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I would like to pick up where the noble Baroness, Lady Greengross, left off, and talk a bit about dementia, partly because I have a very close friend whose wife has dementia and I have been following the path of this for the last seven or eight years, but also because this is an issue that affects hundreds of thousands of people. The Alzheimer's Society reckons that: there will be 1 million people with dementia by 2025; dementia costs the country £20 billion now; one in three people over 65 will die with dementia; only 40 per cent of those have a formal diagnosis-that figure varies
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We know all of this. The All-Party Parliamentary Group on Dementia, the National Audit Office and the Alzheimer's Society have identified that significant resources are wasted on poor-quality care-for example, through crisis admissions into hospital or long-term care. There are opportunities to save money in dementia care across a wide range of settings; for example, by investing in early intervention and prevention services. In a way, those matters are the test of this Bill. Can we save the money and deal with the people who have got dementia? How can we promote a shift of NHS resources away from acute hospitals into community-based services, as recommended by the NHS Future Forum and the recent inquiry by the All-Party Parliamentary Group on Dementia?
I know that the Government recognise that a sustainable NHS in the future requires a new long-term settlement on social care to ensure quality for people facing disability and long-term illness. We think that this amendment will help with that. When I was looking at this amendment, I remembered that I myself was given a speaking note that said, "Of course, health covers social care, too". That is not good enough any more; it is not good enough to say that by writing health into the Bill and giving the Secretary of State responsibility for it, we are somehow covering social care. Apart from anything else, it has not worked. We know it has not, and we are where we are. There are some very serious issues.
What does my friend whose wife has Alzheimer's face? For seven years they have been coping as her Alzheimer's has progressed, and coping very well indeed, but he is now getting on, too. I thought it might be worth looking at what is in store for him, and perhaps when the Minister responds to this debate he can also address what is in store for this person. We know that the local authority is making cuts in day care; he has told me that his respite care is being reduced at the moment because of the strains under which the local authority finds itself. We know that the assessments for his wife-and himself, possibly, as he gets older-will get more and more difficult as the criteria move up the ladder of seriousness.
I am concerned about the immediate problems that my friend and his wife face, but I have become concerned about the medium term as well, which is about the transition and the risks that are posed to people like him in the transition to the new architecture of the NHS. He is absolutely the ideal carer that my noble friend Lady Pitkeathley has been talking to us about for many years. He and his family have taken responsibility for his wife's condition. He has managed the system
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When I was preparing for this debate, I also looked at the report by the King's Fund on integrated care. Obviously, we all know the King's Fund well; it tends to talk about structures and theories and so on, but this report did point to examples, one of which was mentioned by the noble Baroness, Lady Barker, about care for older people in Torbay. I would like to raise two issues that the report referred to and then I would like to mention the ingredients that the King's Fund says are important for integrated care, and to see how those apply to what is proposed in this Bill.
"Stroke care in London and Manchester has been improved by planning the provision of these services across networks linking hospitals. Manchester uses an integrated hub-and-spoke model that provides one comprehensive, two primary and six district stroke centres. Results include increasing the number of eligible patients receiving thrombolysis within the metropolitan area from 10 to 69 between 2006 and 2009. In London implementation of a pan-London stroke care pathway and the development of eight hyper-acute stroke units has improved access and reduced length of stay in hospitals: 85 per cent of high-risk patients who have had a transient"-
"Defined populations that enable health care teams to develop a relationship over time with a 'registered' population or local community, and so to target individuals who would most benefit from a more co-ordinated approach to the management of their care".
How will that be achieved without, for example in London, NHS London to drive the integrated stroke system? How will that be achieved when we have
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"Aligned financial incentivesthat support providers to work collaboratively by avoiding any perverse effects of activity-based payments; promote joint responsibility for the prudent management of financial resources; and encourage the management of ill-health in primary care settings in order to prevent admissions to hospitals and nursing homes".
"Information technology that supports the delivery of integrated care, especially via the electronic medical record and the use of clinical decision support systems, and through the ability to identify and target 'at risk' patients
A physician-management partnership that links the clinical skills of healthcare professionals with the organisational skills of executives, sometimes bringing together the skills of purchasers and providers 'under one roof'"-
My final remarks are that I support, of course, the remarks that have been made about moving towards Dilnot and making sure that its proposals are carried out. If this amendment helps to take that forward, then I think that is right and we should support it. The noble Baroness, Lady Barker, was quite right, though, when she said that the Law Commission report was crucial to this exercise and to the national assessments. I do not think it is a case of one being set against the other, but there is absolutely no doubt that it is vital for the delivery of national assessments.
I understand that the noble Baroness and her colleagues have not appreciated the attentions of some of the campaign groups that have been concerned about this Bill. Well, you know what? You cannot choose your campaign groups. As a politician, you just have to listen to what they say and then decide whether you like it or not. The noble Baroness has obviously not enjoyed their attentions, but I wish them all the best. I think they are doing exactly the right thing, but I would say that.
This is an important issue. We easily lapse into structures, and words about structures, and we lose sight of the fact that this is about our fellow citizens. When I look around this Chamber, I know that a lot of your Lordships are carers who are taking responsibility for people in a very direct fashion. I will not say who you are, but I know who you are and I know that you are as passionately concerned about this matter as we are on these Benches. It is very important that we take the opportunity this Bill offers to make progress on this issue.
Earl Howe: My Lords, with Amendments 244 and 260DA, the noble Lord, Lord Warner, has taken us to the important matter of the relationship between the NHS and social care, and I agree with him that this relationship is in a real sense symbiotic. The noble Lord presented us with some sobering facts and messages about the increasing pressures that are likely to arise in our health and social care services over the next two decades, and it is in large part because of those looming pressures that the Government have brought forward their proposals for health service reform. The noble Lord deserves to be listened to with close attention, and I again pay tribute to his work as a member of the Dilnot commission.
Looking first at Amendment 244, we strongly agree that integrated services are important. The noble Baroness, Lady Greengross, brought home that message compellingly. This is why, throughout the Bill, there are duties to promote and encourage the commissioning and provision of integrated services. It is a vital principle. However, sympathetic as I am to the spirit of the amendment, I feel that the Bill's current wording already provides for what it seeks to achieve. I would already confidently expect the annual report to cover aspects of service integration, and that is because integrating services, both between different parts of the NHS and between the NHS and other public services, would be essential to providing a seamless and high-performing health service. The change of culture that the noble Baroness, Lady Emerton, and my noble friend Lady Barker spoke of will not happen overnight, but it can be encouraged and promoted by shining a bright light on how well or badly the NHS is performing in this area.
Turning to Amendment 260DA, the Government are absolutely clear that a key objective of social care reform must be to improve outcomes for individuals and their families and carers using social care. Again, I completely understand why the noble Lord has brought forward this proposal, and I recognise that the amendment has been carefully crafted. In explaining the amendment, the noble Lord expressed worry about whether the Government are serious about pressing ahead with
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We agree that reform of the system is urgent and we debated these very issues recently and in some depth in a debate led by the noble Baroness, Lady Pitkeathley. If the Committee will forgive me, I will not repeat what I said on that occasion. However, on 15 September, the Government launched Caring for Our Future: Shared Ambitions for Care and Support, which was an engagement seeking views about the priorities for improving care and support. This focused period of engagement has been welcomed by stakeholders and, although it officially concluded on 2 December, we will continue to work closely with the social care sector as we formulate our proposals for reform.
The noble Lord proposed that the duty to secure improvement should include efforts to reduce the barriers to integration of health and social care. We are very much aware of the concerns about the integration of services and have asked the NHS Future Forum to consider this in more detail. This work is being undertaken in collaboration with caring for our future, the engagement on social care reform. Appropriately, there is integration of this work on integration.
I would say in particular to the noble Baroness, Lady Pitkeathley, that "Caring for our future" has also been considering the recommendations of the Law Commission and the Commission on the Funding of Care and Support, including those on portability, assessment and eligibility for social care. This has highlighted her point about the importance of clarity of the state offer to help people to plan and prepare to meet their own care costs.
Given this ongoing work ahead of publication of the White Paper on social care reform, we do not want to pre-empt our consideration of the feedback from the engagement or to make changes to the existing statute when more fundamental reform is already planned. Indeed, the Law Commission's recommendations seek to address the current piecemeal nature of social care legislation, having noted that social care statute is confusing and unclear. However, I emphasise again that the Government have committed to legislation at the earliest opportunity, which we believe will be the most appropriate vehicle for debating these critical matters.
In this context, these amendments are unnecessary at this time, although clearly they have been proposed for the best of motives, which I share. It is our view that proposals for reform of adult social care services, including a continued focus on better integration with health services, should be encompassed within the overall proposals put forward in the White Paper next year, and informed by the work of the Future Forum and the engagement with the social care sector that has been taking place in recent weeks.
As long as the noble Lord realises that I am not in any way dismissing the importance or salience of the issues that he has raised, I hope for the reasons I have given, he will feel able to withdraw his amendment.
Lord Warner: My Lords, I have listened carefully to what the Minister has said. I am not totally astounded to hear his remarks and I am grateful for the generous way in which he made them. However, I also listened carefully to other people in this House, in particular, the noble Baroness, Lady Barker. I certainly cannot see why the Government cannot move on Amendment 244. It does not pre-empt in any way their decision-making on the Law Commission, Dilnot or anything else they want to write about in terms of their White Paper in the spring.
The flavour of this debate is that we need to give some particular attention in this Bill to integration between health and social care. Requiring the Secretary of State specifically to deal with that issue in his annual report is a very good signal to be given to the outside world and, particularly, to the NHS. A number of people who have spoken today have suggested that that signal needs to be given.
I was not expecting to get a lot of progress on Dilnot but I want to come back briefly to subsection (1) of the new clause to be inserted in the Bill under Amendment 260DA. I feel strongly that we need a duty of this kind on the Secretary of State to balance the equation with the NHS. I shall take advice from a lot of people outside this House on whether we should come back to this issue on Report. At the moment, my instincts are that we will want to but I want to hear what people outside this House in the sector have to say. But I certainly reserve the right to come back on that issue, which I am happy to discuss with the noble Earl further if he wishes to do so. In the mean time, I beg leave to withdraw the amendment.
"(hb) a subsidiary of a company which is formed under that section and wholly owned by the Secretary of State,"
Earl Howe: My Lords, this set of amendments is predominantly made up of a series of minor government amendments to Schedules 4 and 5. Many of them make minor or technical changes to these schedules to
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The amendments also amend the definition of "qualifying company" in Clause 294, so that under the Bill we will be able to transfer property to a subsidiary of a company wholly owned by the Secretary of State, not just to companies owned directly by the Secretary of State. They also amend Schedule 4 to allow such subsidiary companies to be members of the statutory risk-pooling schemes for meeting liabilities of NHS bodies.
This group also includes one other amendment on Schedule 5, tabled by my noble friend Lord Lucas. Amendment 254 amends the Freedom of Information Act 2007 so that the criminal offence of taking certain actions to prevent disclosure of information held by a public authority is expanded to include information held by service providers. I can reassure my noble friend that the Government are committed to extending the scope of the Freedom of Information Act to increase transparency. To do this effectively, we need to spend time properly considering the issues raised. It would not be appropriate to rush through changes that have not received proper scrutiny.
