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Lord Elton: My Lords, the Minister has reeled off a whole galaxy of organisations, bodies and committees which are interested in this. Who has ministerial

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responsibility for this and what central point in Government is co-ordinating all this effort so that it makes sense and has effect?

Lord West of Spithead: My Lords, I am sorry I banged on a little long, but I get quite excited about this subject. The Central Sponsor for Information Assurance lies within the Cabinet Office. But since my appointment last June, this has been an area that I am particularly interested in. Many nations are very vulnerable and we need to look at it very closely.

The Countess of Mar: My Lords, can the Minister assure us with absolute confidence that the national identity register, the National Health Service register and particularly the children’s register will be totally secure from people who want to crash into those networks?

Lord West of Spithead: My Lords, without knowing the exact detail, hand on heart, the only way you can be totally sure that no one with remarkable skills can get into a system is if there is an air gap. I do not know the situation regarding those registers but I will get back to the noble Countess in writing. If there is an air gap, it is impossible to get into a system. If you are connected, I am afraid, and if you have real capabilities, at the end of the day it is possible.

Baroness Hanham: My Lords, I appreciate that this is probably a very difficult area for legislation, but is the Minister satisfied that, if anybody is caught carrying out either cybercrime or cyberterrorism, there is suitable legislation under which they may be prosecuted?

Lord West of Spithead: My Lords, one of the problems is that this comes from all parts of the world and it is quite difficult to achieve what the noble Baroness suggests. Certainly our discussions with the G8 and internationally are aimed at making sure we can grab these people who range from individual hackers, who sometimes just want to cause damage—they have done some quite nasty things in the past to various countries—through to state-sponsored issues. For the purpose of national security one cannot talk about those at the moment, but we are taking action on them. It would be extremely difficult to put a lot of people on trial, where they deserve to be.

Lord Roberts of Llandudno: My Lords, many new databases have been established, such as the national dismissal register. What do we have to monitor the various independent databases to make sure that they come within the Data Protection Act and other legal requirements?

Lord West of Spithead: My Lords, in terms of those databases coming within the Data Protection Act, they are monitored. If those systems are attacked, we give advice, and if someone believes they are being attacked, we will look into it. I would not want to go any further into what we can achieve in knowing whether something has been attacked and penetrated.

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The Earl of Northesk: My Lords, is the Minister satisfied that advisories and patches issued by the likes of CPNI and UKCERT are issued in an adequately timely and proactive way, as, for example, with the current vulnerabilities relating to SCADA—the Supervisory Control and Data Acquisition system—and certain elements of the CNI?

Lord West of Spithead: My Lords, in the past we perhaps have not been as timely as we should have been. That has now rapidly been caught up. We had a Cabinet meeting only recently. It is an issue that I have taken a lot of interest in and we are gaining ground. It is important that that information is given in a timely way and it is my intention that that should be done. But this is a very difficult and complex area and the more joined up and capable we become at talking to each other on all these systems, the more vulnerable we become, which is why one has to put in place very strict rules, monitor them, and do all the other things necessary to protect them.

Health: Sickle Cell Disease

2.59 pm

Lord Smith of Clifton asked Her Majesty’s Government:

Baroness Thornton: My Lords, the Government support a number of initiatives in this area. We have introduced antenatal and neonatal screening programmes for sickle cell disease, and the Department of Health is implementing a training programme in scanning for stroke risk. Furthermore, we support the national standards and guidelines for the clinical care of children with sickle cell disease and the use of the Royal College of Physicians’ guidelines for the management of strokes in children.

Lord Smith of Clifton: My Lords, I thank the Minister for that reply. In answer to a Written Question of mine on this subject, it was stated that strokes in young people was for the royal colleges, while, thankfully, the Department of Health has taken a lead in adult stroke strategy. Why is there that difference? Is it a symptom—I hope to be assured that it is not—of racial discrimination within the National Health Service, because, of course, the vast majority of strokes in children are in young sickle cell patients of Afro-Caribbean origin? Secondly, will the Minister assure us that central government funds will be forthcoming to ensure that all sickle cell children are offered screening for stroke risk and treatment with chronic blood transfusion, where appropriate, to prevent strokes?

Baroness Thornton: My Lords, I thank the noble Lord for those questions. The Government support the existing guidelines that I have already referred to. Indeed, he will be aware that the majority of people who have strokes are over the age of 55; some 110,000 adults have strokes and approximately 400 children had strokes last year. Prevention of strokes in children and managing their rehabilitation after a stroke is very

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different as compared with adults, but that does not mean that we do not have to have a strategy in place for dealing with that. Preventing strokes in children with sickle cell disease requires repeated blood transfusions and even bone marrow transplants, which may be appropriate. The different approach required for the management of the rehabilitation of children affected by strokes needs to be run by a consultant paediatrician and a haematologist. It is covered, therefore, by the guidelines published by the Royal College of Physicians.

