The right honourable Sir Brian Francis Kerr, having been created Baron Kerr of Tonaghmore, of Tonaghmore in the County of Down, was introduced as a Lord of Appeal in Ordinary and took the oath, supported by Lord Hutton and Lord Phillips of Worth Matravers.
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, the NHS has made excellent progress in implementing this important health and safety legislation, which ensures that patients receive safe, high-quality care from staff who have not worked excessive hours. Only doctors in training remain to become fully compliant by 1 August and two-thirds of them are already working a 48-hour week averaged over 26 weeks. Our overriding principles are patient safety and the quality of care. This is paramount to all that we do.
Baroness Knight of Collingtree: My Lords, has the Minister noted the severe warnings from the president of the Royal College of Surgeons and bodies representing junior and hospital doctors who are far from pleased about the arrangements that have been made so far and who should know what they are talking about? They say that this diktat will mean surgeons not being properly trained, patient safety being severely compromised and hospitals closing. Does the Minister really think that the problem should continue to be met by junior hospital doctors being ordered by their NHS bosses to lie about the hours they work in order to keep to the restrictions? Why cannot the Government simply refuse to accept these rules or ignore them as other countries do?
Lord Darzi of Denham: My Lords, I am aware of these debates and refer to a publication from the Institute of Medicine in the US, which is the US academy. It stated that the surgery profession was concerned about the shift in work mentality, loss of professionalism and decreased access to quality surgical care; but that it was difficult to assess how much of the complaining represented rhetoric and resistance to change rather than valid criticism.
I am here to share evidence with noble Lords. The evidence is quite clear from the Institute of Medicine's publication-the error is human. In 1999, between 44,000 and 98,000 people died in hospitals from adverse effects. The single and most important contributor is sleep deprivation and fatigue. The reduction to 48 hours a week is to enhance patient safety and, let us not forget, to enhance the social well-being of doctors, who have the highest rates of divorce, addiction and depression.
Baroness Finlay of Llandaff: My Lords, will the Minister tell the House how many services requested derogation in January this year, and what has been set
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Lord Darzi of Denham: My Lords, there have been 200 successful applications across 13 specialties, which represents about 3 per cent of all the rotas. I could write to the noble Baroness with details of which regions and what specialties. The 3 per cent is what we believe needs to be derogated by 1 August. However, if there are strains on services within a period of 26 weeks-we calculate the 48-hour week over a period of 26 weeks-the employing organisation could request further rotas to be derogated.
Baroness Tonge: My Lords, I am sure that many of us in the House who have had medical training will welcome the introduction of the 48-hour week. I well remember the hours that I worked as a junior hospital doctor-they were the hardest times of my life. Will the Minister enlarge a little on what he has just said? Many hospital trusts are still not ready to introduce a 48-hour week for their junior doctors in training. Why is this so, when they have had 10 years of unprecedented increase in their funding? Will any action be taken against those managers who fail to introduce the directive?
Lord Darzi of Denham: My Lords, I am grateful to the noble Baroness for raising the issue. She is correct that we have had 10 years to get these rotas compliant. There are 200 rotas and, to be fair to the service-I am sure that the noble Baroness will agree-there are some sub-specialties for which we find it extremely difficult to make these rotas compliant: for example, transplantation in children and some neurosurgical disciplines. As a result, we have requested derogation for another few years. This is a health and safety directive, so if an organisation is not compliant, the accountable officer, who is the chief executive, will be accountable for breaking the law in relation to the 48-hour week.
Lord Darzi of Denham: My Lords, I am told that the directive was introduced in Europe at a time when impact assessment was not a part of the introduction of European legislation. However, I share the noble Lord's concerns about its impact on the quality of training for the future generation of surgeons, which is an important issue. To address that, we need to start a dialogue not around the numbers of hours of training, but on how we can improve the quality of the hours of training. The noble Lord is well aware that some units across the country which have a dedicated curriculum may separate elective from emergency services or use simulation, all of which are training tools. Some organisations have different training cultures in addressing the quality of training. My right honourable friend the Secretary of State recently asked Medical Education England to look at the impact of the European working time directive on the quality of training.
