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9 Nov 2009 : Column 582

The Minister of State, Department of Energy and Climate Change (Lord Hunt of Kings Heath): My Lords, if noble Lords asked shorter questions and gave shorter responses, we would have time for more questions. We are in the 24th minute.



2.59 pm

Asked By Baroness Cox

The Minister of State, Foreign and Commonwealth Office (Baroness Kinnock of Holyhead): My Lords, we remain deeply concerned at the appalling human rights abuses and the lack of a credible transition to democracy in Burma. Over 2,100 political prisoners remain behind bars, and the country's ethnic nationalities suffer oppression and discrimination. Aung San Suu Kyi's meetings with our ambassador on 9 October, and with the United States Assistant Secretary of State last week, are a small but welcome development. We will continue to press for real progress and genuine dialogue between the Government, the Opposition and ethnic nationalities in Burma.

Baroness Cox: My Lords, in thanking the noble Baroness for that sympathetic reply, I ask whether she is aware that, on a recent visit to the Shan, Karen and Kareni peoples of eastern Burma, we found that they still continue to suffer from sustained military offences by government troops? Their shoot-to-kill policy has driven tens of thousands more civilians into hiding in the jungle where they have to live in harrowing conditions of danger and deprivation. Might Her Majesty's Government consider increasing some cross-border aid to help these people to survive in those conditions, especially with the imminent onset of the rainy season?

Baroness Kinnock of Holyhead: I thank the noble Baroness, and of course am aware that offences against the Karen, the Shan, the Kareni and the Kokang in recent months are of grave concern. DfID is increasing its support for groups channelling cross-border humanitarian aid into Burma. This year about £360,000 of DfID funding is being used by NGOs for cross-border aid delivered to eastern Burma from Thailand, so it is happening. About £500,000 is being provided for healthcare in Shan and Kachin states across the border from China. Proposals are under consideration to increase funding on both borders in 2010. We will continue to review the level of support and the targeting of these programmes and I am sure we will rely on the noble Baroness to keep us on our toes.

Baroness Rawlings: My Lords-

Lord Archer of Sandwell: My Lords-

The Minister of State, Department of Energy and Climate Change (Lord Hunt of Kings Heath): My Lords, self-regulation does rely on noble Lords being prepared to give way. Could we hear the noble Baroness first, and then perhaps my noble and learned friend?

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Baroness Rawlings: Thank you very much. With Burma on the External Relations Council agenda on 17 November, what is Her Majesty's Government's position towards continuing sanctions?

Baroness Kinnock of Holyhead: Her Majesty's Government's position is to ensure that we see progress in Burma. We need to see all political prisoners released and the democratic opposition and ethnic nationalities being able to participate in deliberations and dialogue, otherwise any future movement towards election would lack credibility and validity. Therefore we have no wish to remove sanctions until such time as we see that kind of progress taking place. When and if we do, we will do it.

Lord Archer of Sandwell: My Lords, while commending the work which the Government have done already, given the mass murders, tortures, rapes, human minesweepers and mass evictions in the Karen and Shan provinces, would my noble friend agree that if that did not evoke the responsibility to protect, it would be difficult to imagine a situation which would? If it were happening in the West, there would by now be at least an arms embargo. Will the Government initiate discussions at the UN Security Council with a view to getting some action on this?

Baroness Kinnock of Holyhead: The noble and learned Lord rightly describes the horrific situation that we see in the ethnic-nationality areas in Burma. The Prime Minister-we should commend him for this-wrote in August to the UN Secretary-General Ban Ki-Moon and his fellow UN Security Council members, calling for that exact global arms embargo against Burma. We believe that no one should be selling arms to a Burmese military regime which continues to have such an appalling human rights record. The EU, the US and others have had a comprehensive arms embargo in place for many years, but the time now has come for all countries to end the sale of arms to Burma.

Lord Dykes: My Lords, I return to the Minister's Answer. Will the Minister now undertake to have direct talks between the British Government and the American Secretary of State, not just the Assistant Secretary of State, about the US's disappointing and timid policy and very hesitant tactics towards this quite odious and obnoxious regime? Is it not time now that real dialogue with the opposition party took place, not just a pretence?

Baroness Kinnock of Holyhead: The noble Lord raises an important point. There is a misconception that the position of the United States has weakened. We agree with the US that, in the absence of progress, sanctions need to be kept in place. Our shared objectives remain the release of political prisoners and dialogue between the Government, opposition and ethnic groups. We need to see a genuine transition to democracy and if the NLD, the opposition party which Aung San Suu Kyi leads, is calling for dialogue-which it is-we would welcome that, but on its terms, not those of the military junta that is in control.