Lord Walton of Detchant: My Lords, does the Minister agree that this disease is the result of a genetically determined abnormality of the red blood cells that almost exclusively occurs in people of Mediterranean and African origin? In consequence, the cells which develop this sickle-cell shape tend to clump together and damage the internal lining of the arteries that supply the brain, and that is the principle cause of stroke. In order to be able to detect this risk, ultrasound scanning is necessary, and there is clear evidence from recent American research that the risk of stroke in such individuals, particularly in children, can be reduced by about 90 per cent by regular monthly blood transfusions. Is she satisfied that there are adequate facilities in the NHS for that ultrasound scanning and regular transfusions?

Baroness Thornton: My Lords, the noble Lord is absolutely correct and has given the House a very helpful summary of the issues. We are working, through the Sickle Cell and Thalassaemia Screening Programme to agree standards, testing protocols and a standardised training scheme to ensure the establishment of appropriate scanning with transcranial Doppler scans. These, as well as lifelong blood transfusions, are key parts in the management and prevention of strokes in children with sickle cell disease. The Government are working to ensure that over the next year a regional service should be available throughout England.

Baroness Trumpington: My Lords, is there any liaison between this country and a clinic in Jamaica, which I have visited, devoted to the treatment of and research into sickle cell disease? The clinic is doing valuable work in a country which, after all, has to live with the disease. I would be very interested to hear the Minister’s reply.

Baroness Thornton: My Lords, I should be surprised if that were not the case, although I shall write to the noble Baroness to confirm that. We are working with American colleagues to ensure that the specialist care for these children is developed.

Baroness Whitaker: My Lords, following the question of the noble Lord, Lord Smith, about discrimination, can my noble friend tell me if there is an overall strategy relating to sickle cell anaemia as a whole?

Baroness Thornton: My Lords, we have been involved in developing a strategy and implementing a number of services for patients with sickle cell disease. These include the implementation of the programme of

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transcranial Doppler scanning; the establishment of managed clinical networks; the funding of training posts for registrars, nurse consultants and clinical scientists; the recognition by the royal colleges of the need to increase training in sickle cell disease, including changes to the examination syllabus for doctors and health professionals; and the funding of a database to track patients in the care they require.

Baroness Barker: My Lords, the incidence of this disease varies greatly. Seventy per cent of people who suffer from it live in London. Are PCTs in areas where it is prevalent given additional funding to enable them to purchase specialist services and care?

Baroness Thornton: My Lords, they are being given additional funding. I do not have the figure in front of me at the moment, but I can write to the noble Baroness.

Earl Howe: My Lords, the Minister will know that many children with sickle cell disease suffer a series of silent strokes which are often not detected until a full-blown stroke occurs. These silent strokes are detectable through changes in the child’s behaviour—for instance, drowsiness—and in their handwriting. What is being done by the Government to ensure that the education services and teachers are aware of the needs of pupils with sickle cell disease?

Baroness Thornton: My Lords, I do not have a detailed answer about the education service. The National Health Service has been publishing information about this, and it is being used in the areas of the country where sickle cell disease is prevalent.


3.07 pm

Baroness Royall of Blaisdon: My Lords, with the permission of the House, at a convenient point after 4 pm, my noble friend Lady Taylor of Bolton will repeat a Statement on Afghanistan. Immediately after this, my noble friend Lord Hunt of Kings Heath will repeat a Statement on the funding and expenditure of political parties. This will be followed by a Statement on the Lisbon treaty repeated by my noble friend Lady Ashton of Upholland.

Health and Safety (Offences) Bill

Brought from the Commons; read a first time, and ordered to be printed.

Crossrail Bill

Baroness Royall of Blaisdon: My Lords, I beg to move the Motion standing in the name of my noble friend Lord Bassam of Brighton on the Order Paper.

Moved, That it be an instruction to the Grand Committee to which the Crossrail Bill has been recommitted that they consider the Bill in the following order:

Clause 1

Schedule 1Clause 2Schedule 2

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Clause 3Schedule 3Clause 4Schedule 4Clause 5Schedule 5Clause 6Schedule 6Clauses 7 to 10Schedule 7Clauses 11 to 15Schedule 8Clause 16Schedule 9Clause 17Schedule 10Clauses 18 to 45Schedule 11Clause 46Schedule 12Clause 47Schedule 13Clauses 48 and 49Schedule 14Clause 50Schedule 15Clauses 51 to 58Schedule 16Clause 59Schedule 17Clauses 60 to 67.—(Baroness Royall of Blaisdon.)

On Question, Motion agreed to.

Health and Social Care Bill

3.08 pm

Report received.

Clause 1 [The Care Quality Commission]:

Lord Lipsey moved Amendment No. 1:

(a) the Secretary of State has commissioned a review, to be prepared with the aid of an independent assessor, of the case for and against, and alternatives to, the merger of the Commissions referred to in subsection (2),(b) the Secretary of State has published an assessment of the outcome of that review, and(c) a draft of the instrument has been laid before, and approved by a resolution of, both Houses of Parliament.