As part of this work, the Freedom of Information Act will be subject to post-legislative scrutiny and the Cabinet Office has recently concluded a public consultation on an open data strategy, which is aimed at establishing how we ensure a greater culture of openness and transparency in the delivery of public services. I understand that my noble friend has already met with officials to discuss his concerns around freedom of information and this Bill, which I hope reassured him. If he has additional concerns following this debate, I would be more than happy to write or to meet him to discuss this further. I hope that that will enable him not to press his amendment when we reach it.
Baroness Thornton: My Lords, I should like to ask one question and to make one remark. Even the Minister smiled when he used the words "openness" and "scrutiny". Given our previous conversations about the information that the House has not received, I do not intend to rehearse that again but I would look at colleagues in the Liberal Democrat Party and say just how shocked and amazed I am by their lack of willingness to want proper openness and scrutiny on this Bill.
( ) in sub-paragraph (5), omit "in its area""
(a) omit paragraph 49 of Schedule 2 to the National Health Service Reform and Health Care Professions Act 2002, and
"( ) On the abolition of the Health Protection Agency, the Secretary of State will allocate their functions and any others he or she considers appropriate to an Executive Agency with its own chief executive as accounting officer with a management board with an independent chairman and at least three non-Executive Directors with expertise in its functions selected by the Department's Chief Scientific Adviser.
Lord Warner: My Lords, we come now to Clause 53 and the proposed abolition of the Health Protection Agency. I shall speak to Amendment 257ZA in this group, but in doing so I should make clear that I do not support the abolition of the Health Protection Agency, and I have every sympathy with the Front-Bench amendment that Clause 53 should not stand part of the Bill. I should not be unhappy if I lost my amendment because the clause itself was removed.
However, if the Government are going to proceed with this casual vandalism against an internationally respected organisation, I would hope that we could secure some damage limitation, which is what this amendment attempts to do. I will leave it to my co-signatories of this amendment, who have much more scientific and clinical expertise than me, to explain why we need to protect the independent scientific and research expertise of the Health Protection Agency in any new organisational form that there is for it.
As the Minister who helped to shape the Health Protection Agency in its present form by bringing together a wider range of scientists in one organisation, I want to put on record that it has acknowledged the
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I should also make clear that when confronted with crises involving areas of great public concern-I cite as examples the great concern in 2003 and 2004 about the growth in healthcare-acquired infections, and, later on, the Litvinenko affair and the concerns about polonium-210-the independent scientific advice from the arm's-length Health Protection Agency was absolutely vital to giving the public confidence in how we were moving forward and dealing with those issues. It was the people from the Health Protection Agency, particularly during the Litvinenko affair, who were able to stand up in public and give scientific reassurance in that area. It is that independence of scientific expertise that I am very anxious we should preserve in the move to abolish the Health Protection Agency.
Amendment 257ZA would ensure that if the functions of the Health Protection Agency are to be transferred to the Secretary of State and the Department of Health, there should be a distinct executive agency with its own chief executive as accounting officer, and a management board with an independent chairman and at least three non-executives with expertise in its functions, selected by the department's chief scientific adviser. The amendment would also ensure that staff had the freedom to secure and discharge external research contracts.
These changes will help to retain high calibre staff over time, and indeed the scientific reputation of what is currently the Health Protection Agency, in its new guise. I believe that they have the support of the staff of the HPA and reassure them about scientific independence and the ability to carry on seeking research contracts.
Lord Turnberg: My Lords, my name is also attached to Amendment 257ZA. I also do not like the idea that the HPA is to be abolished, so I hope my amendment is not necessary, which it will not be if the proposal that the clause should not stand part of the Bill is agreed.
I have, of course, extolled the virtues of the HPA on a number of occasions in your Lordships' House. You could say that I would do that, wouldn't I?, having been the chairman of the predecessor of the HPA, the Public Health Laboratory Service, but it is certainly true to say that it is the envy of the world, and I am not the only one who says that. The Centers for Disease Control and Prevention in Atlanta, in the United States, are a very well funded counterpart with which we collaborated very strongly, and even they recognised this excellence and envied the fact that we, unlike them, had a network of laboratories across the country primed and ready to detect outbreaks of infection wherever they occurred. Those laboratories were linked into a central laboratory at Colindale, where highly specialised tests could be carried out when needed for unusual infections and where epidemiologists could link up outbreaks in one area of the country with outbreaks in another, so that it was possible to track the speed and spread of infections and prevent them developing into epidemics.
The fact that the HPA is hardly ever in the news is testament to its success in protecting the population. If your Lordships think that because it is so good there is now less need for such surveillance, let me point to the fact that just one set of infections-those responsible for food poisoning-remain a considerable health hazard, and gives rise to about 1 million cases per annum in the UK. Although it is usually fairly mild and often not reported, some cases, such as those due to E. coli, can be very severe indeed, and in the particularly vulnerable can be fatal. Food poisoning is, unfortunately, not showing any signs of decreasing, so the need for constant vigilance is high and the role of the HPA remains absolutely vital.
The amendment sets out two of the planks needed for the agency to contribute to its key roles. The first is the degree of independence that it needs to be able to give advice not only to those out in the field who need to act but very specifically to the Secretary of State and the Government. The HPA must not be seen to be simply the mouthpiece of government. It must have the independence that is so necessary to its credibility. It has stood it in good stead over the years. Its advice is respected and accepted, and we should not lose that now.
The other element of the amendment is the need to be able to undertake research. If the agency is to keep ahead of ever-changing bacteria and viruses, which seem to mutate every week, and to be able to develop new ways of rapid detection, it needs access to research funds. For example, it has excellent high quality researchers, two of whom have recently been elected to the fellowship of the Academy of Medical Sciences, which is a demonstration of their esteem. Over the years it has been fortunate to have access to research funds from the Department of Health, and I understand that that will continue. That, of course, has been of enormous value, but the agency has also attracted research funds in fairly large amounts from external grant funders, and this is funding won in open competition. There is a fear that as an authority that is rather more closely identified with the Department of Health, access to those external funds will be denied to it.
The amendment makes the clear case that the agency must continue to have access to these funds in order for it to function at the highest level. I hope that the Minister will accept the case and look sympathetically at the amendment.
Lord Patel: My Lords, my name has been added to Amendment 257ZA and I have tabled Amendment 260 in my own name. I shall try to explain why I have added Amendment 260 to this group. There has been some advice to degroup it, and I have been tempted, but I have left it where it is. First, I agree absolutely with what my two friends, the noble Lords, Lord Warner and Lord Turnberg, have said in relation to independence in research and in the expert advice that Public Health England will be giving, and I shall support that by giving some details.
First, however, I shall refer to the funding issue. I do not understand why it has been suggested that Public Health England should not be allowed to bid for external research funding. I cannot see what the
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Where does it come from? The largest source of external research funding comes from the National Institutes of Health in the United States for high containment work on infectious diseases. Both the noble Lord, Lord Turnberg, and I know from experience that to get a grant from the NIH is very tough. The agency also receives external research funding for vaccine evaluation, as well as from the recent licensing of one of HPA's research-generated products by the Food and Drug Administration in the United States. The agency has a product called Erwinase that is used to treat childhood leukaemias, which clearly demonstrates the commercial benefit of its ongoing research and income-generating potential. That sets out the picture as far as research income is concerned, and I repeat that I do not understand why the agency should not be allowed to bid for it.
The second issue is that of publication. The agency must be independent enough to be able to publish evidence and offer expert advice on all topics in which it has expertise, regardless of government policy. For the public to have confidence in their public health agency, it must have the independence to publish. The Government may not take the advice they are given, but the agency must have the independence needed to be able to publish it, so again I cannot understand why it might not be allowed to do so. Nor can I understand why it cannot publish in any journal it wishes on any of its research or advice. To achieve all this, it is important that it has an independent board with an independently elected chairman. That is one of the crucial amendments I wish to see if we are going to go ahead with Public Health England as an executive agency of the department. That is also why I have tabled Amendment 260, which offers the belt and braces needed if, as the Government intend, Public Health England is established as an executive agency. If it is not given independence in terms of research, advice and its board, what we would then need to do is set up a non-departmental public body. That is the purpose of Amendment 260.
Lord Walton of Detchant: My Lords, I too support this amendment, although like the noble Lords, Lord Warner and Lord Turnberg, I would much prefer to see Clause 53 deleted from the Bill. Throughout my professional career I have been familiar with the expertise of the former Public Health Laboratory Service. It conducted research, carried out microbiological
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I just do not understand the purpose of the Government in abolishing its successor, the Health Protection Agency, which has continued to follow that pattern and to supervise the work of laboratories across the country which were formerly part of the Public Health Laboratory Service. Again, it is difficult to understand what the purpose is of abolishing a body that has proved to be so effective, which continues to give excellent service and which, as other speakers have said, attracts external research funding. If it were to be absorbed into the Government under the Secretary of State, I believe that it would be less able to fulfil its functions and to carry out the distinguished research in which it has been involved over many years. For that reason, while I strongly support the proposal that Clause 53 should no longer stand part of the Bill, if-for the reasons that I hope can be explained by the noble Earl-the Government decide that that clause should remain, it is crucial that we have an amendment such as the one before us in order to preserve the activities of such a vital scientific institution.
Baroness Finlay of Llandaff: My Lords, I have added my name to Amendment 260, but I should like also to talk about the problem of abolishing the Health Protection Agency. I must declare an interest because at the moment my daughter is on a placement there and is most impressed by the work that she has seen. There will be a very specific problem for the Health Protection Agency if it is not completely independent, and that relates to Medical Research Council research funding. If the agency is part of the Department of Health, it will find it more difficult to secure MRC funding. That may also apply to Wellcome funding, but the problem will be particularly acute with regard to funding from the MRC, which is the highest rated funding that the agency can get.
Also, as has already been said, the agency is internationally renowned and recognised for the excellence of its work and looks set to bring in more work to the UK. It is now working with the World Health Organisation on disaster planning. In planning for new disasters that might take place, it is important that countries know what other countries are going to be doing. We have sea borders, but if there is a massive disaster in another country we cannot go to its assistance if we do not know how its systems work. The Health Protection Agency is the leading body in this work on behalf of the UK. It seems very short-sighted to do anything that would destabilise this organisation.
It has been suggested that it could be moved, possibly into universities. The difficulty is that the pressures of research evaluation within the university might mean that some of its research-which takes a very long-term view and may not deliver results in the very short term-would be subject to pressures that could undermine its independence. Its complete independence is essential
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Baroness Masham of Ilton: My Lords, I, too, would like to support what has been said about the HPA. It is so well thought of across the world, and infections spread across the world. Infections are getting much more complicated, with drug resistance, and we need the HPA more than ever. I ask the Minister one question: whatever happens to it, will it have an independent chairman?
