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The noble Earl and I agree on the principles of improving data quality and I hope that I have reassured him that we have policies in which we can, at least, engage clinicians and provide them with the tools to make that happen. I hope that he will, therefore, be able to withdraw his amendment.
Earl Howe: My Lords, that was a helpful answer from the Minister and I thank him for it. We would all acknowledge that there is good practice, as well as less good practice, in this area, but there are no doubt problems to be addressed. How best do we do that? Part of the answer lies in encouraging accreditation, as I argued in Grand Committee; part of it lies in external review and in performance management. Most of all, however, the answer lies in better collaboration between clinicians, finance officers and business managers, with, as the Minister rightly said, clinicians taking ownership of data. The arrival of quality accounts creates a real opportunity in that sense.
Again, however, we should not forget about setting appropriate standards for data quality. The Audit Commission said in paragraph 57 of its report:
“Standards used for regulation and registration should include a requirement to ensure the quality of data and to submit accurate information. The current Standards for Better Health omits this. Use and submission of poor quality data should have direct regulatory consequences”.
Therefore, it envisaged the CQC being involved in this area. Clinicians, as the Minister indicated, are likely to take ownership of the raw data for such things as patient outcome and mortality ratios. They are less likely to be closely involved in the statistical analysis of the data, an area where there is scope for things to go awry. We need to be mindful that there is a limit to the extent to which clinicians can oversee everything produced as statistics. Nevertheless, as so often, and in this area above all, I have confidence in the Minister wanting to get things right. I have no doubt that he is doing his level best to ensure that this part of the Bill will result in something that we can all value and be proud of, so I beg leave to withdraw the amendment.
Clause 8 : Regulations under section 6
Lord Darzi of Denham: My Lords, in moving Amendment 20, I shall also speak to Amendments 21, 35, 36 and 37. The Delegated Powers and Regulatory Reform Committee has recommended two changes to the Bill. The first relates to the procedure for exercising powers to create secondary legislation relating to quality accounts; the second relates to consultation by the trust special administrator on the draft report. These amendments act on those recommendations.
First, on quality accounts, the committee has recommended that the mechanism for exercising the powers in Clause 6(5) be subject to the negative procedure, including the first occasion on which the power is used. The powers in subsection (5) enable the Secretary of State to make regulations to omit prescribed providers
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We originally considered the affirmative procedure appropriate when the power was first exercised, since the intention is to omit specified providers from the ambit of the duty currently under consideration. The negative procedure was considered appropriate for subsequent amendments to those regulations, since the intention is that the power will, in most cases, then be used to extend the duty to publish quality accounts to those previously excluded. The committee considers that the negative procedure should provide an adequate level of scrutiny even on the first occasion. The regulations will be subject to public consultation before we bring them before Parliament and there remains, of course, the option for the Merits Committee to comment on them and recommend further parliamentary debate as appropriate.
On the recommendations relating to trust special administrators, new Section 65H of the National Health Service Act 2006, proposed in Clause 13, requires those administrators to consult certain persons specified in that section—for example, staff and staff representatives—on a draft report. Subsections (7)(c) and (10) of the new section currently permit the Secretary of State to prescribe in regulations additional persons from whom the trust special administrator should request a written response, or with whom they should meet. Amendments 36 and 37 change the mechanisms by which the power is exercised from regulations to directions. Amendment 35 is a technical drafting amendment to bring about consistency in wording.
Amendments 36 and 37 are in direct response to the Delegated Powers and Regulatory Reform Committee’s recommendations that the mechanism for exercising the powers relating to consultation by the trust special administrator should be consistent for NHS trusts and PCTs. The committee took the view that parliamentary scrutiny was not necessary, favouring the approach that has been taken for PCTs. I am grateful to the committee for its recommendations and I beg to move.