The noble Lord said: My Lords, in view of the fact that I have chosen “Statement afternoon” to do so, I seek not to detain the House for any more time than is necessary to move this amendment. I am sorry to have provoked a mass walk-out before I have said anything controversial. Later on, such few members of my audience as remain will no doubt join those who are

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departing from the Chamber. I will be reasonably brief and in order to be reasonably brief, I shall not spell out yet again the case for my amendment. At Second Reading I set out the case for not proceeding with this amalgamation and a number of noble Lords backed that in Committee. This really is the most modest amendment imaginable to deal with the difference of opinion over amalgamation. All I am asking is that when the Bill has gone through, Ministers spend a month or two taking another look at the arguments for and against and decide whether the amalgamation really is in the public interest. I could not do that myself because I am deeply committed to the view that it is not in the public interest. If the noble Lord, Lord Darzi, who has been very attentive and kind in listening to my arguments on this case, said, “I will do that”, all will be done and dusted—the Government could just go ahead and do that; the amendment is not needed in the Bill.

I will not make the case for why we need the amendment but I will deal with the case for “Why not the amendment?”. What has persuaded Ministers on this? I believe them to be persuaded; the noble Lord, Lord Darzi, is an honest man and he sometimes does surprise us but my understanding is that he is not likely to support the amendment. I will go through the arguments against. I am sorry if I am taking the noble Lord’s thunder in doing so. I was taught in my days in politics that you should always get your retaliation in first.

There are three arguments for not adopting the amendment. The first, which was set out in a letter to me from the Minister in another place, Ben Bradshaw, is that it will cause disruption to the staff of the three organisations being amalgamated; that is, delay will totally unsettle them and they will all go off and get other jobs. Many noble Lords have experience of amalgamations, mergers, changes in structure and so on and they will have heard this argument time and again. My experience is that it is invariably hugely exaggerated. With regard to the people in the Commission for Social Care Inspection, my understanding is that there are not an awful lot of jobs as social care inspectors going begging to which they could rush because there had been a month’s delay while the arrangement was being looked at again. As some noble Lords will know, I am quite involved—one of my less serious aspects—with horseracing and the Tote. For years—since the Labour Government first promised, in, I think, 1997, to sell off the Tote to the private sector—its employees have been in a state of suspension, not knowing whether the Tote would exist or whether their jobs would exist. Meanwhile, the Tote has gone from strength to strength: its profits rise and the number of employees leaving is not very different from the figures for anywhere else in the world. It manages to cope with uncertainty. Uncertainty is a fact of human life and most of us cope with it perfectly well. If the staff of the three agencies concerned were under tremendous pressure to go and work somewhere else I would understand the worry involved, but we are talking about only a month or two, so that is not a plausible reason, although it is the kind of reason that invariably finds its way into ministerial briefs. It is not true that uncertainty is involved.

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The second argument against the very short delay that I have proposed is that the Bill has gone through the House of Commons, which expressed its opinion on the subject and passed the proposal, and it is not therefore for your Lordships’ House to stand in the way of the expressed will of another place. I will make two points on that. First, if I were a more eloquent person than, alas, I am, and I had managed to persuade Ministers that having another look at the whole thing was the right way forward and that we should therefore have a delay, would Ministers worry for a single second that there had been a vote in another place in favour of the proposal? Of course they would not; they would just say, “We have thought further and we are changing this”, and they would go back to another place, which would be happy to accept that, and it would be agreed to. This is really is a piece of constitutional dogma masquerading as an argument to suit ministerial convenience, and it will not for a moment wash.

In any case, let us suppose that we ran a political system where Ministers were, one way or another, incentivised to resist all possible change to all possible Bills by whatever forces—perhaps the Civil Service, perhaps other bodies, I do not know. If we ran a sensible system, it would operate as follows. The Bill would go through the House of Commons. Thereafter, it would be clear that there was not consensus in favour of what the Government were proposing and there would be arguments either way. It would therefore make perfectly good sense to have another, final, brief look at the Bill before deciding to proceed with the policy. There would be no need for an amendment to the Bill; there would be a commencement date and Ministers could decide not to commence if they were convinced that it was not the right thing to do. That may seem like constitutional outrage to some people here, but it seems to me a sensible way of doing business.

3.15 pm

The third argument that I have heard advanced—I hope I am wrong about this in some ways—is that the new commissions have been agreed by the noble Baroness, Lady Young of Old Scone. She will be the chair of the new organisation and she has done it on the basis that what she is going to get is what is in the Bill and that it cannot be changed. Here I admit to a difficulty, because if anyone is going to take on this mess, I would prefer it to be the noble Baroness, Lady Young of Old Scone. It anybody can make silk purses out of sows’ ears, she is the person I would back to do that.

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