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Secondly, we also agree with the Court of Appeal that a clear distinction needs to be made in the application of immigration control between people who have a
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In our view, persons subject to immigration control have a lesser claim to social housing than British citizens and others with a right of abode in the UK or a right to equal treatment under EU law. We believe that it is appropriate and justifiable for Section 185(4) and Section 119(1) to continue to apply in respect of housing applicants who are subject to immigration control. We consider that Schedule 15 will deliver a remedy which is compatible with the European convention for the following reasons. It will ensure that British citizens and other eligible applicants who have a right to live in the UK now will be able to rely on ineligible household members to convey entitlement to homelessness assistance. They will no longer be denied accommodation as a result of the immigration status of their dependants or be placed under pressure which could make them consider leaving the UK because they were unable to obtain accommodation when faced with homelessness.
The declarations of incompatibility do not extend to the effect of Section 185(4) on eligible applicants who are subject to immigration control and do not have a right to be here. We do not consider that there is a need to extend the remedy to them. There is strong policy justification, weighty reasons, why people who only have permission to be in the UK should not be able to rely on ineligible persons to convey entitlement to homelessness assistance or priority for long-term social housing. Perhaps I may remind the House that none of that affects the ability of eligible people, such as refugees, to obtain homelessness assistance if they are vulnerable in their own right.
The Joint Committee also asked what information the Government have to support my statement in Committee that Section 185(4) affects a very small number of people. We do not routinely collect data that identify the number of cases where applications for homelessness assistance fall within the scope of Section 185(4). However, in May 2008, my department asked all local housing authorities in England informally to provide an indication of the number of such cases that they have dealt with over the past year. Responses have been received from 188 local authorities—53 per cent of the total—and 57 per cent were nil returns. Many of the positive responses have provided the authority’s best estimate of the cases experienced and are very good initial estimates in grossing up non- returns. Between 250 and 400 applicants who were British citizens or EEA nationals may have been affected by the operation of Section 185(4) in England during the previous year. That is between 0.3 per cent and 0.6 per cent of the number of applicants who were accepted as owed the main homelessness duty.
The Joint Committee also asked how the number of individuals affected influenced the Government’s approach to the declaration of incompatibility. The numbers affected played no great part in our response. We are
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The Joint Committee also asked whether it would be possible to arrange publication of the Explanatory Notes to accompany the amendments before Report stage, which has not been possible. Explanatory Notes for the whole Bill will be published when the Bill goes back to the other place and I will reply to the letter including details of our estimates.
I know that I have wearied the House. I probably have even wearied the noble Earl who asked the question, but, having put that detail and explanation on the record, I hope that noble Lords will agree that Schedule 15 will not only remedy the incompatibility but will genuinely set a fair balance between the interests of UK taxpayers and the rights of individuals who come to the country with no claim on public funds.
7.30 pm
The Earl of Onslow: My Lords, I thank the Minister for that detailed answer. She could not possibly expect me or anyone else to absorb it all and retain it in their brains at this time of day. It is very complicated and obviously I shall have to read it again. I still have a worry, not about the head of the family but about subsidiary family members. Let us take the situation where a man is completely legal here but the status of his pregnant wife or girlfriend is under query. If she was completely okay, one set of rules would apply to her; but if her case was pending, a lower set of rules would apply to her. If she was then moved to, let us say, a 12-month tenancy agreement and her immigration status was settled as fully okay during that time, the family would then be landed with a second-class remedy which it would not have had if the settlement had come in earlier. I hope the Minister is following me because I think I am getting it right
I am not going to press the amendment. It is obvious that the Minister’s officials have gone to an enormous amount of trouble, for which I am grateful. We look forward to her letter—perhaps not with the glee with which one looks forward to a Valentine’s card, but we will be pleased to hear the answer and I thank her for that. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Schedule 15 [Ineligible persons from abroad: statutory disregards]:
Baroness Andrews moved Amendments Nos. 189 and 190:
Schedule 15, page 234, leave out lines 27 and 28 and insert “decisions mentioned in section 35A(2)(e).”
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On Question, amendments agreed to.
[Amendment No. 191 not moved.]
Clause 318 [Orders and regulations]:
Baroness Andrews moved Amendment No. 192:
On Question, amendment agreed to.
[Amendment No. 193 not moved.]
Baroness Andrews moved Amendments Nos. 194 and 195:
On Question, amendments agreed to.
[Amendment No. 196 not moved.]
Baroness Andrews moved Amendments Nos. 197 to 201:
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“In Schedule 4, in paragraph 4, the words from “be authorised” to “Government to”.” |
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“In section 128(2), the words “, or as the case may be re-determined,”.” |
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“In section 58(1)(b), the words “the Commission for the New Towns or”.” |
On Question, amendments agreed to.
Baroness Andrews moved Amendment No. 202:
Clause 322, page 148, line 26, leave out “this Act extends” and insert “Parts 1 to 3 (including Schedules 1 to 15) and Schedule 16 extend”
The noble Baroness said: My Lords, I am tempted to tease the House by saying this will take just as long, but it will not.
Amendments Nos. 202 and 203 to Clause 322 make it clear that orders under Part 4 can extend to the whole of the United Kingdom. This means that the necessary consequential or transitional provisions can be drafted to achieve their intended effect. Of course, any provision that affects the devolved Administrations will be proposed only after full consultation. Amendment No. 206 amends Clause 323 and inserts a necessary reference to “revocations” as both Schedule 16 and orders made under Clause 319 deal with changes to secondary legislation. I beg to move.
On Question, amendment agreed to.
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Baroness Andrews moved Amendment No. 203:
On Question, amendment agreed to.
Baroness Andrews moved Amendments Nos. 204 to 207:
On Question, amendments agreed to.