Baroness Symons of Vernham Dean: My Lords, I pay tribute to the noble Baroness, Lady Cox, for her extraordinary work on this issue, which she has carried

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out in this House for as long as I can remember. I regret to say that when I first answered questions on this issue 13 years ago, I had to give appallingly similar answers to those that my noble friend is giving. Can she shed light on this? Is there any realistic sign of a change in policy among the Burmese Government?

Baroness Kinnock of Holyhead: I fear that I see very little signal or likelihood of a change of policy to the extent that would satisfy those of us who believe in supporting and working towards the democratic standards, values and principles which we would adhere to in this Chamber. It is extremely important that we make that case clear, that we maintain sanctions against this regime, and that we maintain our strong and forceful dialogue with it. Our Prime Minister continuously raises the issue of the freedom of Aung San Suu Kyi. If she could obtain her freedom and the opportunity to work with her NLD party colleagues, that would be real progress. I, too, very much respect the work of the noble Baroness, Lady Cox.

Arrangement of Business


3.06 pm

Lord Bassam of Brighton: My Lords, after consideration of Commons amendments to the Health Bill, my noble friend the Deputy Leader of the House will repeat a Statement on energy national policy statements. This is a new and novel procedure.

Privileges Committee

Membership Motion

3.07 pm

Moved By The Chairman of Committees

Motion agreed.

Health Bill [HL]

Main Bill Page
Copy of the Bill
Explanatory Notes
Commons Amendments

Commons Amendments

3.07 pm

Motion to Commit to Committee of the Whole House

Moved by Baroness Thornton

Lord Naseby: I seek clarification from the noble Baroness. An unusual procedure is being followed. I am not entirely clear what happens to these amendments after they have gone into Committee and at what point they link up with the Bill which, I understand, we were hoping dispose of this evening.

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Baroness Thornton: We will go into Committee to discuss a new matter. The usual channels have agreed to that procedure. Then any amendments to the Commons amendments will be put before the House and decided on, and then the Commons amendments, as amended or not, will be put and decided on. The House will then revert back to the discussion of Commons amendments.

Motion agreed.

House in Committee.

Motion on Amendment 1

Moved by Baroness Thornton

1: Insert the following new Clause-

"De-authorisation of NHS foundation trusts

(1) In the National Health Service Act 2006 after section 52 insert-

Application of sections to

(1) Sections to apply to-

(a) an NHS foundation trust authorised under section 35 on an application under section 33;

(b) an NHS foundation trust established under section 56 to which subsection applies.

(2) This subsection applies to an NHS foundation trust if-

(a) at least one of the trusts on whose application the NHS foundation trust was established was an NHS foundation trust within subsection , or was an NHS trust all or most of whose hospitals, establishments and facilities were in England, or

(b) the NHS foundation trust is the result of a succession of mergers under section 56, any of which involved an NHS foundation trust within subsection or an NHS trust all or most of whose hospitals, establishments and facilities were in England.

52B De-authorisation: regulator's notice

(1) The regulator may give the Secretary of State a notice under this section if it is satisfied that-

(a) an NHS foundation trust to which this section applies is contravening or failing to comply with, or has contravened or failed to comply with, any term of its authorisation or any requirement imposed on it under any enactment, and

(b) the seriousness of the contravention or failure, or, if there has been more than one, of any of them taken together, is such that it would justify the Secretary of State making an order under section .

(2) The notice must be in writing.

(3) With the notice the regulator must give the Secretary of State a report stating the reasons why it is satisfied as mentioned in subsection .

(4) Before giving a notice under this section, the regulator must consult first the Secretary of State (unless the notice follows a request by the Secretary of State under section ) and then-

(a) the trust,

(b) any Strategic Health Authority in whose area the trust has hospitals, establishments or facilities, and

(c) any other person to which the trust provides goods or services under this Act and which the regulator considers it appropriate to consult.

52C Grounds for de-authorisation notice

(1) In determining under section whether the making of an order would be justified, and in determining whether to give a notice under that section, the regulator must consider these matters (among others)-

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(a) the health and safety of patients;

(b) the quality of the provision by the trust of goods and services;

(c) the financial position of the trust;

(d) the way it is being run.

(2) The regulator must publish guidance as to the matters (including those mentioned in subsection ) that it proposes to consider in making those determinations.

(3) Before publishing any guidance under this section, including any revised guidance, the regulator must consult-

(a) the Secretary of State,

(b) each NHS foundation trust to which this section applies,

(c) each NHS trust intending to make an application to become an NHS foundation trust, and

(d) such other persons as the regulator considers appropriate.

52D De-authorisation

(1) If the regulator gives notice under section in relation to a trust, the Secretary of State must make an order for it to cease to be an NHS foundation trust.

(2) An order made under subsection must specify the date when it is to take effect, which must be within the period of 5 working days beginning with the day on which it is made.