Baroness Pitkeathley: My Lords, while the doctor's clinical practice is obviously of great importance, also of great importance is the ability of the doctor to liaise outside the clinical practice-for example, in the social care arena. Will my noble friend assure the House that that side of the doctor's practice will not suffer from the 48-hour directive?
Lord Darzi of Denham: My Lords, any doctor employed in the National Health Service who might provide services within an NHS provider or outside in social community services will be obliged to comply with the 48-hour working time directive.
Lord Darzi of Denham: My Lords, I am grateful for the noble Lord raising that important issue. Anaesthetists should get more rest than surgeons. Some of us may enjoy the odd nap here, but it is a dangerous thing to do in an operating theatre. The answer to the question is valid: a number of rotas have been requested for derogation in anaesthesia, but we hope that within two years we will be able to resolve some of these issues.
The Minister for Communications, Technology and Broadcasting (Lord Carter of Barnes): My Lords, an amendment to the 2007 European roaming regulation will put an upper limit on operators' wholesale charges of €1 per megabit of data transmitted from 1 July this year. This will reduce to 80 cents and 50 cents per megabit on 1 July 2010 and 2011 respectively. Consumers will also benefit from obligations to provide greater transparency on pricing on the cost of data roaming.
Lord Mitchell: My Lords, I thank the Minister for that Answer. It is encouraging that these prices are coming down, but data roaming charges in the EU are still twice those of voice roaming charges, which are significantly more than domestic prices. It strikes me that that is something of a rip-off. In a world of Twitter, YouTube, Facebook and all the rest of it, it is essential that these prices are brought down. First, what are the plans to have these prices reduced further? Secondly, it appears that these network operators are acting in concert. Are there any plans within the EU to investigate their activities?
Lord Carter of Barnes: My Lords, the noble Lord makes a number of points. He is right in his observation that there are an increasing number of alternative sources of communication across this country and Europe. He is also right to identify that, while voice roaming prices are coming down significantly in some areas, data roaming prices are still higher. During the current framework review, there was a debate across Europe as to whether retail price capping should be introduced on data roaming in the same way as it has been on voice roaming. A decision was made not to do that but to apply regulation on the wholesale rates in the first instance to see whether that brought the necessary competitive benefit at the retail level. At the retail level on voice charging, we are seeing significant increases in competition and lower prices. Many Members of this House will have seen advertisements from a range of operators advertising free roaming across Europe this summer. As to the suggestion of collusion between operators, that would be a serious breach of competition law and I believe that action would be taken if it had been happening.
Lord Razzall: My Lords, I appreciate that this is a structural problem in the department that the noble Lord is about to leave, but does he accept that there is a problem when one department protects, on the one hand, the interests of the mobile phone operators, whose interest is to maintain higher roaming charges-and mobile phone operators are a significant player in UK business-and, on the other hand, the interests of the consumer, who has an interest in those charges being dropped? How can one department look after the interests of both?
Lord Carter of Barnes: My Lords, I am not sure that I recognise or accept the conflict as described. As the noble Lord is aware, this sector is regulated by an independent statutory regulator, which is a competition authority in its own right and can therefore not only apply forensic regulation for the sector but do so within the frame of competition law. As far as the department is concerned, it is perfectly possible for it to recognise both the industrial strength and advantage that we have in this sector and, at the same time, the fact that there are consumer interests that need to be protected.
Lord De Mauley: My Lords, while everyone will, I am sure, welcome cheaper roaming data and call charges, have the Government given any thought to whether putting a cap on charging in one area might risk the communications companies increasing charges elsewhere in their businesses or reducing quality to compensate? What discussions have been held with the EU about this?
