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Lastly, I would like to strongly support my noble friend Lord Astor’s request for a full debate as soon as possible, because there are several other matters that need covering in this.

Lord Tunnicliffe: My Lords, I hope that I have, in part, answered both the noble Lord’s questions. We have been quite clear that we are not saying that these recommendations come with any new money. We are saying quite openly that they will have to be managed within the present allocations to defence, as part of the budgeting and planning round. They will be implemented because they will add value to defence within the constrained financial situation. If any party that could credibly form an Administration wants to promise more money, I will be very happy to note it. But I think we all recognise that we live in constrained times, and we have to manage and get best value.

On the matter of the Royal Signals units, I have set out the units that will be disbanded and the unit which will no longer be reserve-manned. We have no intention of laying off the skills; we will do all we can to redeploy skilled individuals within other TA units. As noble Lords know, I have no part in whether or not there will be a full debate. If there is to be one, I hope that the Minister will be here to answer it, but if not, I shall perform as best I can.

The Earl of Shrewsbury: My Lords, can the Minister assure me that the proceeds of any property sales under the rationalisation referred to in the review will

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be reinvested in new property for the Reserve Forces and that great care indeed will be taken to maintain the footprint across the country? I declare an interest as a former honorary colonel of a cavalry squadron.

Lord Tunnicliffe: My Lords, no, I cannot give the first assurance because I cannot pre-empt the Treasury rules which will be in place at the time. The Government constantly reassess how they rationalise their estate and I simply cannot predict how the property sales will be treated. On the matter of care, yes, I should strongly say that we will rationalise the estate with great care. We are putting together a team to look at this. As noble Lords will know, the estate consists of some 2,000 sites. The review confirmed the importance of the volunteer estate, but noted that it was old, expensive, underused and located to serve the population centres of the 19th century, as opposed to those of the 21st century. To ensure that the reserve has an estate that is modern, provides value for money and is correctly located to match changes in the demographics and national infrastructure, the review recommended that the Ministry of Defence conducts a detailed requirement-based review. That will be done.

Lord Ramsbotham: My Lords, like the noble Lord, Lord De Mauley, I declare a past interest as a former Inspector General of the Territorial Army. When I was doing that, we concentrated very much on the employers, and we formed the National Employers’ Liaison Committee. I shall return to that in a moment. I warmly support the words of my noble and gallant friend Lord Craig about the problems that may arise when we have, as I hope we will, a very comprehensive defence review, resulting in a possible revisiting of this comprehensive report, which I have not yet read—but knowing General Cottam, I am sure that it has been extremely well done. I also echo the words of the noble Lord, Lord Astor, in calling for a debate, which is entirely needed.

Without employers there are no volunteers. Last year in Afghanistan, I found nine bus drivers from a bus company in Enniskillen who were all working in one company. That was a remarkable tribute to them. When I was inspector general, I suggested to the MoD that one thing that it could do for the employers would be to relieve them of the employers’ contribution to national insurance as a reward for letting people go. The Minister mentioned assistance and support, but can he be more specific about what there is in this for the employers? Without that we will not have their support in the future, particularly as we go into the economic black clouds that seem to be ahead of us.

Lord Tunnicliffe: My Lords, I am afraid that I cannot answer the question in detail. The review involved the National Employer Advisory Board. Its views were taken on board. I recall that there has been a reorganisation of the payment of reserves, particularly when they are deployed, but I do not know what that did for the employers. I will come back to the noble Lord in writing.

Viscount Tenby: My Lords, leaving strategic considerations on one side for the moment, does the Minister agree that one of the strengths of the auxiliary forces, in particular the Territorial Army, is that they

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reinforce the geographical and social links between the Armed Forces and our local communities? Thanks to the necessary reorganisation in the Regular Army, those links have recently been weakened, but in the past they have, let’s face it, made the British Army the envy of the world. An additional benefit lies in this being a means by which young people can gain a taste of what service life is like. Will the Minister undertake to ensure that these important concerns are taken care of and paid attention to in the future?

Lord Tunnicliffe: My Lords, I agree with everything the noble Viscount has said. Section 1.6c of the report recognises that point for the first time. We all recognise that reservists are particularly well placed to connect with the nation, but we have actually spelt it out in this report.

Although Regular Forces make a connection with the nation, reservists are often better placed to connect, integrate with and influence the community in which, in their civilian lives, they live and work. The special ethos of volunteer service is what distinguished a reservist, in Churchill’s words, as twice the citizen. I also commend the value that is brought to the individuals in their reserve experience. It genuinely adds to the wealth of our community.

Viscount Tenby: My Lords, I should have declared an interest as having served in the Territorial Army for eight years.