Baroness Cumberlege:My Lords, I speak to Amendment 260, in the name of the noble Lord, Lord Patel. It is probably not the time to go around memory lane, but I want to draw on some experiences that I have had. I was the hapless Minister responsible for the Health Education Authority. Some people may remember the Health Education Authority. It was largely independent and its funding came through the department. I should not speak ill of the dead, but it really was a nightmare. One of my lasting memories of my modest ministerial career was when we had a Starred Question in this House, asking why government money and very scarce resources should be spent on a leaflet, produced by the Health Education Authority, entitled, I think, 69 Ways for Better Sex. It was the first that I or the department had ever heard of it. Perhaps one of the interesting things was the number of noble Lords who said they could not take part in the debate unless they had seen a copy of the leaflet.
The HEA went completely off the rails. It was only when we were reading or listening to the media that we found out what it was up to. In the end, it not only alienated the Department of Health and the Government, it alienated local health authorities, with their responsibilities for public health. It was they in the end who asked us to close it down. Well, we did. Listening to the current proposal for Public Health England to be an agency, I think that is a good idea, although I know it is very unpopular with the Faculty of Public Health and others. An executive agency, although not totally independent, will operate with a degree of autonomy from Ministers on a day-to-day basis. While not as independent perhaps as a health authority, it will be recognisable as an entity and have its own identity.
The only model that we have got in health of an executive agency is the MHRA. Its chairman, noble Lords will know, is Professor Sir Alasdair Breckenridge,
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Here is an example or model that actually works. It has been tried and tested, and is a model we could certainly adapt for Public Health England. However, I suggest to my noble friend that the important thing is to keep the public health constituency with us on this. It is important that it has a real involvement in choosing the chairman of this new agency. If it is involved, that will go someway to ensuring the agency will be a success. It should also be involved in the recruitment and appointment of the non-executive members. We have a highly credible organisation here that could be a very good model for Public Health England and I hope my noble friend will consider those points about the appointment of the chairman and the non-executives, and the formation of that board.
Lord Warner: I was the Minister responsible for the MHRA and very much share the noble Baroness's views on this. There are some slight differences, one of which is that a lot of the funding for the MHRA, in effect, comes from the pharmaceutical industry, in terms of licence fees. However, I was well aware of the MHRA experience, and my own experience of it, in trying to craft Amendment 257ZA, which does bear some resemblance to that. I certainly would not argue with the idea that the number of non-executives under my amendment should be larger than three-it does say "at least three". I will certainly go along with her that some outside expertise, in quite substantial numbers among the non-executives, is an extremely good model.
Lord Beecham: My Lords, I am tempted to open by invoking, if not the Health Protection Agency, then perhaps the protection of the local environmental health department, because conditions in this Chamber, at this temperature, are hardly conducive to anyone's good health. However, that is a matter perhaps for the House authorities to look at.
I rise to express the view that Clause 53 should not stand part of this Bill and to support my noble friend Lord Warner's Amendment 260. I do the latter on the basis that that would be a fallback position, because I entirely concur with the view expressed in particular by the noble Lords, Lord Turnberg, Lord Patel and Lord Walton, and the noble Baroness, Lady Finlay, who have of course such a distinguished history as leading clinicians in these and other medical fields. Part of the thrust of the argument is the need to maintain not only a functioning organisation which
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Amendment 260 would create an executive agency for the Health Protection Agency. It is arguable that executive agency status would not of itself lead to the required or desired degree of independence whereas perhaps a special health authority would conceivably achieve that. There is a difference of view from the Government about the status of a special health authority. Their preference for Public Health England is that it should be an executive agency. They argue that a special health authority would not be appropriate. They point to analogous situations of agencies created for the Medicines and Healthcare products Regulatory Agency and curiously, by way of analogy, the Met Office, as organisations which are deemed to have sufficient independent status, albeit operating as executive agencies of their respective departments.
Neither of those arguments can be sustained. The role of Public Health England is a much wider one than either of the two bodies to which their document published earlier this year refers. A regulatory agency is not the same as an organisation which has to advocate and oversee a wide range of services, such as Public Health England would be required to do, and the Met Office is hardly an organisation which is required to be independent of Government in preparing its weather forecast. The analogy is somewhat ludicrous.
There is also, of course, the very important point made by noble Lords about the need for independent status in order to attract some of the funding, both charitable and contractual, on which in particular the Health Protection Agency is critically dependent and which might be endangered by its absorption into Public Health England in a way which would make it clear that it is no longer independent. That is not to say that the creation of Public Health England in the form of a special health authority would not of itself be desirable. The bringing together of a range of functions under the auspices of Public Health England, although not, I would argue, the Health Protection Agency, would be welcome.
A number of professional bodies have commended the principle but clearly have reservations about how the new structure would work. The Association of Directors of Public Health, for example, makes it clear that Public Health England should include health protection and emergency planning, health improvement and health services in its main areas of work and, in addition, provide an independent science base and advice to the Government and the devolved Governments. One of the arguments against creating a special health authority was that it would not be able to deal with devolved Governments. I would have thought that that is something that the Government could deal with relatively easily.
The role of Public Health England should also support the national Commissioning Board and provide support for local directors of public health. However,
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A number of questions arise in respect of the position of the Health Protection Agency. There is a need to maintain capacity within the service and particularly for robust arrangements for emergencies and for interim arrangements, pending the completion of the reorganisation. Perhaps the Minister, when replying, could indicate how far the department has been able to explore the issues of capacity and the position in relation to the provision of those emergency services. The point was also made that clarity is needed about responses to incidents at local, sub-regional and regional level. Again, perhaps the Minister could indicate how far discussions have gone and what proposals there are for ensuring that that response at the various levels indicated would be guaranteed by the new arrangements. There is also an issue about the role and responsibilities of the directors of public health and local health protection units. Again, perhaps the Minister, if she is not able to reply to that point tonight, could write to noble Lords about that.
A point was raised which I almost have to apologise for raising yet again, which is the position of second-tier authorities in connection with their responsibilities under the auspices of the Bill, and in particular their relationship with Public Health England. Concerns were also raised in a joint statement recently issued by the Local Government Association, the BMA, the Faculty of Public Health, the Association of Directors of Public Health, the NHS Confederation and even the Royal College of Midwives, a broad grouping, all of which have reservations, even though generally approving the thrust of the Government's policy. In particular, the case was made for public health arrangements to be organised at the different levels, at the "supralocal level" as they call it-that is to say, a conurbation area rather than just the individual local authority area-and at a subnational level. They supported an integrated model in which large local authorities might host subnational functions on behalf of Public Health England; in London, for example, where there is an elected mayor, or in Greater Manchester, where there is a combined authority, and perhaps other cases where authorities could come together. Again, it would be interesting to learn whether the department sees that as a potential way forward.
There is another serious range of issues around public health observatories, which have suffered a significant loss of capacity, according to the Select
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There is another organisation that has been identified as one that has uncertainties about its future: the United Kingdom Association of Cancer Registries, an organisation for cancer intelligence that, again, agrees in principle with the proposals. Its director, noting that the organisation's future would lie with Public Health England, said when he was giving evidence that he did not know yet what the structures would be and that there was uncertainty leading to the risk of losing skilled staff. It is interesting that the word "risk" crops up on the day when we have discussed risk registers. Perhaps in the fullness of time we might learn whether or not that particular risk is one of those identified in the registers which we spent an hour debating today.
"We are concerned at the lack of clear plans for Public Health England to be established at the regional level. The idea of 'sub-national hubs', in some ... undefined ... alignment with the sub-national structures of the NHS Commissioning Board and the Department for Communities and Local Government does not seem to us adequate ... Public Health England needs a clear structure of regional accountability".
In summary, the preference of the Opposition would be to see the Health Protection Agency preserved with independent status and to see Public Health England created as a special health authority, guaranteeing, at least to a degree, its independence, which cannot be guaranteed when, in the words of the Minister in the other place, it is simply another form of embodiment of the Secretary of State. For these reasons, the Opposition support the amendments. I will not be asking the House to divide now but this is a matter to which, in the absence of a positive response, we may well have to return on Report.
Baroness Northover: My Lords, the noble Lord, Lord Warner, is right about the international status of the HPA. In many ways, the proposals for Public Health England take its development a step further by building on its successes and bringing other organisations into the new Public Health England. Independence of scientific expertise, as he and other noble Lords have
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When we discussed the provisions in Clause 8 that set out the Secretary of State's health protection functions, we touched on Public Health England and the abolition of the Health Protection Agency. Public Health England will be the national component of the new public health system and will be established as an executive agency as part of the Department of Health. It will bring together activity currently spread across a range of bodies, including the Health Protection Agency, into a new unified body directly accountable to the Secretary of State. It is important to emphasise that the agency is just one component of a system that is currently fragmented, opaque and spread across central government, local government, the NHS and other arm's-length bodies such as the Food Standards Agency and the National Treatment Agency. We want to replace all that with a clearly defined and much more unified system for protecting and improving the nation's health. Public Health England will be able to build on the recognised expertise within our public health system from a range of organisations.
We understand that there have been some concerns about the status of Public Health England. I hope that I can reassure noble Lords that further amendments in this area are not necessary; I hear what they say about those concerns but I hope that we can address them. As an executive agency, Public Health England will have a distinct identity and a chief executive with clear accountability for carrying out its functions. Its status will underline its responsibility for offering scientifically rigorous and impartial advice. As we design Public Health England, we will work closely with stakeholders to ensure that it offers support for directors of public health and their partners in the local system. We talked more about the local side of that the other day.
Many noble Lords have expressed concerns about the independence of Public Health England and the need to ensure that it has appropriate corporate governance. We have listened to what people have said. I can say for the first time that we can commit today that the chief executive of Public Health England will chair a board. This will include at least three non-executive members who will provide independent advice and support. We expect the non-executive members to have relevant experience in the public health field, local government or the voluntary and community or private sector in order to provide a broad range of experience and challenge and advise on how the organisation can maximise its income generation abilities. In addition, we will be looking to one of these non-executive directors to have the necessary skills to chair Public Health England's audit and risk committee, which will provide assurance on risk management, governance and internal control for Public Health England.
Baroness Cumberlege: My Lords, that is great opportunity lost. If we are going to have an executive agency on the lines of the MHRA, that organisation has an independent chairman, not a civil servant. What we really want is an independent chairman. The majority on the NHS Commissioning Board are non-executives. I am very grateful to the Government for going some way, but a little stride further would be very welcome.
Baroness Northover: I thought that noble Lords would be delighted to hear my announcement, but I hear that they are less than thrilled. I will take that back and consider carefully what my noble friend has said about striding further forward, and see how best people's concerns can be addressed.
My noble friend Lady Cumberlege asked whether the public health community would be involved in selecting the chair and non-execs of Public Health England. We will give very serious consideration to how the chief executive and the non-executive directors are appointed although in the case of the chief executive the final decision must of course be with the Secretary of State.
Some noble Lords have suggested that a special health authority model might be appropriate and Amendment 260 would have that effect. The key issue here, as the noble Lord, Lord Beecham, correctly identified, is that Public Health England will exercise functions that are wider than just the health service in England. In particular, Public Health England will have UK-wide responsibilities. I heard what he said about believing the devolved Administrations could somehow or other be sorted out but I am not so certain. Public Health England will have responsibilities for highly specialised health protection functions such as radiation protection and will therefore need an organisational form that can operate across the whole of the United Kingdom, and a special health authority is normally established in relation to England only. It cannot be established under secondary legislation to exercise UK-wide functions that relate to reserved matters or in relation to functions in England that do not relate to the health service-that obviously would be a challenge.
