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On Question, amendment agreed to.

Baroness Murphy moved Amendment No. 198:

The noble Baroness said: I have already spoken to this amendment. I beg to move.

Baroness Thornton: Amendments Nos. 198 to 203 would replace the emergency procedures in the Bill with those contained in the Civil Contingencies Act. The noble Baroness gave a lucid exposition of why that was the case and what the Government’s response has been up to this point. I understand the intention. However, the Public Health (Control of Diseases) Act is not the Civil Contingencies Act. The types of provisions that could be made are very different and it would therefore be inappropriate to apply the civil contingency emergency regulations procedure.

For example, Amendment No. 203 would require the recall of Parliament to debate and approve regulations made using the urgent procedure. Recalling Parliament is not done lightly. Such an action is reserved for essential debates of great national importance. This might indeed be one but, on the other hand, it might not be. If there were an outbreak of a new infection abroad, similar to SARS, the World Health Organisation could recommend that certain surveillance systems were put in place—the noble Baroness referred to those. We would want to use the public health emergency powers to create regulations that would enable the surveillance regime to be implemented without delay. However, it would surely not be appropriate to recall Parliament to debate such a measure.

Amendment No. 199 also would allow regulations made using the urgent procedure to be amended by Parliament before they were approved. It is not normal parliamentary procedure to allow regulations to be amended. Regulations that may need to be set in place in times of a significant threat to public health may be technical and based on scientific understanding and advice from experts such as the World Health Organisation and the Health Protection Agency. It would not be appropriate to enable such regulations to be amended during their passage through both Houses on the basis of decisions that could be taken on a political rather than a scientific basis.

I understand the Committee’s concern that the measures taken under urgent regulations must be subject to safeguards. That is why we have ensured that safeguards built into the provisions will remain even when the regulations are made under the urgent procedures, such as only including powers that overlap with those of a justice of the peace when there is a serious and

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imminent threat to public health requiring a right of appeal to a magistrate. Therefore, I hope that the noble Baroness will feel able to withdraw her amendment.

Baroness Murphy: I thank the Minister for that reply. Obviously, my noble friend Lady Stern will have to look at the response and discuss with her colleagues on the Joint Committee whether it meets their anxieties. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 199 to 203 not moved.]

Clause 123, as amended, agreed to.

Clause 124 agreed to.

Schedule 11 agreed to.

Clause 125 [Entitlement: Great Britain]:

Baroness Barker: In the absence of the noble Baroness, Lady Greengross, and the noble Lord, Lord Hodgson of Astley Abbotts, I hope that it will be in order for me to speak to Amendment No. 204, after which other noble Lords may wish to contribute to the debate.

The Deputy Chairman of Committees: Would the noble Baroness prefer to move Amendment No. 203ZA so that noble Lords can speak to it?

Baroness Barker: I think that the noble Earl, Lord Howe, is in a position to move Amendment No. 203ZA.

Baroness Thornton: If the noble Earl would move the amendment, that would probably be the most sensible way to proceed. The noble Baroness could then speak to her amendment.

Earl Howe moved Amendment No. 203ZA:

The noble Earl said: This amendment raises an important issue, which I am sure the noble Baroness, Lady Greengross, would want aired in the Committee. It concerns the point at which the health in pregnancy grant is to be paid. We understand that the Government’s intention is to pay it in the 25th week of pregnancy, whereas there are all sorts of arguments to suggest that, for practical as well as health reasons, it would be preferable if it were paid earlier and if the health advice to the expectant mother were given earlier than the 25th week. That is the purport of Amendment No. 203ZA and I should be interested to hear why the Government have taken the course that they have in paying the grant in the 25th week.

While I am on my feet, perhaps I may also speak briefly to Amendment No. 203A in the name of my noble friend Lord Hodgson. This amendment raises two principal issues. The first is the form in which the health advice is to be given to the expectant mother and the question of who gives it. The second is the likely scope and content of that advice. I am seeking two assurances on behalf of my noble friend. The first is an assurance that giving and receiving the advice will be a precondition of the health in pregnancy grant

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being paid and that there is no question of expectant mothers receiving the grant before receiving the advice. Secondly, I should welcome an assurance that the advice will be given to the prospective mother in person by a healthcare professional, that it will be tailored to the woman and her circumstances and that it will not simply take the form of a leaflet thrust into her hand without a proper discussion or explanation of what it contains.

The list of matters included in Amendment No. 203A is not intended to be exhaustive but I think that it addresses the issues that appear to be the most salient in the context of maternal and neonatal health. The amendment invites the Minister to comment on the headings listed in it and on whether she believes that those are indeed the most important areas that the advice will need to cover. I beg to move.

Baroness Barker: Amendment No. 204 is grouped with the amendment so ably moved by the noble Earl, Lord Howe, and I am glad that it is, for reasons that will become obvious. When the Treasury starts to make health policy, I think that it is time for Parliament to start asking serious questions and there is absolutely no doubt that this is a piece of Treasury-inspired policy formulation.