22: After Clause 8, insert the following new Clause—
“Duty of providers to account for car park revenue
(1) Each of the bodies listed in section 6(2) must, in accordance with regulations made by the Secretary of State, produce a report in respect of each reporting period which accounts for the use of revenue raised from all car parks under their control.
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(2) The report must contain the following—
(a) the level of revenue raised from each car park,
(b) a breakdown of how the revenue has been distributed, which clearly specifies if and how the revenue has been spent to directly improve healthcare provision,
(c) the tariffs charged in each car park, including any special rates for hospital staff or members of the public who have driven patients to hospital.”
Lord Palmer: My Lords, I apologise to the House that I was not able to give this amendment an airing in Committee. However, I feel strongly that it is absolutely wrong that people should have to pay a large proportion of their wage in car parking fees, particularly for the more menial tasks for which they get paid in hospitals, such as cleaning floors. This also affects those who arrive at a hospital to attend the accident and emergency department. You may, for example, only have a broken finger and so will put in enough money for the four hours that is meant to be the maximum time before you are seen. However, if it takes a little longer than that, you may get back to your car to find it clamped. As I have said, the main point of the amendment is for the Government to look favourably in particular on lower-paid workers within the National Health Service and those who visit people who are terminally ill or under conditions of accident and emergency. I beg to move.
7.30 pm
Baroness Barker: My Lords, as the noble Lord, Lord Palmer, was unable to move this amendment in Committee, we did not get the chance to talk about it. I wish to give him some support, although I have no doubt that the Government will not. I know that the Scottish Executive have introduced measures of this kind; indeed, they have gone further and are bringing in measures to stop hospitals raising revenue from car parks. The amendment tabled by the noble Lord, Lord Palmer, does not go that far.
I support the noble Lord’s amendment for two reasons. First, members of the public are angered beyond measure because they believe that they have no choice in many cases other than to take private transport to hospitals, when they are put in a situation where the NHS is making money from their disadvantage.
The amendment is important, secondly, because there are some patients for whom car parking fees at hospital are detrimental to their healthcare. Many years ago, when I worked in Age Concern, we did a study on non-emergency patient transport, which in those days was being cut back so severely that many older people were forced to make private arrangements to go to hospital. We called our report A Helicopter Would Be Nice, because that is what one of the people said to us. We found older people not going to hospital for appointments that they needed until they could arrange for their relatives to fly back from abroad to take them, or until they could rely on neighbours to take them. Time and again in our research, the stress of car parking and of taking people to hospital and having to run in and out of A&E departments to make sure that the parking meter was topped up came through as something that was not conducive to older people’s health and well-being.
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The noble Lord, Lord Palmer, has in a limited way hit on a big problem, which the NHS has a duty at least to examine. If all that it does is come clean about the amount of money that it is making from car parking, it would be a great step forward.
Lord Mackay of Clashfern: My Lords, I understood that it was one of the principles of the National Health Service that services provided should in general be free at the point of provision. A car park at a hospital is really an ancillary service. People do not go to the hospital for the sake of entertainment or anything of that kind; they go for the sake of receiving a service in the hospital. I commend to the noble Lord the good example north of the border, where, apart from in public/private partnerships, the Government have abolished car parking charges in the hospitals under their control. That is an example that would be well followed.
Lord Darzi of Denham: My Lords, the noble Lord, Lord Palmer, has proposed a new clause that seeks to require trusts to justify their policies on charges for car parking. The idea has merit and should be given consideration, but it ought to be covered in guidance and offered as an example of an issue that could be of local concern. This would achieve the best fit with the way in which quality accounts are being designed, assuming that the noble Lord’s intention is that the duty should form part of a quality account.