On the points raised about Amendment 257ZA, I hope I can reassure noble Lords that the chief executive of Public Health England would be appointed through an open and fair competition and would be solely responsible for its day-to-day operation. Ministers will agree the business objectives for Public Health England and the chief executive will be responsible for putting in place the management structure and using the budget appropriately to deliver these. This operational freedom will be supported by a framework agreement
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During an earlier debate the noble Lord, Lord Turnberg, raised the question-it has been raised again today particularly by the noble Lord, Lord Patel-about the ability of Public Health England to receive research grants. Public Health England will be able to receive research funding from most, if not all, of the sources from which the Health Protection Agency currently receives research income. In the light of the concerns that the noble Lord, Lord Turnberg, flagged up last time, I asked for an analysis of where the HPA currently got its research funding from, in terms of proportions, organisations, amounts and so on. I then asked what would happen in each case. I was reassured to see exactly how Public Health England would be eligible, right across the board it seemed to me, for the kind of grants that currently exist. I am very happy to discuss this further with the noble Lord if he wishes.
In particular, there was concern about what money could be received from the EU and it is very clear that, in terms of the funding rules on intergovernmental organisations such as the EU, the executive agency would no doubt work in conjunction with an academic or analogous institution, as is the case now, to apply for that kind of funding. I appreciate noble Lords' concern about that and how important it is that this is got right. I therefore hope that they will have a really good look at how this would carry across.
Clearly it is extremely important for Public Health England to have scientists who are not only independent but also able to publish-it is important for their own future careers as well as the work they are doing within Public Health England-and to continue to be able to publish. Public Health England would have a very important role in filling evidence gaps and building on the evidence base to improve and protect public health. That is a critical part of what it would be doing, so that would continue. I am not quite sure where the noble Lord, Lord Patel, got some of his concerns from but he is right to probe and to make sure that this is going to work in the future.
Lord Warner: I am slightly bemused by what the noble Baroness has said on research. I would certainly like to know in writing, rather than poring through Department of Health files, what the risk assessment is of Public Health England losing research grants out of the total of £150 million that the noble Lord, Lord Patel, mentioned and in particular, whether it is at risk of losing the MRC grants that the noble Baroness, Lady Finlay, mentioned. We need something clear in writing and not just vague assurances. We also need some guarantees from the Minister about the right of people who are doing research in Public Health England to publish peer-reviewed articles without any censorship from the Department of Health and Ministers.
Baroness Northover: I am sorry if I am being at all opaque. As noble Lords have said, the HPA generates income and conducts research which it is in effect selling out. There is some commercially sensitive information in what I have here: I am sure that we can
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Lord Warner: I do not wish to have any commercial-in-confidence information and I am sure my friends do not either. We want to know what is at risk out of the £150 million the Health Protection Agency is getting now under the new arrangements. If you can guarantee, in writing, that Public Health England is not at risk of losing any of that money I think we will be much more confident. We do not want the details of the commercially sensitive stuff we just want the global figure and the assurances of what it is at risk of losing.
Baroness Finlay of Llandaff: Can we also have the assurance that it will be eligible in the future to apply for a broad range of funding even if currently it does not hold a grant from a particular grant-giving body? I think that that applies to the MRC.
Baroness Northover: I hope the cameras are not shining down on this piece of paper of mine so I can try to give you some of the information that may be less commercially sensitive: there are organisations such as the Wellcome Trust and Research Councils UK. Noble Lords should be very reassured as to how this will work, but as a very junior Minister I have to be extremely careful.
The noble Lord, Lord Turnberg, flagged this up, I took it back and asked for a breakdown of the funding the Health Protection Agency gets. I asked in every instance what would happen in the future and I have a comprehensive answer because I thought it was extremely important. I hope noble Lords will be reassured both by my probing and these answers, even if I dare not reveal them all. I hope we can therefore write and reassure noble Lords that those working for Public Health England will indeed have access to the same kind of grants that they have at the moment.
Amendments 257A and 257B are minor and technical government amendments to Clause 54. These amendments would allow the Secretary of State or the Northern Ireland department acting alone to exercise functions in relation to biological substances for the whole of the United Kingdom. I was asked about sub-national structures. Indeed, Public Health England will have hubs. The precise details of these arrangements will be published shortly. As stated in Healthy Lives, Healthy People, we will provide further detail on the operating model for Public Health England.
I was also asked about emergencies. As I mentioned on the previous occasion when we debated public health, Public Health England will act on behalf of the Secretary of State as a category 1 responder. It will also be able to offer support or leadership in dealing with local incidents short of a full-blown emergency.
Reference was made to one or two other areas. If noble Lords will forgive me, I will write to them to sweep up what needs to be covered. I hope that noble
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Lord Warner: My Lords, my reaction is, "C+: Must work harder". The noble Baroness has given some reassurances but they are certainly not sufficient. She should have a lengthy chat with her noble friend Lady Cumberlege on the MHRA. I would be happy to join them as it is an interesting model and has a lot to offer. The noble Baroness, Lady Northover, may remember the Cadbury inquiry's report on the governance of companies in which it advised that there should be a separate chairman and chief executive. Therefore, the principle of promoting good governance through having a separate chairman and chief executive is well established in both the public and the private sector. She might think about that a bit more.
I do not know about other noble Lords but I was not swept off my feet by the assurances on research. We would like some good assurances in writing, particularly with regard to the ability of the new body to compete for MRC research funds. I continue to have concerns about the ability of any body in this position to publish peer-reviewed articles and findings from research that are uncensored. The road to hell is paved with good intentions. Once a body is inside the Civil Service code, the ability to publish independent utterances and research tends to become a bit more circumscribed. Therefore, we want further assurances in that regard.
"( ) Any function conferred on the appropriate authority by this section may be performed by either the Secretary of State or the Department of Health, Social Services and Public Safety in Northern Ireland acting alone or both of them acting jointly (and references in this section to the appropriate authority are to be construed accordingly)."
Lord Addington: My Lords, I thank everybody who has found time in their schedules to speak in this debate. I pass on the apologies of my noble friend Lord Storey, who is unable to join us due to an illness in his family. I hope that he will catch up next time round.
When I tabled this Question a long time ago, I used the words "school-age sport" because I am rather wary of talking exclusively about school sport as it has never encompassed everything that is required in the education of sportsmen, particularly at amateur level. Indeed, most of my speech concerns amateur sportsmen. We have never had a system within schools that has reached out to everybody and provided them with a basis for the rest of their sporting life. When you are considering embarking on the next stage of your sporting career, you usually have to join a club at some point, certainly if you are an enthusiastic amateur. One of the great fault-lines in our sports participation is the high drop-out rates at the ages of 16, 18 and 21. At those ages our education process changes and work can intervene. We should aim to achieve a balance whereby people continue their participation in sport throughout their lives, or at least make a lasting commitment to it. If one is a very fit and healthy 16 year-old but becomes an unhealthy, paunchy 30 year-old, what was the point of bothering to be fit and healthy at 16? Although the picture of a trophy that you won at an under-15s event which hangs on your wall may help to incentivise you, exercise should be treated as the wonder drug in terms of gaining health benefits from sport. The Health and Social Care Bill should be ringing in our ears in that respect. If you are fit and healthy, virtually everything else that you do
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What I am trying to get at is how we encourage sports participation throughout life. Schools alone have never achieved this. In the past few years many initiatives have come forward, many from government, on what we should try to do to integrate the state and the private sectors in this regard. There was a great deal of consensus on how you should reach out to both sectors, certainly until fairly recently. I have complained at times that there were so many initiatives on the part of various sports that you felt that the same kids were turning up to the same events and swapping tennis rackets for rugby balls, cricket bats or footballs, with a couple of other smaller sports thrown in. The same people tended to turn up for the different sports, but that was possibly a personal impression. I have asked my next question before, but have we ever established which of those schemes was the best in retaining participation in sport through to adulthood? That is the real test. I do not think that we have found that out. Once we have established that, we can build on it. To go back to the amateur sports clubs, something like 22 per cent of our volunteers are involved in them and 2 million people take part in them. They are the big society writ large. In this country that sector is largely self-generating and self-funding. We have a tradition of owning our own sports clubs as regards some of our major sports. That is not the case for all sports but it is for many of them. The funding is provided by the individuals taking part in the various sports and by activities such as running a bar. They have taken on a huge amount of sporting activity which, in other nations, is provided by the state at local government level. These people should be supported, and the main way we can do this is to make sure they have a steady supply of recruits.
When I tried to plan what I was going to say, I used the phrase "elephant in the room" about the School Sports Partnership, something which has led to a degree of controversy in sport which those of us who looked at it a few months ago were not used to. Ofsted praises the project very highly. I have not heard too much against it, but since its demise I have heard some people say "The one I met was not that great". Its objective was to make links between club and sport and to make use of the expertise and enthusiasm of the club, an environment you are in because you actually love the sport-or at least like it. I do not care what you call the scheme or how you do it, it is the enthusiasm that is the important bit. In times of austerity, it might look like something that was ripe for the picking-particularly to someone who was not tuned into this process.
What have we learnt from this process? What is the best way to achieve our aims? The particular individual scheme does not matter, in the end, nor does its name. What matters is how we take the benefit that was created in the good examples and go on with them. We can talk long and hard about what we actually think should be in this process of transferring from school-age sport to adult sport but we can be absolutely sure that,
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Some parents become a taxi service that runs the child everywhere to get on with their sporting life-the ones who say, "If it is summer it must be cricket", or "If it is winter it must be football", and "Oh, we have basketball in between"; I quote one of my neighbours as he helped me change a tyre the other day. We need to reach the group that do not have that support, or at least make it easier for them to access it. If we can do this then we are achieving and expanding our base in one of the most valuable community activities we have.
The world will not change if local team X manages to get a couple more trophies. It will change if we can encourage people to take part in that sport, right down to the third team. If we can encourage people who do not play at the highest level to take part-even if it is just a social activity-we are achieving most of our aims: the regular exercise, the social interaction, the bonding that goes on. If we can encourage people to come into that process early enough we can build on it and do what we can with it.
The political class has put a great deal of effort into encouraging this. We will be making a mistake if we allow doctrinaire activity to get in the way of school-age participation. I have heard quite a lot of worrying things from the Government about the importance of competitive sport. I do not know what uncompetitive sport is: exercise and training? I promised, a while ago, not to use the example of the football match in the film "Kes" again, but I am coming back to it. Those who are familiar with it will remember bored, cold people kicking each other and the ball, half of them not taking part at all. For too many, that is the experience of sport. If, in order to have a competitive match you go down to lower ability groups who are not interested and not tuned in, you can go back to that kind of situation. I hope the Minister can tell me that the importance of good education and connections with outside sporting bodies will be given priority; and that, although we want people to be involved in sport, we will not sacrifice the chance of an enjoyable experience for the sake of simply saying, "You are competing".
