| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Amendment 31 is relatively straightforward and would ensure that the Secretary of State had to consult the APA and ACPO before issuing guidance about collaboration. That is only common sense, as they are the bodies responsible at national level for the other legs of the tripartite police governance arrangement. They are also the bodies with the practical experience of collaboration to be in a position to ensure that any guidance is workable.
My remaining amendments essentially approach the same problem in slightly different ways. That problem is, of course and yet again, the wide-ranging powers for the Secretary of State set out in the new section about directions. The powers are particularly pernicious, because at best they can generously be interpreted as micromanagement, but at worst they represent a means by which policing could be restructured through the back door. I am sure that the Minister will assure me that that is definitely not the intention of the Government but, once the powers are there, someone someday might find it convenient to use them in a way which was not originally intended.
My first and preferred solution would be to remove the powers altogether. That is the approach taken in Amendment 32. Incidentally, that would also apply to the following new section, which is about terminating collaboration agreements, but one amendment in that respect will suffice to make my point. However, I am sure that the Minister will remind us all how important the future stability and resilience of policing is. No doubt he will argue that the Secretary of State should, in extremis, be able to exercise powers to ensure that the police service is fit to meet the very real challenges it faces from serious crime and other such threats.
Therefore, I have also suggested an alternative approach to moderating the way in which the powers of direction can be used. Amendment 34 levels the playing field to ensure that the Secretary of State must use the same criteria demanded of police authorities in judging whether or not to collaborate. That would ensure that the yardstick for all must be efficiency and effectiveness, and that the Home Secretary cannot exercise the draconian
22 Jun 2009 : Column 1418
The new section also ensures that directions can only be given to chief officers through the police authority. That is a very important safeguard to prevent direct political interference in policing by central government, and is a fundamental tenet of ensuring that policing is kept independent of the state. In addition, the powers of direction under the new section are subject to HMIC's view about the merits of the proposed direction. Finally, the authorities and forces concerned must be given an opportunity to make representations about the proposals.
In tabling the amendments, I have sought to restrict what are very draconian, centralising powers. If the powers cannot be removed from the Bill altogether, they at least require reasonable checks and balances to ensure that they are not misused.
7.30 pm
Lord West of Spithead: I shall take Amendments 32, 33, 34 and 35 first, and move on to Amendments 30 and 31. The first amendments aim to take out the direction powers that the Secretary of State would have to help shape the future of policing in the area, something that the Secretary of State is accountable to Parliament for. They would also remove the Secretary of State’s power to publish guidance to support the implementation of the provisions.
One of the key reasons for bringing forward the clauses on collaboration is to ensure that there is this increasingly important means by which to deliver policing benefits from a clear and robust framework that Parliament can approve. At the heart of this is the empowerment of police forces and authorities to enter into collaboration agreements where that is in the interest of policing. However, as the person accountable to Parliament for policing, an equally important part of this is the power for the Secretary of State to be able to ensure that collaboration is done in a way that benefits policing generally, and that arrangements are coherent, transparent and, where possible, consistent. That is not only sensible but constitutionally sound.
If this is to be achieved in reality, any Secretary of State will need the requisite powers to influence collaboration when it is deemed to be in the interest of the overall efficiency and effectiveness of policing. Powers to direct are not new. Indeed, the powers to direct in this area of business replicate and provide clarity to the broad powers that the previous Government enacted through the Police Act 1996. Other direction powers that the Secretary of State already has under legislation that predates this Government give the Secretary of State powers of direction over elements of policing such as performance, priorities and policing areas. These powers, as is the case with our clauses, are
22 Jun 2009 : Column 1419
There is a view that any direction given under this new legislation should be in accordance with the arrangements under the Police Act 1996, in particular Sections 40 to 40B. However, these sections deal typically with forces and authorities found, via a report by Her Majesty’s inspectorate, to have failed to discharge their functions effectively. While these clauses might be capable of enabling actions to be taken to remedy an individual force’s failings, there might be wider strategic reasons, such as a move towards certain operational services being delivered at the regional level, which warrant central direction of a different kind.