Baroness Thornton: My Lords, I should explain on behalf of my noble friend the Chief Whip that an unusual situation has arisen. The noble Baroness, Lady Campbell, who is in her place, has her name down to speak in the debate but is unable to do so because of a breathing problem.
Baroness Finlay of Llandaff: My Lords, she is going to speak. She is feeling better.
Baroness Thornton: My Lords, I am sorry. That is fine. I take this opportunity to inform noble Lords that as the debate is the last business of the day, 90 minutes have been allocated to it.
NHS: Specialist Hospital Units
7.35 pm
Baroness Finlay of Llandaff asked Her Majesty’s Government whether specialist hospital units have an obligation of ongoing care towards their patients when a clinical crisis occurs.
The noble Baroness said: My Lords, I am glad to have this debate in the week that celebrates the diamond birthday of the NHS. Indeed, I believe that the NHS is a glittering diamond today. Sixty years ago, a visit to the doctor would have cost you half a crown. At the end of the day, the GP’s pocket would jingle with the change slipped into it by patients. The visit was expensive and, in return, the GP could do remarkably little; it was really supportive care. Just before the NHS began, penicillin had become available in the community and was a revolution in patient care. My mother-in-law first gave penicillin to a patient in 1946. This very ill, frail patient made a dramatic recovery. The teapot that she gave my in-laws as a wedding present is still in use today, and we call it the penicillin teapot.
Now we have much more than penicillin. We have complex treatments that are life prolonging, with complex side effects and risks. Now patients live actively with their disease for many years.
Data from 2006 in regard to acute beds per million across the 27 European Union countries show about half the number of beds in the UK compared to France, Germany, Austria, Finland and others, with
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The General Medical Council is clear that doctors have a duty of ongoing care. Indeed, its document Good Medical Practice states that the doctor must:
It goes on to state that a doctor must provide a good standard of practice and care, particularly recognising and working within the limits of professional competence and working with colleagues in ways that best serve patients’ interests.
Of course, you do not know what you do not know, and here is the problem. It becomes increasingly hard for clinicians in a general service to know about the complexities and intricacies of many of the drug treatments or potential interventions for patients with complex conditions. Providing continuity of care is an enormous challenge, particularly as general practitioners no longer do their own out-of-hours care. Whoever sees a patient to admit them to hospital, or treats them at home out of hours, almost certainly has never seen the patient before. NHS Direct assures me that the patient’s record is available when the patient calls subsequently, but, of course, that is only the record of the previous telephone call; it does not have access to the whole clinical record. This telephone picture does not include examining a patient or seeing the clinical change in their overall appearance.
Indeed, I expect the Minister will have had the same experience as I had. A clinical scenario described over the telephone sometimes seems to bear remarkably little relationship to what you find when you go to see that patient, wherever they are. Indeed, patients can look remarkably different when they are at home from when they are in a hospital bed simply because they are in a different environment. Some services, particularly those for patients with rare conditions, have handled this well and are exemplars of good practice. The Royal Marsden has a triage system run 24/7 by expert cancer nurses, who will stay in touch if the patient is referred to their nearest accident and emergency department.
Moorfields Hospital also has a telephone advice line for patients, and the medical director tells me that no one has been turned away for capacity reasons in his six years there. Great Ormond Street Hospital is a tertiary care provider with an ongoing obligation of care to patients for whom it is directly responsible, but often patients treated in secondary or primary care are also patients at Great Ormond Street. Staff there describe themselves as having to be “flexible” with beds and ward space to meet their responsibilities to the patients they know. The Royal Brompton and Harefield Hospital runs the heart transplant unit and offers a 24/7 clinical advisory service for all its patients, which patients use very effectively. It is worth remembering that these patients may live far to the north or on the
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My own service studied patient-held records some years ago, but we found that the clinicians did not fill them in because that seemed to duplicate work. The theory did not match up to our expectations, and we abandoned patient-held records.
The difficulty is not with heart transplant patients, for example, who are in a very small population, but with those in larger populations where a lot of patients now live well and for a long time, although at an increased risk of intercurrent illness. Cancer patients are a classic group. If they get admitted it is important that the details are known about their condition, whether they are currently in a clinical trial or not and what the expectations are from their ongoing treatment. Another group is neurological patients with communication difficulties, who may get admitted to a unit where the nursing staff admitting them are just not adequately trained in managing people with complex communication difficulties. To return to cancer patients, though, the pointers that used to be present no longer exist. Many patients with metastatic disease are now doing well on treatment, so the presence or absence of metastases is a poor prognostic pointer.
The Sherwood Forest hospital trust has developed an exciting, innovative system to try to cope with the problem of where its patients get admitted to. Its recurring admissions patient alert, commonly known as RAPA, works by sending an e-mail alert whenever a patient is admitted to hospital through accident and emergency or acute admissions. The clinical nurse specialist allocated as the patient’s key worker is sent an e-mail to her BlackBerry, as is the doctor. That means there is immediate attention and streamlined care, improving efficiency and allowing patients to be discharged earlier. In the past, patients might have languished for days before anyone thought to inform their cancer specialist that they were in hospital.
The values of the NHS are outlined in the consultation document on the NHS constitution. They are about respect and dignity; the value of each person; a commitment to quality of care; compassion, particularly finding time to listen; about improving lives; and, I note particularly, working together for patients. There is a final value: that everyone counts. As the Minister rolls out his changes for the NHS, I make a plea that he embeds a duty of ongoing care as a quality marker within clinical service contracts. There is no reason that a clinician cannot be invited into another trust to see a patient that he or she already knows. Such a visit can provide important continuity of care and inform appropriate decision-making. Where difficult decisions have to be made, it becomes particularly helpful for the patient to be seen by someone who knows the details. There is no substitute for eyeballing and examining a patient.
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