Baroness Heyhoe Flint: My Lords, within the understanding and appreciation of the debate proposed by my noble friend Lord Addington, who I thank greatly, there has to be a key assumption that the quality and quantity of teaching of school-age sport is such that both factors are perfect: in other words, enough weekly hours of sports tuition and of a high enough standard to enthuse youngsters at school so that they wish to continue with such activities when they leave full-time education.
Let us look on the bright side and assume that both these key factors of school sport-quality and quantity-are answered in the positive. Both the current Government
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Common sense decrees that if school sport is an enjoyable and uplifting experience, and if the encouragement is there from the PE staff, youngsters may wish to seek similar happy sporting experiences when they leave school. However, there are many negatives looming that can be erased only by a higher level of investment, and therein lies a drawback-a lack of facilities and organisers for casual sport and recreation and lack of ability to unlock the doors of sports venues in community schools to enable community sport and recreation activities to take place. Just drive around your own city, town or village and observe how many facilities are barred and shuttered after school hours. How many amateur sports clubs have expired through lack of funding to enable them regularly to hire costly indoor sports arenas or artificial turf pitches and the use of floodlights, which help when it is dark? The desire to take up sport after leaving school may be thwarted by lack of local organisations.
However, all is not doom and gloom. Data from the Taking Part survey-a national survey of culture and sport by the DCMS-show that a higher number of adults who currently play sport definitely played sport while at school. Perhaps I could indulge in an initiative promoted and actioned by the England and Wales Cricket Board, again, and show how a governing body of sport-and there are 320 such organisations recognised in the UK-can grasp the nettle and mirror the ECB, which has invested focused resources into increasing participation and growth in the adult game through its adult participation strategy as part of its Whole Sport Plan programme.
Cricket has established strong links between school sport and the club game through the Chance to Shine programme. Chance to Shine is a charity that aims to establish by 2015 regular coaching and competitive cricket opportunities to 5,200 primary schools and 1,500 secondary schools. Last year, more than 1 million boys and girls took part in the schools cricket programme -44 per cent were girls, I am pleased to say-but the most heartening factor, which is perfectly in tune with the theme of this debate, is that more than 29,000 children, 30 per cent of whom were girls, migrated from Chance to Shine schools to local clubs, thus demonstrating the success of the programme in getting more people to play sport once they leave school.
This is just a small case study that shows how the responsibility and drive of just one national governing body has solved a funding problem by working with partners to introduce more opportunities to schools and colleges to reduce barriers, such as extra time
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Maintaining participation in sport, once youngsters leave school, is the biggest challenge facing policy-makers, and we all know the inherent benefits of a fit and healthy nation. Looking to London 2012, the DCMS has developed programmes for school leavers to embrace sporting activities-in particular in Places People Play, which is a £135 million initiative that is being delivered by Sport England in partnership with the BOA and the British Paralympic Association.
Government must continue to take up the responsibility of helping to provide the sporting pathway for school leavers to journey into an adult sporting environment and at least help to provide the opportunity and facilities. After all, you can take a horse to water, but unless that trough is filled, the poor old horse will go very thirsty.
Baroness Howells of St Davids: My Lords, I, too, thank the noble Lord, Lord Addington, for raising this debate. His opening speech and that of the noble Baroness, Lady Heyhoe Flint, were enlightening. What I am about to say about the merits of sport in schools will take a different turn.
On Monday night, I attended an awards evening hosted by Tessa Sanderson's foundation. Tessa is a gold medallist. The foundation, in collaboration with Newham College, seeks out talent, trains and gives much support to those who, because of poverty or ill health, may have missed the opportunity to get involved in sport. Many recipients of the awards paid tribute to the help that they received and talked of how their lives had been turned around. Most of the audience were so moved that there was hardly a dry eye in the room.
One awardee, sitting in his wheelchair, told his story. He left his school at 16 after the break-up of his parents' marriage. He got into drugs, gangs, stealing and so on, and became a "no-good person"-those are his words-until one night, he decided to steal a motorbike, which he drove into a wall. He broke his back and lay in a hospital bed for some considerable time, contemplating suicide. He said he blamed no one, and said that it was his fault and that he needed no sympathy. That was until his mentor came into his life. His mentor introduced him to sport and he has been the recipient of many medals. He is hoping to go for gold in the 2012 Olympic Games. His mentor says that he has a good chance of raising the union jack with pride. His one regret is that he was not introduced to the buzz of sport during his school days. He is now financially secure, enjoying life and would like to influence others.
For most young British black males, sport of one sort or another has been the only means of upward mobility. The have used their talents across as many athletic fields as they have been exposed to. There are too many names to list them here, but noble Lords will have heard those names, Saturday after Saturday. I ask the Minister to consider new ways to improve the quality of teaching sport in schools.
I should also like to introduce the Minister to a programme that I have been involved with through my trusteeship of the Windward Islands Research and Education Foundation. With the enormous support of St George's University, we launched in 2010 a programme called "Sport for Health" in the primary schools on the island of Grenada. In one year, this project has taken off so well that we are hoping for a gold medal in 2012. The prospective gold medallist is a champion for the project. Also, many footballers of Caribbean origin are working with us. Our patron is Garth Crooks, and he is very much a working patron.
There is considerable evidence of the adverse effects of non-communicable disorders on the quality of life. Those disorders should not be an inevitable burden on society, given that it would cost so little to attach sport to school programmes on healthy diets. Already, those pupils in Grenada are using sport to reduce obesity and other non-communicable diseases. Let us shift the paradigm through healthy eating-which we already encourage in schools-and add sport for health. There is no disgrace in dying healthily. Let us go for gold in our schools.
Baroness Grey-Thompson: My Lords, I thank the noble Lord, Lord Addington, for raising this debate and asking some very important questions about what it is that works in sport so that we can improve on it.
It is incredibly important to think about school sport at this time while we all become obsessed with the Olympics and Paralympics. With 233 days until the start of the Olympics and 266 until the Paralympics, we have a unique chance to inspire people to be healthier. I admit to having mixed views on attaching participation rates to the Games. I do not believe that this is the right way to measure the success of the Games, but we have no better time to target people.
I declare interests as a board member of UK Athletics and the London Marathon, as a trustee of Laureus Sport for Good Foundation, and as chair of the Commission on the Future of Women's Sport. As a Paralympian, although I have a background in competitive sport, these days I am learning a lot more about participation, which just means that I get slower every year. However, I am passionate about what school sport can encourage, and not just because I was successful. Actually, I was not that great as a child. I spent a long time doing physical activity before I became good at sport, and I had the opportunity to be okay for a long time.
In sport we need role models, whether they are the gold medal-winning athlete or an amazing PE teacher. Like others in your Lordships' House, I do not believe that what we have is right. Perhaps instead of asking questions, I shall make some suggestions for change.
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Head teachers and governors should be doing all that they can, and in my opinion a lot more, to ensure that PE and sport is provided in such a way that girls find engaging and establish healthy activities and habits for the rest of their lives. If I could wave a magic wand and be just a little radical, I would extend the school day and have PE every single day of the week, to encourage that habit. It would not be something that girls did twice a week; they would do it five days a week. The schools that give more choice on the type of activities in which girls become involved, and where PE teachers pay attention not just to the talented girls, will achieve far higher participation rates.
So, for once, I am asking the Government not for more money for this area but to encourage schools to do more and be more creative, because 80 per cent of women do not currently do enough exercise to be healthy. I do not forget that parents have a role to play in their children's lives and I do not want to negate their responsibility, but it is a challenge for some parents. If you are a mum around my age, you probably had a fairly miserable time in PE in schools. You will have been sent out on cross-country runs and to play hockey wearing gym knickers and not allowed to wear gloves. I speak to so many women whose expression, when I mention sport to them, just turns cold. Because their experience is negative, they do not understand some of the benefits that they can pass on to their children by encouraging them to do sport.
I also understand that sports development is really hard. I did it as a job for two years-my first job on graduation. I understand that that cultural change will not happen on its own. British sport will be better for more girls taking part at school. As the noble Lord, Lord Addington, said, I do not really mind what it is called, but we have to do something to encourage change. If more girls do sport in school, more will carry on afterwards, more will get involved in coaching, volunteering and administration. If the Government want to change representation of women at all levels of society, what better place to start than school sport?
Journalist Liz Jones wrote recently what I would describe as an "interesting article" about women in sport. She was right in some aspects, saying that some girls do not like competitive sport, but we should not throw the baby out with the bath-water. I disagree with her comments about women with sinewy arms not looking attractive and that they should not be involved in competitive sport. I prefer to think about a woman looking strong. We have to encourage girls and women to think differently about what is attractive and what being a strong woman really means for them. In January next year, the Women's Sports and Fitness Foundation is releasing a report on girls' attitudes to sport and physical activity, and I think that this will provide valuable insight into how we can make improvements. I will take the liberty of personally delivering it into every noble Lord's pigeon hole.
Having travelled around the world with the Sport for Good Foundation, I have seen some amazing examples of good practice-projects that have recognised how hard it is to engage girls, and so have worked with their mums. I would love more of this. What better way to encourage daughters and mums than to do sport together?
Just this afternoon, I visited a wonderful school: Highbury Grove in Islington. Yes, it is on a new site, which has the most amazing sports facilities. It has a 200 metre track; it has a swimming pool; it is absolutely stunning. Through sport and music the school has turned around attendance and improved academic grades. Credit should be given to the head and the staff, who see the importance of physical activity. They also work with the local community. Like the noble Baroness, Lady Heyhoe Flint, my plea is for more of that. School sites that are open to a wider community can help change the patterns of participation.
My second favourite topic around school sport is young disabled people being active. There is so much more to do in this area, and I know of many positive changes through Sport England and the other home country sports councils. I do not see enough disabled people being active enough, whether at school or beyond. I am pleased that there have been some positive moves in the direction of more clearly being able to measure participation of disabled people-it is a real challenge. So many reasons are given for the barriers to participation, but I have never believed that something being a challenge is a reason to not try.
This is where schools can make a massive difference to young disabled people, because, if we want a more inclusive society, what better way to do it than through sport? It is even more important that disabled children, very young children, are encouraged to play and be active, because those benefits carry on for the rest of their lives. I also believe that, if we have more disabled people active, that contributes to wider government targets of helping to get more disabled people into work. What I would love to see in this area is better teacher training so that there is far greater understanding of adaptive PE. Where I probably am very radical is that I think we need specialist PE teaching at primary level. I know that there is a cost to that, but I would love general teachers at primary level to have much greater understanding of working with everybody in their class. Finally, teachers need to understand what talent is in disabled pupils so that they encourage and give realistic goals, not tell them they are brilliant just because they are disabled and are having a go. There is a big difference between participation and elite sport.
I do not believe that it is all doom and gloom, but neither do I think that we have it right. If this were a school report, it would read "Could do better", and our young people deserve much better than the provision they currently receive.
Lord Smith of Finsbury: My Lords, it is a privilege to follow the noble Baroness, Lady Grey-Thompson, and a pleasure to be taking part in this very short but important debate. I thank the noble Lord, Lord
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In both informal and formal sport, sport at a young age can lead to riches later in life. Secondly, sport can enhance the educational original experience and overall quality of a school. Sports, both competitive and non-competitive, can make a huge contribution to the atmosphere and culture of a school and the ability of pupils to engage with academic subjects, as well as with their sport. That is why, when I was Secretary of State at DCMS, I encouraged Sport England to come forward with a substantial programme of funding for school sports co-ordinators. That is why we endeavoured, with a modest degree of success, to prevent the selling off of school playing fields. It is why the school partnership programme was a valuable attempt to link the enthusiasm of sporting clubs and societies with the engagement of pupils in schools. These things are not just important for sport; they are so important for the quality of the education as a whole that pupils receive.