If providers wish to talk about car parking charges from a patient experience point of view, they are free to do so. I strongly encourage providers to do that, because it is clearly an issue of concern. I shall not try to address the comments of the noble and learned Lord, Lord Mackay, in relation to contrasting policies on charging north of the border and in England, because I am sure that we shall have opportunities to debate it. However, the matter is of concern to patients and it should be reflected through the patient experience matrix that we are developing with the health service. One’s experience in a hospital is not purely one’s experience in a ward or that of the care that one receives from a surgeon; it also includes one’s experience of the environment and the car park facilities that might be available, as well as the costs associated with it. We updated the guidance on car parking charges in November 2008 and I shall be more than happy to send copies to noble Lords.
I reassure noble Lords that the income generated from car parking charges must be used to improve health services within a trust. It does not leave the trust; that is an important point to make. The whole process of designing quality accounts should be inclusive. Ideas must come from the front line, which includes patients, user groups and others at a local level.
I hope that I have reassured the noble Lord that it is our intention to measure all aspects of experience. I shall strongly suggest that this matter be part of the experience indicators that we are currently developing. If the noble Lord feels that I have addressed some of his concerns, I hope that that will give him the opportunity to withdraw his amendment.
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Lord Palmer: My Lords, I thank the noble Baroness, Lady Barker, for her support. I listened with great care to what the Minister said and I shall read it most carefully tomorrow in Hansard. He did not, however, respond to my point about lower-paid members of staff, who greatly concern me. The fact that people who earn not very much over and above the minimum wage have to spend a vast proportion of their income to park their cars is of great concern. I shall read carefully what the Minister said and may well bring this back at the next stage of the Bill. Meanwhile, I thank the Minister for his response. I hope that he will take on board the fact that there is a very serious point behind the amendment. I beg leave to withdraw it.
Consideration on Report adjourned until not before 8.37 pm.
United Nations
Question for Short Debate
7.38 pm
Tabled By Baroness Howells of St Davids
To ask Her Majesty’s Government what steps they will take to ensure that the United Nations can act in accordance with the objectives outlined in the preamble to the Charter of the United Nations.
Lord Patel of Bradford: My Lords, this is clearly an important debate with a large number of speakers. I take this opportunity to remind noble Lords that if they stick to their allocated time of three minutes, it will allow all noble Lords a fair opportunity to speak within the hour.
Baroness Howells of St Davids: My Lords, today’s debate is an opportunity to explore the options for reforming the United Nations to re-establish its position as the pre-eminent institution in global politics. The UN was created on 24 October 1945 with a commitment from 50 founding members to provide a strong body with power to provide a forum for debate and resolution to preserve the peace. The role of the United Nations has developed and diversified in the 63 years since its inception, yet many of the founding challenges remain.
The horrors that confronted the Allied and Red armies in eastern Europe motivated the founding members of the United Nations to make it much more powerful than the League of Nations. It was given the organs and strength to go further than simply preventing war. It is perhaps in this realm of world health and the codification of human rights where the UN has had its most impressive and unique successes.
As problematic as it may be to conceive of a world where the United Nations had not been created, it is equally difficult to imagine that so much would have been achieved in these areas without the work of those who have so generously served under its name. A World Health Organisation programme eradicated smallpox. UN awareness campaigns limited the scourge of landmines, HIV/AIDS, malaria and other diseases.
Despite its varied and historic achievements, the central organ of the United Nations—the Security Council—is in a state of near total paralysis, perennially handicapped by its inability to deliver in the face of
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When the United Nations was conceived, the shadow of the horrors of World War II still loomed large, not least the collective shame of the international community on discovering the fate of so many in Auschwitz, Belsen and beyond. Yet just half a century later in Rwanda, more than 800,000 people were murdered with nothing more sophisticated than a machete, for nothing more arbitrary than their ancestry. Soldiers wearing the blue beret of the UN peacekeepers were forced to stand by as Tutsi men, women and children were barbarically slaughtered.
Without the mettle, legitimacy or support to act, these peacekeeping actions have even served to worsen the suffering. UN troops with flimsy rules of engagement were used as a human shield while nearly 8,000 Muslim men and boys were ethically cleansed in Srebrenica. Even today in Darfur, essentially the same things are happening with the same wretched and feeble response from the international community. More could—and should—be done. The UN can go some way to addressing this dire need. With these stark and harrowing examples I seek not to shock or appal but to say that we could and should have done better.
