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House of Lords

Monday, 19 May 2008.

The House met at half-past two: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of Chester.

Death of a Member

The Lord Speaker (Baroness Hayman): My Lords, I regret that I have to inform the House of the death of Lord Blease on 16 May. On behalf of the House, I extend our condolences to his family and friends.

2.36 pm

Economy: Offshore Financial Centres

Lord Wallace of Saltaire asked Her Majesty’s Government:

Lord Davies of Oldham: My Lords, the Government have not conducted a review on the costs and benefits of offshore financial centres under United Kingdom sovereignty.

Lord Wallace of Saltaire: My Lords, I am sure the Minister will recall that when the Labour Government came into office in 1997 they conducted a review of the role of offshore centres under British sovereignty, particularly focusing on the three Crown dependencies in Europe: the Isle of Man, the Channel Islands and Gibraltar. In the 10 years which have passed since then the size of bank deposits held in Jersey alone has more than doubled and the whole question of tax evasion at the international level has become a much more acute issue, as we see with a number of issues in the European Union, in the OECD and elsewhere. Is it not time for the Government to revisit this issue?

Lord Davies of Oldham: My Lords, some progress has been made, particularly in the European savings directive which was concluded in 2006 and which we are using to bring as much pressure as we are able to bear on the Crown dependencies and overseas territories to comply. The issue is overwhelmingly to do with transparency. Although they are not as strong as we would like in terms of total compliance, there are signs that the Crown dependencies are making progress. We welcome that development.

Lord Barnett: My Lords, how many serious offshore financial centres are there? And if my noble friend were going to do anything, how would he propose to evaluate the costs and benefits?

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Lord Davies of Oldham: My Lords, the latter question is very difficult—with the absence of information, it is actually impossible to answer at this stage. We look forward to the fact that the Channel Islands and the Isle of Man—the Crown dependencies—recognise the value of complying with the OECD requirements and that the Virgin Islands, the Turks and Caicos and others—the overseas territories—agree with the development of taxation information exchange agreements. Although the agreements are limited, there is some progress and some agreements are being signed, though not all of them with the United Kingdom. The OECD is a powerful assist in these terms and wants to see these tax havens sign international agreements on openness and transparency.

Lord Soley: My Lords, I was going to ask my noble friend about the OECD. My understanding—he will correct me if I am wrong—is that the OECD entered into an agreement with the Channel Islands and the Isle of Man in about 2001 or 2002 and that that agreement placed certain requirements on the Channel Islands. Has my noble friend been in touch with the OECD to see whether the Channel Islands has been living up to that agreement? It is the combination of the OECD and the international agreements that will bring about change in the Channel Islands on this issue. Although the constitutional issues are quite delicate, that is not to say that we should not be applying pressure through the OECD and others. But the issue is constitutional as well as financial.

Lord Davies of Oldham: Indeed it is, my Lords; and the United Kingdom does not interfere with the internal affairs of the Crown dependencies, which are responsible for their own decisions. However, we are using the international structures to bring as much pressure to bear as we can in order that the Crown dependencies and, as I said, the overseas territories engage with openness on tax issues. Until we get to that stage, the kind of question that my noble friend Lord Barnett has addressed is a long way off in the future. However, we want to see openness and the information made available.

Baroness Noakes: My Lords, last November the National Audit Office issued a report entitled Managing Risk in the Overseas Territories which made a number of recommendations for the Government to bolster those territories’ legislative capacity and enforcement capacity. Since then there has been silence. Why?

Lord Davies of Oldham: My Lords, there has been silence because effective pressure has been brought to bear which would not be advanced by much public declamation on what was going on in the relationship between Her Majesty’s Government and the Crown dependencies. As my noble friend Lord Soley indicated, we are in that delicate position where we observe the constitutional proprieties by not interfering with their internal matters while wanting them to shape up and respond to the necessary

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international agreements which are being developed. We are making progress. The progress is not as rapid as we would want—we would have liked earlier and total compliance, which we have not got—but we are making progress.