Directions of the sort described would need to be given both to the police forces involved to incorporate the changes to their structure and to the police authorities to incorporate the appropriate changes to accountability arrangements resulting. It is right to use Sections 40 and 40A to react to failings in performance, but, as we stated in the policing Green Paper, if we are to best serve the public interest, we must proactively engage with the service, including HMIC, and proactively determine where robust and consistent collaboration is needed. Directions here would serve to consolidate a consensus and not simply be used as a last resort, which is what lies behind Section 40. In addition, Section 40 goes no way towards specifying the sorts of directions about collaboration that may be given. The new provision in this subsection provides this clarification. As the Home Affairs Select Committee highlighted recently, there may well be a need to require collaboration to deliver improvements in certain policing areas, and where this is the case, it is right for Government to exercise their powers to achieve this. However, a prerequisite is for Government to have the powers in the first place.
The case for a more robust and consistent collaboration is emerging, with collaboration on functions such as serious organised crime growing. In the light of this progress across policing, we have already asked Her Majesty’s Chief Inspector of Constabulary to work with partners to scope what policing functions could usefully benefit from a more robust collaborative framework. It has, in turn, highlighted a number of areas where it is arguably in the public interest to proceed in a consistent manner across the country.
I know that some believe that the powers being sought under Clause 5 should be expressly limited to those instances where it is in the interests of the effectiveness and efficiency of policing. I agree. This is, in fact, already provided for under Section 36 of the Police Act, which requires any power of the Secretary of State under Section 1 of that Act, which these provisions amend, to be exercised in a manner that promotes those aims. As we have demonstrated with the recent HMIC report, the Secretary of State will always need to be able to assure Parliament that the actions and decisions taken are grounded in the drive to deliver an effective and efficient police service.
22 Jun 2009 : Column 1420
Some have expressed concerns that these powers to direct are compromising the independence of the police. Protecting the independence of the police is at the heart of our constitution and a critical safeguard in preventing the abuse of power by the Executive. However, we must be equally careful to distinguish between this and the Executive’s role in ensuring that policing is delivered effectively and efficiently, ensuring the police have the right structures and processes in place to deliver this public-service ambition, and that it is in the public interest and in no way undermines or threatens the principle of police independence.
The power to mandate in this area, which already exists, has been clarified by these clauses, demonstrating our desire to be clear about our intention in the area. It is unfair to suggest, as some have, that these powers are anything but open and transparent. After all, we set out our intention to consider requiring collaboration in our Green Paper in the summer of 2008. With collaboration becoming a major part of 21st century policing, it is right and proper that, as well as encouraging forces and authorities to pursue collaborative ventures, the Government reserve the right to consult those who are to receive directions—first, to help shape collaboration in those areas where they promote the efficiency and effectiveness of policing at a local, regional and national level, and, secondly, to intervene in those instances where a collaboration may benefit a few but is counterproductive to wider policing interests.
I turn to Amendments 30 and 31. Statutory guidance is one of the key tools available to Government to ensure the effective implementation of new legislation and, in many instances, to clarify the intention of Parliament as a result of debates such as this one. This guidance becomes even more important where the legislation is seeking to drive organisational reform and new ways of working. In these instances, guidance allows delivery agents to avoid some of the pitfalls experienced by others, best value is achieved, and the legislation drives the necessary public service improvements. This is the purpose behind Section 23F, and to remove it would severely curtail the ability of Government to assist and shape public service reform, which is set out by this legislation but is underpinned by meaningful guidance of the kind that officials will work with the service to produce. This will of course include the APA, ACPO and all other partners helping to deliver effective policing. This consultation happens routinely. It is not restricted to the APA and ACPO and does not need to be included in primary legislation.
Whilenon-statutory guidance can be issued without the need for primary legislation, as we have seen at Committee stage in the Commons and here today, there are issues that are best dealt with in guidance but that are sufficiently important that statutory guidance, developed in partnership with partners, is best placed to ensure that delivery agents have regard to it.
I know that that has been a long response but I hope that I have been able to set out the case for why the Secretary of State’s powers to give directions about collaboration and to issue statutory guidance are both necessary and proportionate in collaboration agreements. In the light of my response, I would kindly ask the noble Lord and the noble Baronesses not to press their amendments.