My third point links a little to what the noble Baroness, Lady Howells, said. We do not need to read the recent report, Reading the Riots, about what happened back in the summer to understand why some young people get into trouble, hang about on street corners, join gangs and smash windows. It is not just because of poverty of circumstance-housing, environment and upbringing. It is because of all those things and more, but often it is because of poverty of aspiration. The starting point for any process of regeneration, either physical or social, has to be giving young people a chance to find self-esteem, to find something that they can be proud of themselves for having done, something to give them a sense of real achievement. Sports can give them that.
I would say the same about music, drama, dance and the arts in general as well, but the chance to play sport and to become part of a team, part of a league, to endeavour to excel-the chance to do all those things that sports can be to young people in an exciting and enthusiastic way-can be life-changing. Let us make sure that more of our young people get that opportunity.
Lord Lexden: My Lords, we are all indebted to my noble friend Lord Addington for bringing to our attention once more the twin and linked issues of
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If the state of school sport in the United Kingdom were all that we would like it to be today, with the majority of children being classified as having demonstrated "exceptional performance" under the national curriculum level descriptors on leaving school, we would all be confident that they would be likely to flock with enthusiasm of their own accord to the plethora of amateur associations and clubs that operate in every corner of our kingdom. Sadly, however, in many of our state schools sporting performance leaves much to be desired. Departmental figures for 2010 reveal the depressing statistic that only one in five state schools regularly played in competitions with other schools and that only two children in five regularly played competitive sport, even within their own school, and all this despite more than £2 billion having been spent in attempts to rectify the position.
The independent sector, on the other hand, continues to provide many centres of excellence, as shown by Millfield School, for example, with its outstanding sporting record. At school level, partnerships between the state and independent sectors-a point that as a former general-secretary of the Independent Schools Council I always stress wherever appropriate-offer an immensely important way forward, as I think more and more people have come to appreciate over recent years.
Although the report is some years old, the Institute of Youth Sport at Loughborough University has analysed sporting partnerships between the independent and state sectors. The report mentions numerous benefits to the pupils involved, including increased self-esteem, motivation expectations, new chances to try sports that had not previously been available, the establishment of new links between schools and local clubs, and the dispelling of misplaced preconceptions that the pupils in the two sectors had about each other. As many speakers in this debate have stressed, schools must be opened as fully as possible to the wider community. Such great gains-to individuals and to society as a whole-should be extended as widely as possible. School partnerships between the two sectors must be conducted on an equal basis, bringing enjoyment and satisfaction on both sides. For my part, I continue to regret that as soon as possible I fled from the rugby field and the cricket pitch for the tranquillity of the school library.
What should be our overall aim? If we could work towards ensuring continuity for pupils, we could end the distinction between school sport and sport in later life, and the two would become merely different points along the same spectrum, as my noble friend Lord Addington stressed at the outset. My noble friend Lady Heyhoe Flint also lent strong support for that view. I believe that this is what we should be trying to do, especially if we are to avoid squandering that increased enthusiasm and participation created by the
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Success in this venture will spring from partnerships between sports organisations and the nation's schools, underpinned by a high degree of volunteering. Apart from areas where government agencies such as Sport England could help to facilitate such partnerships, progress should proceed as far as possible without heavy-handed bureaucratic intervention. Perhaps more responsibility for the initiatives that are undertaken could rest primarily with school heads, although of course the local clubs themselves would be equally important partners.
Finally, and most importantly, such a strategy would go a long way towards improving the health of scores of children and encourage the virtues of sportsmanship that are just as important off the field as they are on it. It was Cicero who taught us that:
Well, my straightforward and brief answer to that is, "None whatever". I have to say that I am outraged, as are thousands of others, that the actions taken by the coalition so far have destroyed the hard-won foundation for sport laid by the previous Government. I can tell noble Lords that it was not easy. Successive Labour Sports Ministers, supported by the health and educational lobbies, battled to increase the reality of PE in schools and to open up the reality of sporting extracurricular activities, which other noble Lords have mentioned. They succeeded, and when the coalition took over, it had the potential to improve not only the health of the nation but to bring about a fair and broad introduction to sport at grass-roots level. Within that framework, school partnerships had offered expert, well trained staff and the network of school sport partnerships that held the prospect of high-level professional input into schools, which had been lacking in the past and which we had all bemoaned.
So let us fast-forward to the arrival of Michael Gove, Secretary of State for Education for the coalition Government. He promptly announced a cut of more than £160 million of funding for sport in schools. He did this by removing the ring-fencing of that money, allowing heads to decide where the extra money should be spent. When league tables of academic achievement dominate the priorities of heads, the likelihood of that money being spent on academic subjects becomes, for them, irresistible. That decision, taken by the Secretary of State without any public consultation or discussion
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To take away basic school sport is to wreck grass-roots sport-the vehicle by which individuals may later choose a specialist sport to provide a lifelong interest and involvement in that sport. The Secretary of State ignored at a stroke all arguments about the benefits of sport across the nation, as others have mentioned-health, well-being and educational advantage. It is clear that Michael Gove is sport-phobic, even philistine, and it is even more astounding when viewed against the promises of sporting legacy to be achieved against the background of the 2012 Olympics.
So much for the promises which helped London to win the Games, and so much for the vision of the noble Lord, Lord Coe, of a healthier sporting nation. Even the Prime Minister is a very keen sportsman. However, they all find themselves well and truly rumbled. The coalition fails to understand the crucial role of schools, both secondary and primary, where well taught sport can be embedded as the foundation for children's future sporting lives. Instead, the DCMS, the Secretary of State and the Sports Minister show their total lack of understanding of the nature of a sporting heritage. Grass-roots sport is the key to success. Their belief that competitive sport is the answer-that Olympic-style competition might be the spur-completely misses the point. As has been said, for a small minority of very talented individuals that may be the case. For the vast majority, however, it will prove disastrous.
All the evidence shows that Labour's investment in sport was having a rich return. Our ambition of 2 million more people becoming physically active by 2012 and for 60 per cent of young people to be doing at least five hours of sport per week became a reality. This is now on the scrapheap of coalition dogma. That is why I am so angry. For the first time, students in state schools-93 per cent of the school population-were provided with a well funded framework for a sporting legacy. The statistics of the outcome of the Labour investment of £1.5 billion from 2003-08-specialist school colleges, as have been mentioned, school sport co-ordinators, school and club links, and a host of other initiatives-showed a 10 per cent increase in active participation across the community. By his draconian action, Michael Gove has put paid to this, with only government support for competitive sport to hide his nakedness.
But noble Lords can relax. Public schools, which educate just 7 per cent of our children, know better. Their comprehensive programme of expensively funded school sports continues unabated. They provide a full range of sport, competitive and non-competitive, and they will be richly rewarded. In future, even more privately educated athletes will hold aloft the winning trophies and wear the gold medals around their necks. The rest-the 93 per cent-will look on to a world that has been ruthlessly denied them.
Finally, to put the tin lid on it, the Government have announced an additional £41 million for the Olympic opening ceremony, presumably for hundreds of synchronised maypole dancers. What a total lack of judgment. That money should have gone back into schools and grass-roots sport. It is most dispiriting. The coalition has lost its way.
Baroness Garden of Frognal: My Lords, I thank my noble friend for calling this debate, the importance of which is exemplified by the calibre and the expertise of those who have spoken this evening and the quality of their contributions. It is not often that we get the chance to debate the quality of teaching of PE and sport and the positive impact it can have on lifelong participation, and I am very pleased that we have been able to do so today.
Ofsted's report, Physical Education in Schools 2005/2008, published in April 2009, found that the overall quality of teaching in physical education was good or better in two-thirds of the schools it visited, although it was more variable in primary schools. The previous Government's PE and Sport Survey 2009/10 found that 84 per cent of pupils aged five to 16 participated in at least two hours of physical education per week in curriculum time. However, the survey also found disappointingly low take-up of regular competitive sport by young people, with only around two in five pupils taking part in regular competitive sport within school, and only around one in five in regular competitive sport against other schools. That is hardly a good platform on which to base lifelong participation in sport. I rather share with the noble Baroness, Lady Grey-Thompson, some memories of those miserable days on cross-country runs and foggy sports pitches. For those like me who were not in any way built for sport, this did nothing to enhance self-esteem.
However, noble Lords throughout this debate have spoken of the very wide-ranging benefits of sport which of course start with a good teaching experience. The noble Baroness, Lady Howells, the noble Baroness, Lady Grey-Thompson, the noble Lord, Lord Smith, and others indicated the importance of enthusiastic and motivated teachers at school to ensure that young people regard sport as fun. This is really important if we are to encourage young people to continue sport after school and into their adult life. We know that there are ages and stages when participation drops. As my noble friend Lord Addington indicated, 16, 18 and 21 are the key ages at which participation drops. There are particular concerns about cohorts, including girls and young women, and indeed young people with disabilities who are not encouraged to continue in sport, as might serve them well. We heard from the noble Baroness, Lady Howells, about the life-changing effects of sport, the inspiring programme in Grenada, and the event she attended recently at Newham College.
I will pick up one or two of the references to particular sports. My noble friend Lord Addington asked for examples of the best schemes targeting community participation. We have an example from England Netball, which developed the Back to Netball programme aimed at tempting women who have dropped out of the sport to return through a fun and flexible
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As part of delivering a legacy from the London 2012 Olympic and Paralympic Games, the Secretary of State for Culture, Media and Sport has stated that he wants to create a culture of people playing sport for life and has already written to all the national governing bodies of sport saying that they will be required to focus more on youth from 2013-specifically the 14 to 25 year-old age group. He will be making an announcement in January about a new strategy for participation which will include better links between schools and sports clubs in the community. Contrary to what the noble Baroness, Lady Billingham, was saying, we are not walking away from increasing participation. Every sports governing body will have individual targets in their 2013-17 sports plans that they will have to reach.
The ambition is for every secondary school club to be linked to a multi-sport club in their area and for sport governing bodies to have much stronger relationships with schools. As we have heard today, young people who join a sports club are far more likely to continue playing sport when they leave school. By providing the right coaching or activity at the right time and in the right place, we can bridge the gap between school and community sport through satellite clubs and sports hubs. Sport England is working with 34 national governing bodies of sport to increase the number of five to 19 year-olds taking part in club sport or taking on leadership and volunteering roles within sport. Those roles are also extremely significant in involving and enthusing people.
Places People Play, Sport England's £136 million lottery-funded mass participation legacy programme-which was mentioned by my noble friend Lady Heyhoe Flint-includes Sportivate, a £32 million programme that gives 14 to 25 year-olds access to six-week courses in a range of sports including judo, golf, tennis, wakeboarding, athletics, and parkour-or free running. That programme is aimed at those who do not currently choose to take part in sport in their own time, or who do so for a very limited amount of time, and will support them to continue playing sport in their community after the six weeks is up. There is also the Sports Makers programme, which is recruiting tens of thousands of new sports volunteers, aged 16 and over, to organise and lead community sporting activities across the country.