Lord Lawson of Blaby: My Lords, what discussions have the Government had with the Government of France, which is in a not altogether dissimilar position so far as Monaco is concerned?

Lord Davies of Oldham: My Lords, just how similar France’s position on Monaco is to ours on the British Crown dependencies is a moot point; as the noble Lord will recognise, the French constitution has been somewhat different from the British one since probably 1789. The French are exercised about Monaco, but on the whole Monaco presents a problem that is overwhelmingly to do with individual rather than company and corporate taxation. Although the British Government are concerned about individuals’ obligations to meet proper taxation we also have anxieties about companies and corporations so far as some of our Crown dependencies and overseas territories are concerned.

Lord Newby: My Lords, does the noble Lord accept that one of the major costs that ends up with the British Government is in tax forgone where British companies are evading tax by establishing activities in some of the territories over which we have effective control? Given the increasing pressure on the Government’s finances, should this not be a reason for the Government to inject a new sense of urgency into looking at how British companies and those tax havens are interacting to the disbenefit of the Exchequer?

Lord Davies of Oldham: My Lords, there is no shortage of urgency. The Treasury is always keen to ensure that the proper resources are directed to it from those who owe it tax.

Health: Polyclinics

2.45 pm

Baroness Greengross asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, the Government are investing £250 million to support the NHS in expanding primary care services. Primary care trusts are carrying out open procurement during 2008-09 for over 150 new GP-led health centres and over 100 new GP practices. These new services will not replace existing family doctor services but give the public extra access to primary care into a range of other community-based health services.

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Baroness Greengross: My Lords, I thank the Minister for that helpful reply. Can he reassure me that people with chronic conditions will still have access to the specialist consultants who are normally available only in acute hospitals, and that the capacity of primary care trusts will be improved so that they can provide the diagnostic care that will be needed?

Lord Darzi of Denham: My Lords, this policy is in response to the changing demands in health services. As was alluded to by the noble Baroness, we see demand in the next 10 years to deal with an ageing population and long-term conditions, which are a result of the success of the NHS in the past decade. We need a health service that is responsive and has the expertise needed to treat patients nearer to home. The purpose is to provide the resources that a primary community service needs to tackle challenges in the future.

Lord McColl of Dulwich: My Lords, does the Minister recognise that although there may be a place for polyclinics, especially in parts of east London, a lot of very genuine concern has been expressed by thousands of GPs and their patients that really good general practices may be replaced by polyclinics? I know that the Minister does not intend to do that, but will he reassure those who are worried?

Lord Darzi of Denham: My Lords, the health centre is very different from the polyclinic, which was a recommendation made through a review that I led with a hundred different practitioners in London—including general practitioners—to provide more integrated care around the needs of patients. The measure does not involve closures or shifting primary care; it builds on the excellence of primary care that this country has enjoyed for many decades. The purpose of the polyclinics is to provide more integrated and personalised care, and does not mean shifting GPs away from their patients. We have described the federated or networked model, which has been acknowledged by the Royal College of General Practitioners in its September report, by the NHS Confederation in its December report and by the NHS Alliance.

Lord Rea: My Lords, is my noble friend aware that I spent part of my professional career working in a health centre with many of the features of a polyclinic? It was a success with both staff and patients because those who worked there were involved in its planning, construction and subsequent administration. Can he assure me that the proposed polyclinics will be built only after consulting and listening to representatives of the population they will serve and those who will work there, and that they will not be imposed, owned and run by a private sector healthcare company or consortium which may be partly outside public control?

Lord Darzi of Denham: My Lords, my noble friend has eloquently highlighted the fact that clinicians are practitioners, partners and leaders. We have made it clear to PCTs that they should involve local clinicians, and the patients who use their services, to plan not just

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the geographical location of clinics but the services that they provide. However, to avoid any conflict of interest that may destabilise the procurement process, we have suggested that there should be a clear distinction between those who design the services and those who bid for the contracts.