Lord Carter of Barnes: My Lords, the noble Lord raises a relevant point, which was central to the Government's decision not to support the imposition of retail price caps on data roaming at this stage, because, as he rightly observes, regulation applied in one area can have a displacement effect in another. In relation to voice roaming charges, many of the mobile
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Lord Carter of Barnes: My Lords, it undoubtedly is a piece of pan-European price regulation, but it would be fair to say that the specifics of voice roaming charges across Europe lend themselves almost uniquely to the requirement to have a pan-European solution. Indeed, many voices-including my own, in other lives-argued strongly for the European Commission to take a lead on this, because it would be invidious for any individual country to take a leading position, as that country would have ended up doing what the noble Lord, Lord Razzall, was suggesting, and disadvantaging its own commercial interests in favour of other European country players. Therefore, this requires a European approach. As to whether it sets a precedent for others areas, I think that there are few other markets with the same characteristics.
The Minister for Communications, Technology and Broadcasting (Lord Carter of Barnes): None, my Lords. The decision to repeal the beer orders, in the Supply of Beer (Tied Estate) (Revocation) Order 2002, was taken on advice from the competition authorities. Any decision to re-evaluate the market will be a matter for the OFT.
Lord Razzall: My Lords, does the Minister accept that since the so-called beer orders were introduced in 1989, there has been a significant change in the market that often disadvantages particularly the consumer or the tenant of public houses? Is he aware that the Business and Enterprise Committee of another place has recommended that this should be looked at again? In particular, what does he have to say about the
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Lord Carter of Barnes: My Lords, I have been increasing my knowledge of the beer market with enthusiasm in anticipation of this Question, and the noble Lord is right to point out that since the so-called beer orders were revoked, the market has changed significantly. The noble Lord rightly points to the Business and Enterprise Committee report, which raises a number of general issues along with that of the beer tie. As he knows, my department is due to respond to the report within 60 days, subject to further developments on this matter.
I suspect that he is also aware that the Campaign for Real Ale, known as CAMRA, is for the purposes of this discussion a designated body under the Enterprise Act 2002 and is therefore qualified to submit a super-complaint to the Office of Fair Trading. It has indicated that it intends to do so shortly on issues related to the beer tie. That would result in the Office of Fair Trading having to consider the complaint very carefully and respond within 90 days. On the specific point about an organisation being able to look at the matter again in an open-minded fashion, I have every confidence in the ability of the OFT in that regard.
Lord De Mauley: My Lords, as we have apparently heard from the Minister, it is now government policy to embrace price control. Are the Government considering whether to follow the Scots example by putting a minimum retail price on beer?
I mention this in light of the fact that the FSB, in its report to the current inquiry, states that a recent survey found that 99 per cent of the publicans who responded said that the situation had not changed or improved. Is it not now the time for strong and clear action?
Lord Carter of Barnes: My Lords, the noble Lord makes a point about the change in circumstances since this was last looked at, and he is absolutely right to highlight the fact that the published research shows that a significant number of strong voices rightly make the point he has alluded to. The position of the competition authorities on this is rightly that if there is new evidence that there has been a significant change in circumstances, the evidence should be submitted. As I said in response to the noble Lord, Lord Razzall,
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The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bach): The Government are piloting "virtual courts" that allow magistrates' courts in London to hear cases where the defendants appear by live video link from a police station to the court. A second pilot will begin in Kent in the near future. The pilots will be subject to robust evaluation. If successful, this technology could be used in other parts of the country. There are no other proposals for courts to sit outside a formal courtroom.
Lord Clinton-Davis: My Lords, I thank the Minister for that reply. What has been the reaction so far of the Law Society and the Bar Council to this proposal? In particular, can he summarise the position of those practising in the criminal courts, and can he respond to the criticisms that have been voiced by both the Law Society and the Bar Council?
Lord Bach: My Lords, we have been working to actively engage defence practitioners, normally solicitors, and their representative bodies in the development of the pilot. We particularly appreciate the constructive input provided by practitioners and the Law Society itself. There has been a good response from defence solicitors wishing to participate in the scheme and in the rota. However, the representative bodies have expressed some concerns about elements of the pilot. These include concerns to ensure that the process is fair for the defendant; concerns about practical and policy issues around the process, such as the health and safety of defence representatives in the police station; and concerns about the operation of the legal aid system for virtual court hearings.
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