a whole with a golden opportunity to speak and act
with one voice for the good of the entire population. The Government have not allowed us to seize that opportunity, which I believe is a great pity. I beg to move.4.15 p.m.
Lord Warner: Perhaps I may deal first with Amendments Nos. 3 and 5. I do not believe that these would add anything to the Bill. If there are people whom the Secretary of State or the National Assembly for Wales believe need to be consulted, they will be able to do so whether or not that is required by the Bill. These amendments do nothing to extend or facilitate the Secretary of State consulting those with whom he needs to consult before taking action. I suggest that all they do is add to the length of the Bill without actually fulfilling a useful function.
I turn now to the more substantial amendments, Amendments Nos. 9, 10 and 11. I understand where the noble Earl is coming from. As he was speaking I had a slight sense of deja vu during which I relived some of those glorious hours on the Health and Social Care (Community Health and Standards) Bill. However, I should say that agreement has been reached between the UK Government and the devolved administrations that the Bill should be introduced as it is. Perhaps I should go over the ground on this point.
The structure of Clause 2(1) gives the HPA the functions of the UK Government and the National Assembly for Wales but, under Clause 2(6), not the functions of the Scottish Ministers and the Department of Health, Social Services and Public Safety in Northern Ireland. It creates quite consciously procedures by which Scottish Ministers and the department in Northern Ireland may give the HPA the devolved or transferred functions included in Clause 2(1) in their parts of the UK, subject to the agreement of the Secretary of State and to scrutiny by the Scottish Parliament and the Northern Ireland Assembly. I shall return later to the Secretary of State's functions, an issue that the noble Earl raised.
I recognise that the noble Earl and some colleagues take the view that it would be desirable for the HPA to carry out Clause 2(1) functions for Scottish Ministers and the Department of Health, Social Services and Public Safety, in Northern Ireland, as well as for the Secretary of State and the National Assembly for Wales. However, whether we like it or not, it is a feature of the devolution settlements—that is water under the bridge—that the devolved authorities take their own decisions in certain areas. The Bill reflects that; the amendments do not. In effect, they try to rewrite slightly the devolution settlement that, for better or for worse, Parliament agreed.
Nevertheless, it must be recognised that, for the first time, we will have a body that has a legislative basis for exercising health protection functions in every part of the UK. It may not be in quite the legal format that the noble Earl would prefer, but it enables those functions to be co-ordinated by the HPA. I shall give some examples in a few moments. Many of the responses to
our 2002 consultation exercise argued that there were benefits from having radiation protection services provided on a UK-wide basis, as Clause 3 allows. It would be unfair of me not to acknowledge that some argued essentially for the noble Earl's approach. We have achieved much of what is necessary through the structure of the Bill as drafted.There is no doubt that Scottish Ministers and the department in Northern Ireland intend to make use of the health protection services to be provided or commissioned by the Health Protection Agency. Scottish Ministers plan to give the agency certain responsibilities for providing advice on chemicals and for commissioning advice on poisons, by means of the procedures in Clause 2(7). Their rationale is that that capitalises on the formation of the HPA to maintain high standards for these specialist services.
Northern Ireland will look to the HPA, as now, to commission services for it from the National Poisons Information Service and to provide advice on chemical incidents. The intention is that the Communicable Disease Surveillance Centre in Northern Ireland, which is currently part of the HPA and funded by the Department of Health, Social Services and Public Safety, will transfer to the HPA and continue to operate in Belfast. A lot of such joined-up work is happening, although the Bill may not be structured exactly as the noble Earl would like.
The UK-wide approach for which the Bill allows is already reflected in working practices. For example, there is unified HIV/AIDS surveillance across the whole of the UK. There is also a Five Nations Working Group, comprising the UK plus Ireland, which agreed, when SARS first emerged, that the HPA should establish a SARS task force. Calls from the World Health Organisation for assistance over SARS are channelled via the HPA. The various Chief Medical Officers also agreed that the HPA should set up an expert working group, with representatives from each part of the UK, to co-ordinate work on SARS. The HPA convenes weekly teleconferences on current topics, such as avian flu, which involve Wales, Scotland and Northern Ireland; it is also working with the devolved administrations on developing planning, training materials and running scenario planning exercises on preparedness. Similarly, the UK Government and the devolved administrations work together very closely on preparedness for bio-terrorism.
I am trying to tell the noble Earl that, in the hypothetical case that he cited, there would not be a void north of Gretna Green. There is a planning system that reassures the people of Gretna Green and people north and south of it that is a system is in place for co-ordinated and joined-up work in this area. The situation is not quite as bad as the noble Earl suggests. The structure of the Bill provides for co-ordinated work across the UK. I hope that I have given examples to show that it works in practice.
The noble Earl asked in passing why it was necessary under the Bill for the Secretary of State to give consent when Scottish Ministers and Northern Ireland departments wished to confer functions on the
HPA. That matter is covered in the noble Earl's latter amendments. It is highly unlikely that the Secretary of State would refuse a proposal by Scottish or Northern Ireland Ministers to confer a Clause 2(1) function on the agency. As I have said, we are trying to secure a totally co-ordinated approach across the UK, but there could be times when it would be sensible to agree that a particular function should be conferred only after the HPA had time to absorb other pressures. This is a timing issue; it gives the Secretary of State the opportunity to phase a transferred function to the HPA if workloads or priorities suggested that that was necessary. That is the significance of the provision.
I hope that I have reassured Members of the Committee that we have a co-ordinated approach, and that the amendments are not necessary.
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