(3) On an order under subsection taking effect in relation to a body, it ceases to be an NHS foundation trust and a public benefit corporation and becomes a National Health Service trust.

(4) The order must specify, in relation to the trust, the matters mentioned in paragraph 5(1)(a) to (c) of Schedule 4 and, where the trust has a significant teaching commitment, the matters mentioned in paragraph 5(1)(d).

(5) The order may provide for any provision under subsection specifying the number of executive directors and non-executive directors to take effect at the end of a period specified in the order.

(6) Schedule 8A makes further provision about trusts in respect of which an order is made under subsection .

(7) If it appears to the Secretary of State to be necessary in order to comply with provision made under subsection , or made by regulations under paragraph 4 of Schedule 4, the Secretary of State may by order-

(a) terminate the office of any executive or non-executive director of the trust;

(b) appoint a person to be an executive or non-executive director of the trust.

(8) Within seven days after the day on which the Secretary of State makes an order under subsection the regulator must publish its report under section .

(9) In this section "working day" means any day which is not Saturday, Sunday, Christmas Day, Good Friday or a day which is a bank holiday in England and Wales under the Banking and Financial Dealings Act 1971.

52E Secretary of State's request

(1) If it appears to the Secretary of State that there are grounds for the regulator to be satisfied as mentioned in section , the Secretary of State may request the regulator in writing to consider exercising its power to give a notice under that section.

(2) A request under this section must-

(a) specify the NHS foundation trust to which it relates, and

(b) state the grounds relied on by the Secretary of State.

(3) The Secretary of State must lay before Parliament any request under this section.

(4) If within the required period the regulator does not give a notice under section in response to a request under this section, it must, within that period, publish its reasons for not doing so with a statement as to how it has complied with section.

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(5) The required period is-

(a) 14 days beginning with the day after the regulator receives the request, or

(b) any longer period specified in the request.

(6) The Secretary of State may by order extend or further extend the required period."

(2) Schedule 2 (which inserts Schedule 8A to the National Health Service Act 2006, which makes provision about de-authorised NHS foundation trusts) has effect."

Baroness Thornton: My Lords, these amendments address a fundamental omission in the foundation trust regulatory regime. The omission recently came to light following the events at Mid-Staffordshire NHS Foundation Trust. The amendments were introduced to the Bill on Report in another place. Given this late introduction I am pleased that the debate on these amendments will take place under Committee rules, allowing your Lordships' House the chance to debate them.

NHS foundation trusts are a key part of the Government's health reform programme and are proving to be a success. The autonomy afforded to a foundation trust offers the best model for improving the provision of healthcare, allowing greater freedoms and autonomy to those who can demonstrate high performance. However, the events at Mid-Staffordshire Foundation Trust demonstrated clear failings to its patients, the public and the NHS. The Government are committed to learning the lessons of these events to ensure such events cannot happen again.

My honourable friend the Minister of State for Health, on introducing these amendments in another place, said that they acted on two of the many lessons we have to learn. First, Monitor, the independent regulator of foundation trusts, should have the power to remove foundation trust status where a foundation trust fails to live up to the high standards. Secondly, transparent democratic accountability is vital when a foundation trusts fails.

The amendments need to be viewed in the context of the existing powers of intervention. The National Health Service Act 2006 provides the independent regulator, Monitor, with a range of powers of intervention in foundation trusts. These can be used in the event of a significant breach of the terms of authorisation or requirements in legislation. Monitor's powers include the removal of any or all of the directors of the board or requiring the board of a foundation trust to do, or not do, specific things.

As noble Lords will be aware, the Bill also contains clauses relating to trust special administrators, which would enable Monitor to trigger deauthorisation of a foundation trust that is no longer sustainable in its current form. This is as a preliminary to the deauthorised trust coming under the control of a trust special administrator as part of a prescribed six-month process.

The proposal presented for consideration today is the final missing option between those extremes. It would enable Monitor to trigger deauthorisation for a sustainable foundation trust. Foundation trusts are authorised on the basis of being high-performing organisations. It is logical that, should they fail to live up to the required standards and lose public confidence, powers should exist to remove their foundation trust

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status. A power to deauthorise provides a clear message that foundation trusts must maintain the high standards that are expected of them, and provides the public with the confidence that organisations must continue to earn the right to continue as foundation trusts.

The new Section 52B provides that triggering deauthorisation will be a decision for Monitor. Under the proposals, when a foundation trust has breached any term of its authorisation, or requirements in legislation, and the breach is so serious that it justifies deauthorisation, Monitor may trigger deauthorisation. Triggering deauthorisation will be a complex decision. The new Section 52C establishes a framework requiring that Monitor considers four factors: the health and safety of patients; the quality of services that are provided; the financial position of the trust; and the way it is being run.

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