My noble friend Lord Addington and the noble Baroness, Lady Billingham, have berated us once again on the School Sports Partnerships front. The noble
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We will build on the good work already being done by schools to encourage more pupils to play competitive sport both in their school and against other schools. I stress that we are not trying to dismantle school sport partnerships. We are happy for schools to continue to work in partnership with other schools if they wish to do so. We are simply not requiring them to and instead entrusting partnerships to schools for them to continue to fund them from within their school budgets if they want to.
There are all sorts of partnerships. My noble friend Lord Lexden spoke of the very successful schools partnerships between state and independent schools, which enhance the prospects of a range of children and young people who would not otherwise have access to particular facilities. We are encouraged by the fact that more than 10,000 schools have signed up to be part of an exciting new competition, mentioned by my noble friend Lady Heyhoe Flint, which will harness the power of the London 2012 Olympic and Paralympic Games to inspire a generation of young people to take part in competitive sport, and will culminate in a national finals competition. The first of these will take place in May next year at the Olympic Park. In response to the noble Baroness, Lady Grey-Thompson, I say that more than 30 sports are involved in this, so there should be something for everyone to participate in. We hope that all young people-boys, girls, young men and young women, the disabled and the fully able-will find something that will be interesting and fun to participate in.
The noble Baroness, Lady Grey-Thompson, mentioned the difficulty of engaging girls and women in sport. It was great to hear that England's netball team recently became 2011 world series champions. Following the World Championships this year, we have 12 world champions in Olympic sport, of whom six are women; and 18 world champions in Paralympic sport, of whom eight are women. The participation figures for women's sport do not make great reading. The Government will be much tougher at holding sports to account and encouraging them to ensure that girls enjoy sport as much as boys.
My noble friend Lady Heyhoe Flint also mentioned the community use of school sports facilities. The Government are encouraging more community use of school sports facilities through extended schools programmes. We hope that they will remain open for more people to enjoy.
The noble Lord, Lord Smith, talked about sport giving young people self-esteem, and about how life-enhancing that is in all sorts of ways that range far wider than sport. Significant evidence shows that sport can have a positive impact on behaviour. When it is used as part of a wider development programme of education and support, it can certainly lead to reduced
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The contributions to this short debate have focused very much on the wider impact of sport on life-enhancing skills. We have heard about a sense of achievement. My noble friend Lord Lexden spoke of the virtues of sportsmanship and my noble friend Lord Addington of the social benefits and of a wide range of other activities that add to them.
I am conscious of the time. I end by thanking all noble Lords who took part in this stimulating debate, and give special thanks to my noble friend Lord Addington for raising this important issue. We are all shaped by our experiences. No doubt the shape of many of us here reflects the amount and quality of PE and sport we experienced and enjoyed at school, and the extent to which we took that participation with us into adulthood. As we count down to the Olympic and Paralympic Games we can be excited and proud of all that is going on in school and community sport. The Government will continue to work hard to ensure that sport remains a key part of our national life.
(a) the provision of ethics committee opinions and other approvals,
(b) with the National Institute for Health Research and NHS trusts, delivering a consistent, efficient process for obtaining permission for research carried out under the scope of the Research Governance Framework for Health and Social Care (referred to as "NHS R&D permissions"),
(c) with the Medicines and Healthcare Products Regulatory Authority, improving the regulation of clinical trials of medicinal products, and
(d) other such functions as may be specified in regulations including those currently being undertaken by organisations which will cease to function following the implementation of future legislation.
(a) providing general oversight and guidance as it considers appropriate in relation to activities within its remit,
(b) publishing annual metrics and indicators on all research approvals within its remit,
(c) working with relevant bodies across England, Wales, Scotland and Northern Ireland to address differences in practice and legislation, and providing supporting guidance or codes of practice that apply across the UK,
(d) superintending compliance with requirements imposed by legislation relevant to its remit,
(e) monitoring developments relating to activities within its remit, and
(f) facilitating and promoting health research involving human participants or their data.
(6) In carrying out its functions, the HRA must, so far as relevant, have regard to the principles of best regulatory practice (including the principles under which regulatory activities should be transparent, accountable, proportionate, consistent and targeted only at cases in which action is needed).
Lord Willis of Knaresborough: My Lords, I beg to move, at last, Amendment 258 and will speak to Amendments 260A, 260B and 260C, which stand in my name and those of other noble Lords. I put on record my thanks to noble Lords across the Chamber for the way in which they have supported a series of proposals and amendments concerning research. This has been a non-party political area of the Bill and I am deeply grateful to them.
On Monday, the Prime Minister launched a new strategy for UK life sciences with all the hype that he could muster-quite right too, as it is an outstanding document and contribution to life sciences. Our research is world beating, our National Health Service has a patient database unrivalled anywhere in the world and we are putting together a research and governance framework that will make the UK the place to do health and medical research. It is UK patients who will benefit by having novel and ground-breaking treatment literally years earlier than could have been hoped for five years ago when the noble Lords, Lord Darzi and Lord Sainsbury, set out with a very similar message. There is no difference between either side of the House on that issue.
By coincidence, the amendments before us today will help deliver that strategy-and deliver it earlier. At the heart of the delivery platform for the strategy for improved outcomes for patients is the Health Research Authority, established not as a creature of Government but as a full NDPB. In essence, the amendments in this group would put in the Bill the commitments that the Prime Minister gave this week, and that the Secretary of State gave when he accepted the proposals made by the Academy of Medical Sciences in its ground-breaking report, A New Pathway for the Regulation and Governance of Health Research.
To date, establishing the Health Research Authority via the Bill has not been the Government's preferred option; I think I am safe in saying that to the Minister. Instead, the usual cautious Civil Service-driven approach of creating a temporary vehicle meant that a special health authority was set up on 1 December to carry out many of the functions of a future NDPB. However, much of the confusion, duplication, delay and obfuscation outlined in Sir Mike Rawlins's report will continue to exist, as we wait for another Bill that may or may not
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The Minister argues that the special health authority will do almost everything that such a Health Research Authority will do, but is this really the case? Will it really have the authority or the power to change much at all? The research community welcomed, as I did, the transfer of the National Research Ethics Service to the special health authority, but what about the plethora of other regulatory bodies? Ethical approvals, including the storage of tissue, from the HTA, and embryo project licences from the HFEA will still be required. Ethics and Confidentiality Committee approval will still be needed for exemptions to common-law confidentiality. Permissions from the Administration of Radioactive Substances Advisory Committee will be needed if research clinicians wish to administer radioactive substances. All the powers of the Medicines and Healthcare products Regulatory Agency will remain exactly where they are.
As a special health authority, the Health Research Authority has absolutely no authority to deal with the different legislative regulatory arrangements across the devolved nations. It was quite interesting that with Amendment 260, tabled by the noble Lord, Lord Patel, the Government prayed against creating a special health authority because it would be able to deal only with England; it would not be able to deal with the rest of the United Kingdom. This is exactly the sort of organisation that has been set up to deal with this crucial area of health research.
Crucially, there will still be the vexing issue of individual National Health Service research and development approvals. Unless the HRA is set up as an NDPB in this Bill, approval processes, which are often taken sequentially rather than in parallel, with often conflicting advice from different bodies, will continue to cause confusion, delays and frustration, and the UK will continue to see research programmes haemorrhage away to international competitors as clinical trials persist in being problematic-exactly the opposite of what A New Pathway for the Regulation and Governance of Health Research is preaching to us this week.
Amendment 258 would establish the Health Research Authority in primary legislation-now-as an NDPB and set out the HRA's role in co-ordinating the approval and regulation of health research. Subsection (3) provides for the transfer to and the management of,
Subsection (3)(a) covers the transfer of functions of the National Research Ethics Service to the HRA when it is established as a full NDPB, but the wording is broad enough to cover other research approvals that could be transferred-for example, those of the Human Fertilisation and Embryology Authority, the Human Tissue Authority, the Ethics and Confidentiality Committee and the Administration of Radioactive Substances Advisory Committee-all without the need
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Subsection (3)(b) covers the HRA's role in providing NHS R&D permissions, which it would undertake jointly with NHS trusts. Amendment 260C, which I will come to in a minute, allows for a more detailed exploration of the exact role of the HRA in NHS R&D permissions. Subsection (3)(c) covers the HRA's role in supporting the MHRA in the regulation of clinical trials.
Subsection (4) explores the general functions of the HRA. At the moment, some regulatory organisations are very good at providing advice and support; others, quite frankly, are not. High-quality guidance is needed in some areas, and where this is currently absent or confusing-for example, in the use of patient data in research, which is an absolute minefield-subsection (4)(a) would ensure that researchers apply appropriate standards consistently across all studies, with the HRA becoming an authoritative source of guidance both to support researchers and NHS trusts and to build patient confidence in research.
while subsection (4)(c) addresses the important area of UK-wide research frameworks. The regulation and governance pathway is currently fragmented across the whole of the United Kingdom. Some research approvals, such as those of the HFEA, apply to the whole of the UK; some apply to England and Wales, with different arrangements in Scotland, as happens with the HTA and the ECC; and some are managed separately in each Administration, as happens with the NHS R&D permissions in individual healthcare trusts. The complexity of the system can create additional barriers for researchers, which is a huge barrier to the UK being the prime destination in terms of research.
Put simply, Amendment 258 would allow the Health Research Authority to be set up with a minimum of detail, allowing the details to be worked out in consultation with the broad community, and indeed with public consultation, but it would mean that any future government would have to work on putting it into action, rather than waiting for some legislation, which may or may not come down the track. The real issue is that if we are left with a special health authority, we will be left with it in four, five, or perhaps even 10 years' time. We will have lost the opportunity to move forward. It is that serious.
Amendment 260A is a probing amendment, which sets out the specific health research functions that should be transferred to the Health Research Authority. What we are saying is that, in addition to the National Research Ethics Service, it would be easy in this piece of legislation, which the Government may or may not take forward-and this is entirely a probing
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Amendment 260B is again a probing amendment, which seeks to strengthen the link between the Medicines and Healthcare products Regulatory Agency, the MHRA, and the proposed Health Research Authority. In effect, it would establish a duty of co-operation between the two organisations. It is expected that the new Health Research Authority will take on most aspects of the regulation of health research, except for the regulation of clinical trials of investigational and advanced therapy medicinal products, which will continue to be regulated by the MHRA. This simple amendment seeks clarity from the Government around their expectations for the relationship between the Health Research Authority and the MHRA.
Finally, Amendment 260C is the crucially important probing amendment because what it would do is establish an organisation called the "National Research Governance Service". This is hugely important because one of the biggest barriers to effective development of clinical trials at the moment is getting NHS R&D permissions. It took one hospital five weeks to get the necessary permissions for a kidney research clinical trial; in another it took 29 weeks. Getting a stroke programme up and running took one week on one site and 35 weeks on another. The average time it takes to get a cancer trial up and running is something like 80 weeks. It is absolute nonsense, and how the Minister can turn to this House and say we have an opportunity to do something about that and not take it is something only the Minister can respond to-which I am pretty sure he will do very strongly and very supportively of these amendments in the near future.