Baroness Tonge: My Lords, if, after reading the excellent pamphlet NHS Next Stage Review: Leading Local Change, local people backed by local clinicians opted to improve their GP surgeries or perhaps enhance an existing community hospital, would the same financial assistance be available to that primary care trust as if it had opted for a polyclinic?

Lord Darzi of Denham: My Lords, this investment is to increase the capacity of primary and community services. Through this investment, we will see more than 2.6 million walk-in consultations throughout England. We will see more than 500,000 extra registration opportunities across the country. That is the scale of the investment. The decision about what happens locally will be based on consultation with clinicians and with users of the service. The purpose is to increase capacity and enhance choice at a local level.

The Countess of Mar: My Lords, would the Minister agree that, for the people with chronic ailments that my noble friend Lady Greengross was talking about, continuity of GP is extremely important? I know that he recently spoke with a young lady from Great Yarmouth who has no GP. She cannot get any continuity of treatment and finds it extremely difficult to have to go to a new GP and explain her case every time. It is important that she has a GP who knows her. With these new polyclinics, is that continuity guaranteed?

Lord Darzi of Denham: My Lords, continuity of care is one of the most important principles of care in a primary and community setting. I made that clear in our interim report last October. I described it as personalised care, tailored round the needs of the patients. We need to build on that. It is important for a patient to see a clinician who is aware of their history, who has been involved in the management of that history and who will manage it in the future. That is one of the most important principles of this new investment.

Electric Personal Assistive Mobility Devices

2.52 pm

The Earl of Glasgow asked Her Majesty’s Government:

Whether they will introduce measures to allow electric personal assistive mobility devices to be used on roads.

Lord Bassam of Brighton: My Lords, there are no plans to introduce such measures.

The Earl of Glasgow: My Lords, I thank the Minister for that, although it is obviously a very disappointing Answer. Are the Government aware that most European countries, and most states in the United States, welcome the Segway, which is also called the Segway Personal Transporter? The police and emergency services in this

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country see it as having great advantages. It is no more dangerous than bicycling, and a lot more fun, I can tell you. It is technically innovative, self-balancing, carbon-free and ideal for travelling distances of two to five miles—journeys that people usually now take by car. Can the Ministry of Transport really not see the potential of the Segway? It could be a vital tool in helping to solve our transport problems, particularly in inner cities. Could the ministry not at least initiate trials, with a view to considering allowing it to travel in places where at least bicycles are now permitted?

Lord Bassam of Brighton: My Lords, the noble Earl is obviously very keen on Segways. We have an open mind on these matters and keep such things under review, but there are difficulties.

Lord Berkeley: My Lords, is my noble friend aware that many police forces in European capitals use the Segway for apprehending criminals because, as the noble Earl, Lord Glasgow, said, these machines can go on pavements, cycle routes and roads? Why are we out of tune with the rest of Europe in our policing? Would it not be a good idea to let the Metropolitan Police at least trial them?

Lord Bassam of Brighton: My Lords, it is obviously open to police forces in the United Kingdom to investigate the potential of these machines, although my understanding is that their potential is limited. I am not entirely sure that electric personal assistive mobility devices will raise detectives’ performance levels; nor am I necessarily aware that they offer many of the benefits alluded to by the noble Earl, Lord Glasgow.

The Earl of Onslow: My Lords, the noble Lord said that there were difficulties. What are they; can he name even one?

Lord Bassam of Brighton: My Lords, there is a serious safety issue, which I do not think one can take lightly. One German police force undertook some research into this and, within a very short period, discovered that there had been seven major, serious incidents.

Earl Attlee: My Lords, the noble Lord said that he is keeping the issue under review. Has anyone with ministerial responsibility tried one of these excellent machines?

Lord Bassam of Brighton: My Lords, my brief does not extend that far but, if it helps the noble Earl, perhaps I will have a go on one of them myself.

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