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Let us look at the track record. Funding for specialist provision has increased significantly over recent years, from £35 million to fund 3,000 learners in 2000, to £180 million for 3,500 learners in 2006-07. The DCSF has made available additional funds through the Invest to Change programme to improve provision for learners with learning difficulties locally. We are committed to continued investment in this area and we have been clear that this will remain a priority when responsibilities transfer to local authorities. This clause is about ensuring that we make the very most of this investment for the benefit of the young people at whom it is aimed.

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Ensuring value for money when commissioning provision will free up resources to support those young people with the most profound needs.

Amendment 143 would introduce a new duty on local authorities to conduct a full assessment of the suitability of provision for learners with learning difficulties and/or disabilities at least every three years. The noble Lord, Lord Rix, raised this issue at Second Reading and this amendment has been modelled on that included in the Childcare Act 2006. As my noble friend Lady Morgan has written to the noble Lord to explain, we are putting in place a system to ensure that this planning function takes place. However, we do not feel it necessary to legislate for this specific administrative process and I am happy to set out the reasons why for the Committee now.

I should like to reassure the Committee and my noble friend that we are putting in place a system which will ensure that this essential planning process takes place annually, as part of the annual commissioning cycle, and not just every three years, as proposed by the amendment. Local authorities will not be on their own. They will come together, and they have already agreed to do this, as sub-regional groupings that will act as planning bodies. We will support them to build on their existing expertise in this area. They will be required to have regard to guidance on this annual commissioning cycle-this is the point made by the noble Lord, Lord Rix-which will be set out by the YPLA in a national commissioning framework. This guidance is currently being developed in collaboration with our key delivery partners and stakeholder groups, including the National Association of Specialist Colleges. We are not trying to develop this guidance on our own. We are consulting the people and the representative bodies that we know are experts in this field.

There will be a dedicated national team in the Young People's Learning Agency for learners with learning difficulties and disabilities. Regional specialists will provide advice and expertise to local authorities to help them in, among other things, planning specialist provision across local borders, something we know is vital. The React team based at the Local Government Association is already working with authorities to prepare them to take on their new responsibilities. It is also important to remember that local authorities will not be starting from a zero base. Local authorities will already have been working with many of the young people concerned as they were growing up. They already hold a significant amount of information about their needs through the client case load information system database and will be further supported in future with strategic analysis and historic data on learner trends and local needs, provided by the YPLA.

Accountability was raised by a number of noble Lords. There is a range of ways in which local authorities will be held to account. As part of the existing system, local authorities will be performance-managed in relation to the outcomes of young people in their area. Government offices will provide support and challenge to ensure satisfactory performance. Assessments and inspections by Ofsted and other inspectorates will provide a further check on local authority performance.

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In addition, as I mentioned earlier in the debate, the YPLA will have a clear role in assuring coherence of regional plans.

I want to come back to some points that were made. The noble Lord, Lord Ramsbotham, raised the issue of consistency. As I said to the noble Lord, Lord Rix, the consistency we hope to achieve will be through the national commissioning framework and a national funding formula and we seek consistency in all areas. If necessary, the YPLA can be directed by the Secretary of State, through Clause 73, and we will examine whether there is a problem as this rolls out, subject to the passing of the Bill.

I know that the noble Lord, Lord Lucas, tends to see the glass as half-empty rather than as half-full, in this area, certainly, and maybe in others. We will seek to increase the entitlement because, by providing value for money, more money will be available for more learners who need it most. The right reverend Prelate expressed his concern that the driving force would be to have less provision. We would say, look at the track record. We still had disproportion there. In fact, we have increased support and that is right, because we know that demand has increased.

I was asked about "disproportionate" as a comparator. The comparison is between the provision and its cost. Is the cost proportionate, taking all relevant considerations into account? This is about value for money. That is why new Section 15ZA(5) says what it says. Relative cost is not the only thing for local authorities to consider. Others will explain better than I can that value for money is not necessarily about getting the cheapest-we know that from bitter experience in many circumstances-but about getting the best that you can for the money. A local education authority will have to make its own decisions about the best use of resources. It will definitely have to consider its own budget and may well look at what other LEAs are spending for guidance.