Lord Walton of Detchant: My Lords, I also declare an interest as a former commanding officer, and subsequently honorary colonel, of the 1 Northern General Hospital TA. The unit is celebrating its centenary this year—or, at least, its successor unit, the 201 Field Hospital, is doing so. That unit has served with distinction in the Gulf, Iraq and Afghanistan. Anxiety, however, is being expressed by many of the officers, both medical and nursing, over their repeated deployment on operations overseas, which is having an adverse effect, in some cases, upon their civilian employment in the National Health Service. What are the Government doing to increase the recruitment in the regular medical services, so that the TA—much relied upon—may not be required to be deployed overseas so often?

Lord Tunnicliffe: My Lords, first, in view of the stream of confessions to military service that I have heard today, I think it is important, having failed to congratulate each one in turn, for me to congratulate noble Lords collectively on their contributions. I explain to briefers that, when I get up to speak on military matters, I will be surrounded by so much military experience that I will be intimidated.

I have not been briefed on the issue of full-time medical recruitment. I will be very happy to write to the noble Lord on this issue. The report makes the particularly strong point that the reserves uniquely bring niche capability to the Armed Forces. The noble Lord is quite right: nowhere is this more so than in the medical world. The country as a whole thanks those medical professionals who serve in the Reserve Forces for the contribution that they make. We hope that they get professional growth out of that experience.



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Lord Addington: My Lords, is the Minister in a position to comment on the part of the Statement that says that reservist training will be refocused with a greater emphasis on preparation to support current operations? We have been in Afghanistan, for instance, for a while. We have all known for a long time that it could be a very long haul. Why has it taken us this long to come to this staggeringly obvious conclusion?

Lord Tunnicliffe: My Lords, you get asked questions all the time that you cannot answer.

As the noble Lord, Lord Astor, pointed out, the use of reservists on the front line is integrated, in current operations, with Regular Forces. The review says that, if that is what we are going to do, we should review the training and make sure that the training is directed very strongly to that purpose. It says that we should start from the user and work back to the training—unlike some of the training procedures, schedules and programmes, which still have more relevance to history than they have to the outcomes that we are looking to achieve.

Earl Attlee: My Lords, surely the answer to the question posed by the noble Lord, Lord Walton of Detchant, is that we have been exceeding defence planning assumptions by about 100 per cent since 2003. I remind the House of my interest as a serving officer in the TA, although I am not doing very much now. I first signed up to the TA in January 1974, so I think that I know a little about the TA.

Noble Lords: Hear, hear!

Earl Attlee: My Lords, I certainly know that this Government have cut the size of the TA in half during their time. However, there appears to be much that is good in General Cottam’s report. The Minister says that all seven principles have been accepted; I should dearly like to see the general’s first draft.

On the reserves estate, I hope that it does not mean that we are going to sell off the TA centres that happen to be in prime town centre locations, very close to railway stations and ideal for supermarkets.

Many of us look forward to examining the detail of the review. It identifies room for improvement in training. My noble friend Lord Astor of Hever touched on the training of officers and the fact that we have very few of them.

The Statement suggests that new recruits will take part in their units’ collective training within six months of joining. Noble Lords will be interested to hear that I took part in battalion-level internal security exercises well in advance of attending a recruits’ course. I was cadet-trained but many TA soldiers join the TA from the cadets.

The success of training and the speed at which TA soldiers can be trained are crucially dependent on the money available and the number of man training days allocated to a TA unit. However, we do not have any money. Our national public finances are in a mess and the MoD budget is unsustainable.

Lord Tunnicliffe: My Lords, the TA centre review will concentrate in particular on demography—that is, where the public are now and how best to make adjustments. As I said, there will be an important

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emphasis on training, and the number of man training days will be maintained but deployed in a different way. Where it is needed, money will be found within the overall service allocations to the extent that it is used to the best effect. That has to be a caveat that any sensible Government stick to in the difficult circumstances in which we find ourselves. However, through this review, the Government are committing themselves to the Reserve Forces being an integral and valuable part of defence, and I am sure that the whole House will agree that that is the way forward.

Health Bill [HL]

Bill Main Page
Copy of the Bill
Explanatory Notes
Amendments
11th Report from JCHR

Report (1st Day) (Continued)

4.42 pm

Clause 2 : Duty to have regard to NHS Constitution

Amendment 3

Moved by Earl Howe

3: Clause 2, page 2, line 3, at end insert “and the Handbook”

Earl Howe: My Lords, I shall speak also to Amendments 7 and 8. I make no apology for returning to a matter that we debated at some length in Grand Committee—that is, the question of why the Bill contains no duty for NHS bodies and those delivering services on behalf of the NHS to have regard to the Handbook to the NHS Constitution. First, what is the handbook meant to be? In Grand Committee, the Minister made it clear that the handbook was the explanatory guide to the constitution. He said:

“It explains what the constitution means in practice, by setting out the law and departmental policy that underpin each right and pledge in the constitution”. —[Official Report, 23/2/09; GC 21.]

That was absolutely as I understood the position. However, despite that, and despite the duty in the Bill for NHS bodies to have regard to the constitution, the Minister made it equally clear that it was not appropriate to extend that duty to the handbook. When comparing the status of the constitution and the handbook, the analogy that he drew was that between the Bill and the Explanatory Notes that go with it. However, the Explanatory Notes have no force in law; the Bill, when enacted, does.