NHS R&D permissions are currently the greatest barrier in the regulation and governance of health research, with multiple, duplicative checks undertaken at every NHS site. The Academy of Medical Sciences recommended creating a national research governance service-this comes directly from the AMS report-within the HRA to centralise as many of these checks as possible to avoid duplication. The Government have ignored this recommendation and instead introduced standard operating procedures and incentives to make improvements to the current system. Only a civil servant could have done that, when in fact what we want is action.
I say to the Minister that these developments are welcome but it is far from clear whether they will be sufficient to remove this major barrier. Amendment 260C would provide the framework to remove vast amounts of duplication. Subsection (2)(a) of the proposed new clause would mean that the governance checks that apply to every site would be undertaken just once by a central body and would therefore reduce duplication. Let us imagine the effect that that would have on getting clinical trials up and running, particularly large trials.
Some may argue-the Minister may in his response-that it is not possible for a central body to undertake governance checks or to grant NHS R&D permissions on behalf of NHS trusts because trusts are autonomous bodies. I say that that is nonsense. It is essential that we find a way to deliver that. The idea that trusts will not work together and will not rely on a responsible body to do that work for them is something for which there is no evidence to support those claims. Many trusts currently are able and willing to delegate responsibility for the checks, provided that they trust the body undertaking the checks. An independent body, an NDPB, would deliver that, rather than what is proposed by the Government.
swiftly. On the recommendation of the Academy of Medical Sciences, we have set out a 20-day timescale for NHS trusts to undertake this part of their governance checks. At the moment, NHS R&D permissions are the time-limiting factor in all research approvals and examples have been given where it has taken in excess of a year to get a permission at a single site. Twenty days is ambitious. The role of trusts in the process would be reduced as more things are done centrally. But all in all this is a real opportunity for us to deliver a major change in the way in which we put together research programmes.
I hope that my noble friend in his reply, and other noble Lords who will speak to these amendments, will accept that this is a one-and-only chance for us to do something momentous in this House. I trust that the Minister will give full support. I beg to move.
Lord Walton of Detchant: My Lords, I give very warm support to these amendments, which were so expertly introduced by the noble Lord, Lord Willis. As he said, the report of the Academy of Medical Sciences, after a long period of study and a committee chaired by Sir Michael Rawlins, made a number of important proposals, which the Government, in principle, accepted.
This takes the matter very much further. Following last night's very exciting and far-sighted Statement by the Government about the developments in research and their sponsorship of translational research, the need to translate the discoveries of basic medical science into practical developments in patient care, the crucial importance of making access available to the NHS database to enable clinical trials to be carried out, and the crucial importance of more rapid access to new medicines and so on through the NHS, it is crucial to recognise that all those proposals are very important. These amendments would carry that forward.
It is also important that the Health Research Agency, which has already been established, is as yet an inadequate vehicle to further the developments to which the noble Lord, Lord Willis, referred in great detail. It is essential to recognise that to carry forward the developments envisaged in the Government's Statement last night on translational research on the governance of clinical trials and the overall governance of research as a whole in the NHS, something like these amendments must be put in the Bill.
I want to comment briefly on the proposals set out in one of the amendments, to the effect that it would be sensible to remove from the Human Tissue Authority and the Human Fertilisation and Embryology Authority their research components and that these would much more happily settle in the newly defined Health Research Authority. There is a lot of sense in that, because the research carried out by these organisations is important, and it is research that is in many ways crucial to the development envisaged in these amendments.
However, it is important to recognise too that the Human Tissue Authority in its present existence has a major responsibility for regulation-regulating the departments, for instance, in which anatomical work is carried out, and regulating departments of pathology and other teaching functions which are absolutely vital. Similarly, the Human Fertilisation and Embryology Authority is not primarily concerned with research but also has major licensing functions, in licensing organisations in which work under the Human Fertilisation and Embryology Act can be carried out.
I understand that there has been a proposal by the Government that the functions of the HTA and the HFEA might be transferred to the Care Quality Commission. I would only comment, as John McEnroe said, that you cannot be serious. The Government cannot really be serious. This is not an organisation which is set up to handle that type of information. It is crucial to recognise that the Care Quality Commission has very specific responsibilities. It has taken on the responsibilities of three previous bodies, which were involved in looking at healthcare, social care and psychiatric care. It is carrying a major load-
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): Will the noble Lord give way? I am sure the noble Lord will know that through this Bill we cannot transfer the functions of either the HTA or the HFEA to any body at all. Indeed, that was the substance of my undertakings to this House under the Public Bodies Bill debate-that we would defer consideration of those matters until a later Bill. This Bill simply covers the reform of the health service, obviously, and my noble friend has sought to introduce an amendment to set up the Health Research Authority as a statutory body. But I gave an undertaking to this House that I take very seriously: that the consultation process on the transfer of functions from the HTA and the HFEA has to take place. It would be premature for this Bill to cover that matter. For that reason alone, I urge noble Lords to be very cautious about my noble friend's amendment, about which, nevertheless, I will say some warm words.
I wanted to specifically cover that matter, as I notice the noble Baroness, Lady Warwick, looks as if she wants to rise to her feet. I can understand why, because it is important for the Committee to understand that the matters to which the noble Lord has just referred are matters which we will reach in due course, rather than today.
Lord Walton of Detchant: I am very grateful to the noble Earl for clarifying the position, but it is important that in the longer term we shall have to learn more about the future of those two very important authorities.
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Lord Patel: My Lords, I hesitated to rise last time because I saw the Minister getting up, and I thought he was about to make a pronouncement to stop the debate because he had a solution to it all, but I realise now that was not the case.
I strongly support the amendment of the noble Lord, Lord Willis. I have my name attached to it. It is crucial that we hear more than just the setting up of the authority, as the Government have announced a few days ago, to take charge of the National Research Ethics Service. I was part of that organisation until I finished my time in the National Patient Safety Agency and was responsible for setting up much of its work, so I take the blame for its shortcomings, if there were any.
The issue we are discussing is why there is a need to set up the Health Research Authority with wider functions than those of NRES. The report produced by the Academy of Medical Sciences identifies serious issues which are important if we are going to deliver on the life sciences strategy announced yesterday and on which I have highly commended the Government; it is excellent. But if we are to deliver on it, we need to streamline the regulatory processes that currently are so cumbersome. For instance, an NHS research and development permission is required at every NHS site where the research is to take place, and the review by the Academy of Medical Sciences confirms that this is perceived to be by far the greatest barrier within the regulation and governance framework. The current process for obtaining research permissions across multiple NHS sites is inefficient and inconsistent. Local negotiation about research contracts and costings is a further source of delay, together with a lack of agreed timelines within which approval decisions are made. Governance arrangements are therefore very important, and the noble Lord, Lord Willis, told us that the report has highlighted that there should be a governance board as part of the Health Research Authority.
The noble Lord gave some examples of delays which had been highlighted by respondents, including in kidney research, stroke research and multiple clinical trials involved in heart research. The solution is to set up an authority which can provide a national research governance service as a part of it. Clinical trials are another example. The noble Lord mentioned how our global share of clinical trials has fallen dramatically. This is particularly related to the fact that it is cumbersome to conduct clinical trials in the UK. To address the challenges identified around clinical trials, improvements are clearly necessary at both the European and the UK level. I know that discussions are going on and that the department is involved in a revision of UK clinical trials, and I hope that they will come to some fruition. The noble Lord also said that the relationship between the new Health Research Agency and the Medicines and Healthcare Regulatory Agency will be
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The problem is that the existing regulation and governance pathways, which evolved in a piecemeal manner over several years, have now become dysfunctional. Although new regulatory bodies and checks have been introduced with good intentions, the sum effect is a fragmented process characterised by multiple layers of bureaucracy and uncertainty in the interpretation of individual pieces of legislation and guidance. This has produced a lack of trust in the system along with duplication and overlap of responsibilities. There is no evidence that these measures have enhanced the safety and well-being of either patients or the public, so the answer lies in now creating a Health Research Authority with multiple functions in order to go forward.
Baroness Warwick of Undercliffe: My Lords, I declare an interest as chair of the Human Tissue Authority, whose work is affected by the review of arm's-length bodies and is referred to in one of the amendments. The desire to streamline the governance and regulation arrangements to support high-quality research underlies both the Government's intentions and the amendments relating to the new Health Research Authority. These are laudable aims which I certainly support and which the HTA also supports wholeheartedly. Researchers want to get on with their research, and from their perspective what is important is that they see a seamless end-to-end and proportionate process for regulation and governance. The HTA has always striven to do exactly that within its focused regulatory remit relating to research while ensuring that the interests of the public are protected. But transferring the HTA's work in research to the new body, as Amendment 260A proposes, may undermine these aims. I want to focus my brief remarks on that point.
The Department of Health clearly has favoured an option to keep all the HTA's functions together, including research, and will consult on that basis shortly. I believe this is to a large extent because of the HTA's track record of collaborative working to ensure that the regulatory burden on researchers is minimised. I would be happy to provide a range of examples dealing with NRES, the MHRA, the HFEA, tissue banks and clinical pathology accreditation, but in the interests of brevity I certainly will not iterate them now. Suffice it to say that, in the absence of detail at this stage about how the HRA will operate, it would be premature to make decisions now in haste that we may live to regret later. However, I will briefly set out three reasons why I believe that the HTA's research functions should not be part of the Health Research Authority.
First, if the HTA research function transferred to the HRA, some organisations that now have a single HTA licence for all their human tissue activities, including storage of tissue for research, would then be regulated by both organisations, because their other functions would also need to be licensed. There would, inevitably,
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Secondly, and perhaps most importantly, the HTA is the guardian of consent. Splitting it up, which would be the result of this amendment, could risk a different understanding and interpretation of consent and create potentially lower or conflicting standards in different sectors over time.
Thirdly, when the Academy of Medical Sciences review looked at the key issues for researchers, it identified clinical trials approval, NHS R&D approvals and patient information. It is a misnomer to talk about the HTA's research functions in the same breath as these. Although the HTA has a broad regulatory remit, its licensing remit in relation to research is relatively discrete-it extends only to storage of tissue and its removal from the deceased. The HTA does not license the use of tissue for research, approve clinical trials or approve individual research projects.
The HTA reduced licence fees by 30 per cent in the research sector this year and it will make further reductions in 2012-13 as a result of improved efficiency. The marginal cost of regulating research among other activities is relatively low.
The HTA will work closely with the Health Research Authority to provide the single point of access for researchers that retains all the strengths of its current systems and fully meets the requirements of the legislation. The HTA wants and expects to be judged on how it achieves that for the benefit of research.
Lord Turnberg: My Lords, I had a previous bite of this cherry when I spoke at some length in my prayer to take note of the statutory instrument to set up the Health Research Agency a few weeks ago, so I will not be long and will not repeat what I said on that occasion about the need for a research regulatory authority that was more than simply a home for the national research ethics committee. Highly important though that is, my message was that it was essential but not sufficient. If we are to get over the barriers to research posed by the regulatory processes that delay research approval, we must include more functions.
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