My noble friend Lady Blackstone says she cannot believe that what we are doing is necessary; that it goes without saying. Why are we doing this? Well, there is a general duty, as I think she referred to, in the Local Government Act 1999, which already applies to local authority functions, but not to the Young People's Learning Agency, which has specific value-for-money duties similar to those in Clause 40(4)(e) and (5).

Baroness Blackstone: I absolutely accept that there may be a need to apply this to the Young People's Learning Agency, but what I cannot understand is why, because it is necessary in that respect, it also has to be applied to local authorities, when there is already a general duty on local authorities in the 1999 Act. The danger is that every single piece of legislation brought to this House or another place that entails expenditure by local authorities will then have these clauses put in them. That is what I am seeking to prevent. Perhaps the Minister will take this back and consider whether we need to replicate it here. I can see why the Government may have needed it when legislation was introduced on the Learning and Skills Council some years back, but it looks to me as if there has been an automatic application of what applied to the

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Learning and Skills Council to local authorities when it is not necessary, because it is already embodied in legislation.

Lord Young of Norwood Green: I am conscious of the time. I take account of the concerns that have been raised, which I understand. As I said, we are still in discussion with the SEC. We have already said that we do not want to do anything which in any way undermines the role of local authorities in meeting these vital needs. The best thing that I can do in the circumstances is to take away the points that have been raised and come back to noble Lords before Report. On the basis of that assurance, I hope that the amendment will be withdrawn.

Lord Lucas: I apologise for doubting the Government's intentions. The noble Lord has made it perfectly clear that their intentions are pure, and that this is just a bit of drafting mess, which as the noble Baroness, Lady Blackstone, so rightly says, deserves to be cleared up. If the noble Lord's explanation of the word "disproportionate" and its effects is right-I cannot see how that can be construed from the clause as it sits-and if it is intended to mean what the noble Lord said it is intended to mean, it is entirely unnecessary because it falls exactly within the duties as specified by the noble Baroness, Lady Blackstone.

The Earl of Listowel: Care leavers may be outwith this amendment, but at the very welcome annual meeting of the regional commissioning for educational provision an item might be put on the agenda suggesting that talks be held with the YPLA about local authority apprenticeship provision for care leavers. That would involve only a few children leaving care each year. There should be some mechanism to ensure that local authorities think very carefully about this and supply as many as possible.

Lord Young of Norwood Green: We will come back to the noble Earl on that. I apologise for missing that out.

Lord Rix: I am most grateful to all noble Lords who have spoken in support of these amendments. I am very grateful to the Minister for saying that he will take the provision back, look at it and consult again with the SEC. I hope that I can be present at one of those meetings, which will probably take place during the recess as I cannot believe that we will reach Report before October. In that case, and as I have just had a message to telephone my home urgently, I beg leave to withdraw the amendment.

Amendment 94 withdrawn.

House resumed.

Swine Flu


1.03 pm

Baroness Thornton: My Lords, I should like to repeat a Statement made in another place.

"With permission, Mr. Speaker, I would like to make a Statement on the A(H1N1) swine flu pandemic. As of today, there are 7,447 laboratory-confirmed

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cases of swine flu in the UK, of whom a significant number have been hospitalised. Three people have sadly died, all of whom had underlying health problems.

Since the first UK case was confirmed on 27 April, health protection officers, NHS staff from across the UK, and Department of Health officials have been leading the fight to contain the virus. Last week, we started to see a considerable rise in swine flu cases, and the emergence of hotspot areas in London, the West Midlands and Scotland. Since then, cases have continued to rise significantly. There are now, on average, several hundred new cases a day.

This creates challenges on the ground and pressure on services, but the response from the health community has been tremendous. I hope the House will join me in putting on record once again our sincere thanks to the staff in the Health Protection Agency and the NHS, general practitioners and all those who work in primary care. Our efforts during the containment phase have given us precious time to learn more about the virus, to build up antiviral and antibiotic stockpiles, and to develop a vaccine.

We have always known it would be impossible to contain the virus indefinitely, and that at some point we would need to move away from containment to treating the increasing numbers falling ill. That is why last week I announced the move to the outbreak management phase. This gave hotspot areas, where there is sustained community-based transmission, more flexibility to deal with the virus.