I am still troubled by this. In the first place, I am doubtful whether the analogy the Minister drew actually holds water. The handbook is a statutory document; it is mentioned in the Bill, unlike the Explanatory Notes. I take us back to the departmental website. The part of the website devoted to the NHS Constitution makes it clear that the constitution consists of—I remind the House of those words—not only the constitution itself, but also the handbook. It also includes the Statement of NHS Accountability as well, but I shall not return to that issue.

If we look at the way this Bill is constructed, we should take due note of the heading to Clause 1: “NHS Constitution”. Clause 1 introduces and embraces not only the constitution itself but also the handbook. I took that bracketing together to be an implicit

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acknowledgement that the two publications were legally and practicably inseparable for the purposes of interpreting what the NHS Constitution actually was. The Minister’s reply indicated however that the handbook was not part of the constitution. He emphasised that,

“It is not a document that we intend should be legally taken account of by providers of NHS care”.—[Official Report, 23/2/09; col. GC 21.]

If that really is so, we are left wondering what patients and staff are meant to think when they read it. It is explanatory, but at the same time, they do not have to have regard to it. If they do not have to have regard to it, they can ignore it, because nothing will happen to them if they do. Indeed, if they can ignore it, they do not even need to read it. That is the construction which people may well put on the Government’s position on this matter.

The Minister put forward another reason in Grand Committee why it was not appropriate to create a duty to have regard to the handbook. He said that,

I found that very odd. It is certainly true that the first part of the handbook is addressed to “you”, by which is clearly meant, “you, the patient”. But that is no less true of the constitution itself. The whole of the second section of the constitution is addressed to “you”, which means everyone who uses the NHS. However, that fact does not prevent there being a duty placed on NHS bodies to have regard to the constitution. Again, the obvious question is, why not also the handbook? Equally, the Minister said in our earlier debate, and he may well repeat it today, that,

The implication is that its status is not of a kind that would put it on a par with the constitution. I accept that it does not create policy or law, but as I understand it, the constitution itself does not add to people’s legal rights; it is a declaratory document, yet there is a duty to have regard to it.

We should perhaps bear in mind the handbook’s opening sentence.

“The Handbook is designed to give NHS staff and patients all the information they need about the NHS Constitution for England”.

Indeed, it is designed for rather more than that, because, as the noble Baroness, Lady Barker, pointed out in Grand Committee, there are sections of the handbook which qualify or place limits on the open-ended statements made in the constitution. A very good example, which the noble Baroness chose, was the right,

It is only when you read the handbook that you discover that the right can only be exercised at the discretion of the Secretary of State.

The constitution sets out the right to make choices about your NHS care, but it is only when you read the handbook that you are told about the raft of exceptions to that right. The handbook spells out exceptions to the right of access to your own health records and exceptions to the right to receive clinically indicated

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drugs and treatments recommended by the National Institute for Clinical Excellence. In a very real sense, a duty to have regard to the constitution which is not at the same time accompanied by a duty to have regard to the handbook risks, at best, confusion, and, at worst, downright contradiction.

I must press the Minister further on this point. How is it that a document which is to be treated, on the one hand, as an integral part of the constitution is at one and the same time not part of it? How can it make sense for there to be a duty to have regard to the 12-page document called the NHS Constitution, and yet for there not to be a duty to have regard to the fuller document which is meant to tell everyone how the constitution should be interpreted? I beg to move.

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, Amendments 3, 7 and 8 tabled by the noble Earl, Lord Howe, propose that the same list of bodies which are required to have regard to the constitution should also be under a duty to have regard to the Handbook to the NHS Constitution. It may be useful if I reiterate our intentions behind the purpose and status of the handbook. The noble Earl very eloquently described the debate in Grand Committee when I explained that the handbook is the explanatory guide to the NHS Constitution to be used by patients, public and staff. It is a reference guide for these groups, an explanation of what the constitution means in practice to help them understand it. Indeed, the very first sentence of the handbook reads:

“The Handbook is designed to give NHS staff and patients all the information they need about the NHS Constitution for England”.

The words in the constitution are necessarily high-level. The handbook takes these words and explains them in further detail, making each right, pledge and responsibility more accessible and digestible to patients, public and staff. The handbook is the result of extensive research with patients, public and staff into what format would be most useful to help them understand the constitution. For example, the handbook explains to patients, as the noble Earl said, how they can make a complaint and explains in more detail what their responsibilities are. It summarises what a right means in practice, and its legal status, for both a patient and for a member of NHS staff.

The handbook is not guidance; it is an explanatory document and it is certainly not an instruction manual. The words in the handbook do not mean that the NHS has to do anything new or different. They do not express any new laws or policies, or new interpretations of existing rights or policies, which are not already in the constitution. They are merely a summary for patients, public and staff of the current situation regarding the law and departmental policy underpinning each entry in the constitution.


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