My colleague in the other place, Sandra Gidley, described the health in pregnancy grant as a gimmick. She was right. Certainly it is evident that, however good the intention behind this policy, its implications have not been worked through as they should have been. In moving his amendment, the noble Earl, Lord Howe, raised some fundamental questions on this policy’s effect on maternal and neonatal health.

The amendment in my name may appear to be slightly flippant at first, but it is not. It relates to the residence of the mother. Back in the dim and distant past, I had the great pleasure of working on pensions and DWP matters and I understand that this is a standard piece of DWP legislation. I therefore seek clarification that this measure will extend to British citizens who are, for example, in the Armed Forces or partners of those serving in the forces. The Minister will probably reassure me on that. That being so, how will the Government monitor and oversee the system that they have set up and to which the noble Earl referred? How will we know whether people in other countries are going through the system of advice before payment is made? My questions are principally not about payments or the definition of payments but about how the measure will work as a health policy.

Baroness Finlay of Llandaff: Perhaps I may intervene briefly. It seems as though the noble Lord, Lord Hodgson of Astley Abbotts, has tried to make some good come out of this money for the well-being of the child and mother. If this is to be pursued further, I would wish the concept of supportive parenting to be given in the advice. I endorse the requirement suggested by the noble Earl that this should be personalised advice and not just a leaflet or whatever. I also question, although the noble Lord is not here to answer this, the reference to immunodeficiency. However, given that some of us have been trying for a long time to get a

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standardised definition of supportive parenting, this amendment might be, if the noble Lord intends to bring it back, an opportunity to ensure that the next generation is slightly better off than the babies who are being born today.

Baroness Howarth of Breckland: I stand here somewhat inadequately to speak to Amendment No. 203ZA, as I thought that the noble Baroness, Lady Greengross, would be here. Some cogent arguments, which I fail to have with me, as I thought she would make them, have been suggested by a number of medical and nursing groups to say that the 20th week would be far more appropriate than the 24th week to make the grant in the interests of the health of the woman concerned. I support that and hope that I will be more prepared on Report.

The list in Amendment No. 203A is extremely important, but the items are not the sort of things that I would expect to see in the Bill. I would hope to see them clearly outlined in guidance or advice, which would give an even better opportunity to ensure that they were explained in some detail. I am sure that the Minister will say that it is inappropriate to put them in the Bill, but will she tell us about the guidance that they are likely to appear in? I had another point, which now eludes me. I am clearly not doing well today, so I apologise and will come back to the matter on Report.

1.15 pm

Baroness Thornton: The noble Baroness, Lady Howarth, has three or four groups of amendments during which she can see whether she can remember her point. I shall be happy to answer it if I can.

We come to the health in pregnancy grant. The Bill allows the Government to set out in regulations when the grant should be paid. We have published draft regulations to help the Committee in its deliberations, which set out that the grant will be paid from the 25th week of pregnancy. I have placed copies of the draft regulations in the House Library. I know that concerns have been expressed about the timing of the payment, as this amendment demonstrates. However, there are good reasons for the Government’s choice of 25 weeks and I thank the noble Earl for giving me the opportunity to explain them.

First, although we know that maternal health is important at all stages of pregnancy, if the grant is paid at this time not only will it supplement expenditure on all aspects of health and well-being but it will come at a time sufficiently into the pregnancy when it can help to alleviate some of the stress and anxiety that competing financial pressures can cause when women will be thinking about giving up work and possibly buying larger items. Similar payments are made in the later stages of pregnancy in other European countries, including France, Finland and Belgium. Secondly, linking in with existing antenatal care at the 25th and 28th weeks will also keep the burden on health professionals and pregnant women to a minimum. Finally, the Government already have a targeted, voucher-based scheme explicitly aimed at improving diet during pregnancy for women on lower incomes. The health in

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pregnancy grant complements the targeted support already provided by the Healthy Start scheme.

Amendment No. 203A would require that the advice given by health professionals to all expectant mothers must, as a minimum, include advice on a number of specific issues, such as nutrition. I agree wholeheartedly with the principle that all pregnant women should receive the advice that they need to have a healthy pregnancy and delivery. However, I hope that I am able to persuade the noble Earl that we should not seek to specify in the Bill what advice a health professional should provide and when he or she should provide it. The noble Baroness, Lady Howarth, was completely correct in anticipating that that would be my point.

The noble Baroness, Lady Finlay, made the good point that the advice should be tailored. The pregnant woman must have the advice before she can get the grant and that advice must be given by a health professional. We have said in draft regulations that the health professional should be a doctor, nurse or midwife. We are lucky in this country to have highly trained and highly skilled health professionals. It is their role, rather than that of the Government, to decide what kind of advice meets each individual woman’s needs. That advice should be based on the professional’s clinical expertise and the circumstances of the woman concerned.

There is already guidance available for health professionals. The National Institute for Health and Clinical Excellence has produced an advice booklet for health professionals called Routine Antenatal Care for Healthy Pregnant Women, which sets out recommendations on the issues that health professionals should cover in their advice to expectant mothers.