Scientists now expect to see rapid rises in the number of cases. Cases are doubling every week and we could see more than 100,000 cases per day by the end of August, although I stress this is a projection only. As cases continue to rise, we have reached the next step in our management of the disease. Our national focus should be on treating the increasing numbers affected by swine flu. Based on experts' recommendations, and with the agreement of Health Ministers across all four Administrations, I can today tell the House that we will now move to this treatment phase across the UK. This will mean that in England the Health Protection Agency will take a step back and primary care will take the lead in diagnosing and distributing antivirals.

There will be an immediate end to contact tracing and prophylaxis in all regions; GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results; and primary care trusts will now begin to establish antiviral collection points where necessary. This new approach will mean an end to the daily reported figures from the Health Protection Agency.

Our policy on schools is that they should not close because of individual cases of swine flu but they could close if the particular local circumstances warranted it. For example, there may be grounds for closure if a significant number of pupils or teachers are ill. The HPA will advise on outbreak control issues as usual and closures would be reported to the Department for Children, Schools and Families.

I must emphasise to the House that the Civil Contingencies Committee has had lengthy discussions, drawing on expert scientific advice, about who should be treated with antivirals if they contract swine flu. Health Ministers across all four Administrations have

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noted clear scientific advice that the majority of cases in the UK have so far not been severe, with those catching the virus making a full and fast recovery, though a minority of people here and overseas have had more serious illness and some have died.

As we move into the treatment phase, Ministers have considered whether we continue to offer antivirals to all patients displaying symptoms or whether a more targeted approach should be adopted, focusing on those most at risk of becoming more seriously ill. When very little was known about the disease-and especially given the reported fatalities in Mexico-using antivirals prophylactically was sensible to protect people, and may have helped contain the initial spread of the disease.

During the containment phase, experts have had time to study the virus. Some experts now suggest that since the virus has proved largely mild, antivirals should be used only to treat those in designated "higher risk groups"; that is, those more susceptible to developing serious illness or complications. These are all the groups at risk from seasonal influenza, plus pregnant women and children under five. They argue that overusing the drugs can increase the chances of antiviral resistance, and exposes too many people to the risk of side effects from the medicine.

The Scientific Advisory Group for Emergencies says that, on balance, the science points towards a targeted approach, but acknowledges that this is a "finely balanced" decision. Expert advice points to the fact that, as this is a new virus, its behaviour cannot be predicted with certainty. Swine flu is different from seasonal flu in that most serious illnesses have been in younger age groups, as happened in all three 20th-century influenza pandemics. A doctor faced with a symptomatic patient cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill.

Given this, we have decided to take a step-by-step approach. This means that, as in the outbreak management phase, we will continue to offer antivirals to all those who have contracted the illness. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases, particularly in circumstances where doctors are likely to be contacted by patients with coughs, colds and the worried well, in addition to those with swine flu. Expert advice emphasises the high importance of treatment with antivirals of those in the higher risk groups, so we will issue clear guidance to doctors to ensure that those at higher risk get priority access to antivirals within 48 hours of the onset of symptoms.

I acknowledge that this is a cautious approach. Many people will be able to recover from swine flu without the need for antivirals, and may therefore choose not to seek treatment. However, we are much closer to the time when we will receive the first doses of pandemic flu vaccine. This will potentially offer high protection. In the mean time, it is prudent to use our only current measure against the virus-antivirals-to the maximum effect. The science indicates that as we discover more about the virus and develop a more precise categorisation of risk groups, we are likely to reassess our approach and move to a more targeted

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use of antivirals. We will keep this matter under review, with advice from SAGE, and will update the House as and when this is necessary.

Today we will set out these new arrangements through a short guide that will be e-mailed to NHS staff, and will be available online to the public. I know that local GP surgeries and hospitals, particularly in hotspot areas, are coming under increased pressure. So it is important that we do everything we can to reduce the strain on local health services and begin to establish and use alternative routes for people to receive treatment. Initially, this will be via or the swine flu information line; subsequently, it will be via the National Pandemic Flu Service.