We in the United Kingdom must accept our share of responsibility for these failings and ensure that we help to create a United Nations with the funding, structures, transparency and legitimacy to act where it has so painfully failed in the past, a UN whose actions are more than just an amalgamation of the interests of the United States, China, Russia, France and the United Kingdom, and one whose response is not muted and activity not hindered by a structure so spectacularly out of step with a globalised and independent world. While disputes and hostilities are invariably complex and contradictory, surely giving the United Nations the tools to act is much more agreeable than simply looking on as lives are extinguished on an unimaginably horrific scale.
In 1993, the UN General Assembly established an open-ended working group on Security Council reform. The commitment to change was reaffirmed in the millennium development goals but the status quo persists. It is absurd in the multi-polar world of the 21st century that the power of the United Nations is concentrated in the hands of the victors of World War II. Is it not preposterous that Africa and South America, together representing more than 23 per cent of the world’s population, have no permanent representation on the UN Security Council? Many of the conflicts and humanitarian crises that persist today stem from the post-colonial legacy of failed states in Africa, yet they have no voice at the table—an oversight, perhaps.
The United Nations has often been accused of acting only in the interests of its most powerful participant. In recent years, that has been the United States, using the UN to gain legitimacy where it could, acting unilaterally where it could not. Over the next 20 years, many believe that the role of chief puppeteer will fall to China. We are at a crossroads where the opportunity to change and enhance the UN sits comfortably with
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As it did with the creation of the United Nations, the UK should be taking a lead with reform. We need carefully to consider what changes we support to make the United Nations a more effective body. Failure to effect meaningful change would only serve to betray those who fought so fiercely to provide us with a seat at the table. The UK Government’s current position is support for the expansion of the Security Council to include Brazil, Germany, India, Japan and African representation.
In a world of failed states and terrorist threats, it is almost inconceivable that the United Nations continues to concentrate its power in the permanent five, veto-holding powers. Britain is almost uniquely placed among the 192 member states of the UN to take the lead in redressing this asymmetric balance of power. Could we not be bold and cede our right to the veto in exchange for a genuine and far-reaching transformation? One could argue that we would gain influence and achieve more in forgoing our veto and supporting expansion than by maintaining the existing norms.
Maybe relinquishing the veto would be too hard a pill to swallow but we could make the Security Council more effective by limiting its use. This could be achieved through a number of strategies from unilateral action to institutional change. All too often the paralysis which befalls the Security Council is the result of one of the P5 vetoing a resolution supported by the rest of its members. One viable proposal is to change the influence of the veto by insisting that no single member of the P5 could unilaterally veto a resolution supported by the remaining four. No single power could continually act as a wrecking ball against the consensus of the wider international community, thereby freeing the Security Council to consolidate its primacy as the authoritative body in maintaining international peace and security.
The United Kingdom is currently the fourth largest contributor of UN funding, supplying just over 6.6 per cent of the regular budget. Yet the United Nations is chronically under-funded, hindered not least by the failure of some of the world’s richest nations to pay their share. Although a difficult argument to win in our current economic crisis, we should consider the implications of pressure on this budget and look closely at the need to expand it. Money alone will not be the solution to the UN’s ills but we cannot continue to expect it to achieve more while we starve it of funding.
One of the useful things additional funds could pay for is a permanent secretariat for the Security Council. I believe we could instil within it an institutional memory, making more effective the contribution of those elected members.
I have run out of time, so I end by thanking those who have put their names forward to speak in this debate.
7.50 pm
Lord Alderdice: My Lords, among the great pleasures of working in your Lordships' House is not just that wonderful debates are introduced, as this one was by the noble Baroness, Lady Howells of St Davids, but
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