22 Jun 2009 : Column 1421
Viscount Bridgeman: I am most grateful and beg leave to withdraw the amendment.
Amendments 31 to 35 not moved.
House resumed. Committee to begin again not before 8.38 pm.
Health: Mouth Cancer
Question for Short Debate
7.38 pm
Tabled By Baroness Gardner of Parkes
Baroness Gardner of Parkes: My Lords, this is not a new issue. Probably my first controversial amendment in your Lordships’ House was when I moved an amendment to the Health and Medicines Bill 1988 to retain free dental examinations. I said:
“The suggestion to bring in a charge for a dental examination is a retrograde step”.—[Official Report, 19/7/88; col. 1220.]
I was concerned that the introduction of a £3 fee would deter people from visiting their dentist and that they would either not be examined or examined more rarely as they stretched the time between visits to get better value for money.
Knowing that there would be no point in asking people simply to vote for my amendment, I appreciated that the only way to get support was by winning the argument. Your Lordships have their own views on most subjects that we debate and these views are usually very well informed. The day before the amendment was to be considered, I asked every noble Lord whom I could find whether they would please try to be in the Chamber to hear the debate. Fortunately a large number attended from all sides of the House. When put to the vote, the amendment was passed—Contents 118, Not Contents 97. Unfortunately my success was short-lived. The other place reversed the decision and attached financial privilege, so that this House was prevented from reopening the matter.
That was the beginning of the end of national health dentistry for all, but I had no idea how sadly the access for patients would deteriorate, of course aggravated by the introduction of a number of new dental contracts that make it very unprofitable, if manageable at all, for dentists to continue in full-time National Health Service practice.
In last week’s press, a headline read: “Millions unable to get appointment with NHS dentist”. The Which? survey estimated that this applied to 3 million people in the previous two years. Again, there is nothing new there. Ever since Tony Blair assured us that everyone would have access to a National Health Service dentist, the numbers unable to do so have steadily increased. I know that we have heard stories of people pulling out their own teeth, but I am sure that that is a rare situation and no one could do it unless, due to loss of supporting bone, the tooth was very wobbly. I cannot accept that anyone today could willingly tolerate the pain of removing a solidly set
22 Jun 2009 : Column 1422
Enough of the misery of past history. My purpose in raising this issue is to suggest what can be done in practical terms to deal with people’s lack of awareness of the danger of undetected mouth cancer—one of the most unpleasant of all types of cancer. Many of your Lordships will have read the moving articles written by the late John Diamond during his distressing illness. Oral cancer remains a lethal disease for more than half the cases diagnosed annually. Prevention is my aim.
Oral cancer is defined as malignant neoplasms of the lip, tongue, gum, mouth, tonsil and pharynx. There has been no improvement in survival for decades and recent studies show that the incidence is increasing. No other cancer is increasing at this rate. In 1995, there were 3,673 new cases; the most recent figures available show that by 2005 there were almost 5,000 new cases a year, many in males under the age of 45. Nationwide the incidence has increased by 34 per cent, while in Scotland it has doubled in the past 10 years.
The only way to improve this situation in the absence of effective primary prevention is by improved detection of lesions while they are small—that is, in the early stages. Those are not my words; they are in the report, Health Technology Assessment 2006; Vol 10: No 14. It goes on to say:
“This may be achieved by increasing awareness among the population so that affected individuals may present earlier, or by screening or case finding for the detection of small, otherwise asymptomatic, cancers and precancers (secondary prevention)”.
One interesting finding of the report is that, although tobacco was long blamed, the reduction in tobacco usage has reduced lung cancer but over the same period there has been no reduction in oral cancer, which has increased in males in exactly the same age group as that with a decrease in lung cancer. The conclusion is that rising alcohol consumption may be a major factor in the rising incidence of oral cancer.
Delay in diagnosis and presentation with late-stage disease may be due to patient delay or professional delay. Unfortunately, there is no evidence that better education as to signs and symptoms has created an earlier demand from patients for clinical examination. Therefore, there is a case for screening among high-risk groups for early detection of lesions at a treatable stage. Those in the high-risk categories could be offered screening, which the research that I have quoted indicates would be cost-effective.