So, if people think they have swine flu, they should first go online and check their symptoms on or call the swine flu information line on 0800 1 513 513. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, this will give them an authorisation voucher, which a flu friend can take to an antiviral collection point to pick up their antivirals. This may be a pharmacy or a community centre.

As cases rise further, we will move to a system whereby cases are diagnosed and dealt with by the National Pandemic Flu Service. This will take pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre.

Today, I can tell the House that preparations are now at an advanced stage, and that we expect the service to be ready when it is needed. At that point, if people have swine flu symptoms, they should go onto the National Pandemic Flu Service website, or ring the dedicated call centre. However, people in the higher-risk groups should still contact their GP.

Finally, I would like to update the House on vaccines. We have now signed contracts to secure enough vaccine for the whole population. We expect the first batches of vaccines to arrive in August, and around 60 million doses will be available by the end of the year-enough for 30 million people-with more following after that. Administering vaccines will need to be prioritised. We will make a decision on this when we know more about the risk profile.

Most cases of swine flu have been mild and we are in a strong position to deal with this pandemic. But we must not become complacent and, while doubt remains about the way the virus attacks different groups, today's decision on the move to the treatment phase reflects our caution.

I commend this Statement to the House".

My Lords, that concludes the Statement.

1.13 pm

Earl Howe: My Lords, from these Benches, I should like to thank the Minister for repeating the Statement, which makes it very clear that we have moved into a new phase of the epidemic involving a much greater number of current cases than we were looking at a month or so ago, and the probability of an even higher number, by several orders of magnitude, during the

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coming weeks. The national and local response to this situation is quite rightly under continual review, and I accept that it is now appropriate to modify our approach to the way that we tackle the disease. Our emphasis now, as the Minister said, has to be on mitigating its impact on those who have contracted it, taking into account the severity of the virus. That must mean that we make sure that those who are most at risk of severe morbidity or complications as a result of the virus are treated rapidly.

Against that background, I have a number of questions. Am I correct in understanding from the Statement that the stockpile of antivirals will be reserved exclusively for symptomatic patients and those who are seen as being most at risk, and that post-exposure prophylaxis is no longer a strategy that will be pursued, other than with the approval of a GP? I ask this because I wonder about particular situations; for example, what is the policy to be applied in prisons? Are healthcare staff and employees of the emergency services not seen as possible deserving cases for post-exposure prophylaxis?

Can the Minister confirm that a decision on whether to close a particular school will be taken on the basis of a risk assessment by the HPA, particularly in the context of the year groups involved, but that closure of a school should no longer be seen as the preferred option, as I think it has been up to now? Most schools are about to break up for the holidays, which is fortunate, but this means that when term is about to start again in September there may be insufficient information available on which to base a decision on closure. Will schools be advised about the transmission rates in their own areas and other relevant information, including what they should do before the start of term?

What advice is being given to the public as regards avoiding exposure to potential infection? It has been reported in the press that there is a school of thought which states that it is in the interests of fit and able-bodied people to try to contract the virus in order to build up immunity to what may be a more severe version of it in the future. Can the Minister take this opportunity to indicate that this is not sensible advice and that the current virus, although milder than initially feared, is nevertheless capable of making people ill or, indeed, very ill, and that the prudent course is to try to avoid it?

The Minister said that swab tests for swine flu are no longer being taken as a matter of routine and that, as a result, the running total of cases will no longer be a matter of public record. I am sure she will agree that that is unfortunate, and I cannot help observing that if the flu line were up and running, that situation would not have arisen, because we would have had a better handle on the numbers. However, can the Minister confirm that the collection points for antivirals are now determined in all areas? Can she also confirm that the interim helpline for those who suspect that they may have contracted H1N1 is working satisfactorily and that it has the capacity to deal with the very high volume of calls which are likely to arise during the next few weeks? If there are likely to be many tens of thousands, if not hundreds of thousands, of new cases by the end of August, what guidance has been issued to NHS trusts to enable them to cope with the high

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numbers of hospitalised patients that can be expected? What is the Government's view of the capacity of our system to cope with critical care cases on the scale that is implied? Has modelling been done which shows the probable impact of severe cases on critical care beds? What is the clinical attack rate of this virus?

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