On Amendment No. 204, in common with child benefit and tax credits, Clause 125(3)(b) requires a woman to be in Great Britain when she makes a claim to the health in pregnancy grant. As with child benefit and tax credits, the Government intend to prescribe in regulations the circumstances where a woman is or is not to be regarded as being in Great Britain. We have published draft regulations to show how this provision will be used; as I have said, copies are available. These regulations will require a woman to be ordinarily resident in Great Britain and will provide for any circumstances where a woman’s temporary absences may be disregarded.

Removing this power would remove entitlement to the health in pregnancy grant from members of the Armed Forces and their partners who are serving abroad, for example. The amendment would also entirely remove the means of providing for a woman to be ordinarily resident in the UK in order to be entitled to the health in pregnancy grant. Without this requirement, any woman who satisfied the other conditions of entitlement but was not ordinarily resident in the UK could successfully claim, provided that she was in Great Britain when she made her claim. That is clearly not a sustainable policy. I hope that in the light of these arguments the noble Earl will feel able to withdraw his amendment.

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Earl Howe: I am sure that the Committee will be grateful to the Minister for her full reply, which the noble Baroness, Lady Greengross, will no doubt study. I am grateful to the Minister on behalf of my noble friend for her comments on Amendment No. 203A, which was intended as a probing amendment. I am sure that I speak for my noble friend in saying that a list of this kind would not be appropriate in an Act of Parliament. The Minister’s comments were extremely helpful and illuminating. I am sure that it will be necessary to study what she said in some detail between now and Report, but for now I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 203A and 204 not moved.]

Earl Howe moved Amendment No. 204A:

The noble Earl said: On behalf of my noble friend Lord Hodgson, I shall move Amendment No. 204A and speak to Amendment No. 204B. These amendments bring us to an issue raised by the Twins and Multiple Births Association—Tamba—and by Bliss, the neonatal charity. They have noted what seems to be an illogicality of the health in pregnancy grant regarding twin and multiple births. They have called for the grant to be paid per expected child rather than per pregnancy. It might be helpful if I read a brief extract from their submission:

These are fundamental points: multiple pregnancies are different and the advice required for the expectant mother is materially different. The submission goes on:

It was also said that in the UK about one in every 67 pregnancies results in a multiple birth, which equates to just over 10,000 births a year. Twins are four times more likely to die during pregnancy than single babies, seven times more likely to die shortly after pregnancy and 10 times more likely to be admitted to a neonatal special care unit. They also have six times the risk of cerebral palsy. The best chance of survival for a premature baby is a healthy birth weight, so unborn multiple babies need to be well and fully nourished pretty much from the moment of conception.

We do not need to reopen the issue of when this grant will be payable, as the Government have clearly made up their mind. However, as the noble Baroness, Lady Howarth, said, a lot of evidence shows that ensuring that the mother has proper nutrition at conception means that the health of the baby will be more affected for the better than if action is started later in the pregnancy. The fact remains that multiple pregnancies and births present special issues and problems. It would be helpful to hear from the Minister the

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grounds for the Government taking a one-size-fits-all approach to this grant rather than recognising the special issues to which I have referred. I beg to move.

Baroness Finlay of Llandaff: I wish to put before the Committee another piece of evidence in relation to nutrition. It seems that the nutrition that a foetus has in utero will alter the way in which its own foetus will develop during pregnancy later in life. In other words, this is handed on from one generation to the next. We are talking not about nutrition over one generation but about what is probably an epigenetic effect.

Baroness Thornton: Amendments Nos. 204A and 204B have been tabled as a result of concerns that women expecting a multiple birth will receive only the same level of grant as women expecting one baby. I fully understand noble Lords’ concerns but there are two important reasons why we do not support the amendment.

First, I recognise that some women may use the health in pregnancy grant to support their nutritional needs during pregnancy. I know that some noble Lords are concerned that women with multiple pregnancies may have greater nutritional needs and should therefore be paid a higher grant to reflect this. However, there seems to be no reliable evidence to support that view. The availability of the health in pregnancy grant will trigger a discussion with a health professional and bring down the startling figures that the noble Earl mentioned on the number of women who are not receiving nutritional advice. That is one benefit of the existence of the grant. Of course all pregnant women need to pay attention to their health and nutrition.

The Department of Health’s advice on nutrition for pregnant women is based on the recommendations from the independent Scientific Advisory Committee on Nutrition. The committee’s view has always been that there is no evidence to support the view that women with multiple birth pregnancies have greater nutritional needs. We were provided with additional evidence to the contrary by the Twins and Multiple Births Association. We therefore asked the independent committee to look at this evidence—we took it extremely seriously—to see whether its advice would change as a result. It did not. In the conclusions of the committee’s report on this issue, which I am happy to make available to noble Lords, it stated:

We also contacted the chair of the Scientific Advisory Committee of the Royal College of Obstetricians and Gynaecologists to see what assessment he made of the available evidence. He said that,

Secondly, there are the additional costs involved after a woman gives birth to more than one child. There are existing support schemes to help mothers in this situation, where money is paid per child, including

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the Healthy Start voucher scheme, child benefit and the Sure Start maternity grant.

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