The British Dental Association endorsed the specific target in the 1994 oral health strategy that the rising incidence of oral cancer should be arrested by 2005. In 2002, the Chief Dental Officer for England set out, in NHS Dentistry: Options for Change, proposals for a modernised service with a standard oral health assessment. That would include a prevention element that covered,
22 Jun 2009 : Column 1423
Screening programmes have been scientifically evaluated. The HTA report states:
“It was shown that dentists can detect relevant lesions with a sensitivity ... and specificity ... similar to those obtained in other screening programmes”.
Analysis of data from more than 2,000 individuals in two pilot screening programmes showed a correct prediction of oral cancer or precancer in eight out of 10 positive cases. There were false positives, but this is usual in a pre-screen filter and acceptable, as such cases would be identified when given a detailed examination and tests. The prevalence of cancerous or precancerous lesions was 9 per cent compared with 2.7 per cent in the population as a whole. The 2006 HTA report states:
“It would seem that general dental practice should be an ideal place to initiate a programme of screening for high-risk groups since dentists are already trained to examine the mouth and it would be a simple matter to examine for mucosal lesions opportunistically when a patient presents for some other, unrelated, purpose”.
I have no doubt that that is correct. My concern is about the millions of people who are not able to attend a National Health Service dentist and are unable to afford alternative private dental treatment.
The Government tell us that they intend to provide a number of polyclincs with a wide range of treatment. Would these not be ideal places to make oral screening for mouth cancer available? Opportunistic screening—checking the mouth of someone who is attending for other treatment—in general medical practice has not been attempted. GPs do not receive training in oral mucosal examination and the general opinion is that it would be prohibitively expensive to introduce. Could not suitably trained nurses or dental hygienists check the mouths of those attending for other reasons? Clearly they would need a basic training, but they would then be able to refer the suspect cases for further examination and any necessary treatment.
It seems that there may be a problem with this. I understand that, although nurses carry out many procedures as part of a medical team, the Dentists Act may not allow auxiliaries to carry out such an examination for screening for oral cancer. Could the Minister clarify this for me? Will general treatment in a polyclinic operate under rules that would permit this screening? If not, what changes in the law would be needed to make it possible? I know that there has been talk of a new dentists Act for years. Would that be needed to bring about this practical possibility or could it happen under the present laws?
A paragraph that I must read to noble Lords is headed “Heterogeneity” and states:
“Meta-regression was conducted to identify any significant differences in discriminatory ability between the programmes conducted in the two industrialised countries, England and Japan, and in the two developing countries of the Indian subcontinent. In the latter, (basic) trained health workers rather than dentists were employed as screeners, reflecting the prevailing economic circumstances in those regions”.
22 Jun 2009 : Column 1424
It was a much larger, house-to-house, case-finding programme. The paragraph continues:
“No evidence of a difference in discriminatory ability was found”.
It was not the big words in that paragraph that impressed me, but the words,
At that time in 2006, the western world was affluent and the National Health Service had extra money poured in. Now we are facing economic realities and there is a real case for getting better value for money. The Indian screening programme is most interesting and is supportive of my suggestion that people could be effectively trained to carry out such preliminary assessments for oral cancer.
The fundamental purpose of screening is to sort out the apparently well person who probably has the disease from those who probably do not. Experts and fully trained professionals should be used in the final determination, but basic assessments would not require that level of skilled cost to the NHS. It is time for us to address new practical procedures to deal with the growing problem of oral cancer.
7.50 pm
Lord Colwyn: My Lords, I thank my noble friend for introducing this debate this evening. It will be difficult not to repeat many of the points that she has already made.
Oral cancer is an increasing problem but, despite campaigning by the dental profession and other health professionals, public awareness is low. The number of cases has risen markedly in recent years, particularly in the younger age group, most commonly males aged from 35 to 64. Survival rates for those who suffer with oral cancer are low, and about 50 per cent die of the disease. Unlike other cancers, survival rates for oral cancer have failed to improve. A 2007 survey by the British Dental Health Foundation found that public awareness is about 50 per cent, and that more than 25 per cent thought that spicy foods were the primary cause of the condition.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |