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The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Taylor of Holbeach): My Lords, we have regular contacts with Thames Water on all aspects of the tunnel proposal, including its strategic approach to transport. Details on lorry movements are a matter for the project sponsor, Thames Water, and are included in its current public consultation. Final proposals will be in its planning application, expected in autumn 2012. The planning process ensures that environmental factors such as transport impacts will be considered.
Lord Berkeley: I am grateful to the Minister for that reply. He is certainly right that, in its second consultation, Thames Water has reduced the volumes of lorry traffic by half by agreeing to transport the spoil by river, which is about half the total. However, is he aware that in Network Rail's construction of Blackfriars station most of the materials, not just the spoil but other construction materials as well, are coming in by river? I am sure the Minister will agree that that is very commendable, given the traffic jams around there. What will he do to try to persuade Thames Water to do the same for that very much bigger project, including bringing in tunnel linings, concrete and things like that by river?
Lord Taylor of Holbeach: My Lords, the noble Lord has great experience in tunnelling and engineering, which I respect, and I share his view that the river is a great London resource that should be optimised and used for such occasions. It is important to emphasise, however, that at the moment the project is undergoing a consultative phase. There are guidelines on the use of rail and river for the movement of waste soil, for example, which are already laid down. I hope that any members of the public who have an interest in this matter will make their views known during the consultation period.
Baroness Gardner of Parkes: My Lords, is the Minister able to tell us whether he and Thames Water are aware of the great concern of local residents, many of whom I know, about the constant use of their streets in the area? Will there be limited hours of work? Will they have any respite during this work, which I must say is very important for the future of London?
Lord Taylor of Holbeach: My noble friend is right to emphasise that there are local neighbourhood implications in any project of this size. As I have emphasised, the project is at the moment in consultation and it is very important that people who feel they may be affected make their point of view clear. Thames Water has estimated that there will be around 4.6 million tonnes of excavated material generated in the lifespan of the tunnel's construction. The management of that lies with the principal contractor, who will have to abide by the planning conditions laid down when planning permission is granted.
Lord Brooke of Alverthorpe: My Lords, while I recognise that the planning process is still under way, could the Minister, who is very popular in the House, not agree with the view of my noble friend Lord Berkeley that, in addition to spoil, efforts should be made by the contractors to use the river more than they are doing at the moment? Could he not just simply drop a little Christmas note to them to that effect?
Lord Taylor of Holbeach: I am of course grateful to add to the House's Christmas cheer, and this is a great opportunity to do so. I think I made it pretty clear that I saw the river as a great resource and that it would indeed make sense to use it for the shipment of materials, but in the end the process really is that Thames Water has to make the application. I have given a pretty strong steer as to what we expect of Thames Water and, indeed, of the contractors.
Lord Bradshaw: Does the Minister agree that, in view of the large number of accidents to cyclists in London, including, unfortunately, a lot more deaths this year, he should ensure during the process that a proper risk assessment is conducted on the means of both supplying material and taking it away?
Lord Teverson: My Lords, given the importance of bringing in materials, would the Government perhaps ask the construction authorities and Thames Water to look at the use of Cornish china clay spoils materials? They could be brought to London so that we could have the benefit here, while removing some of the spoils from Cornwall.
Lord Taylor of Holbeach: My Lords, that is an unusual suggestion, which even in my wildest moments I had not anticipated being asked. I am sure that anything that makes my noble friend feel more at home must be a jolly good idea.
Lord Berkeley: My Lords, I am grateful to the Minister for his reply and to the noble Lord, Lord Teverson, for suggesting the use of china clay waste-I live in Cornwall and it is dear to my heart. I wonder if I could press the Minister a little further, though. Half the materials may be transported by road, which would mean around 250 trucks a day. The noble Lord, Lord Bradshaw, has also mentioned the risk of accidents to cyclists and so on. Surely it would be a good idea for a planning condition to be put on this development saying that perhaps 90 per cent of all materials must come by river or rail.
Lord Taylor of Holbeach: As I have tried to emphasise, those terms ought to be set in the planning decision. It is not for us at this stage of the process. I have tried to make it clear that there will be consultation, planning and then the award of the contract.
To ask Her Majesty's Government what action they are taking to ensure that police authorities speedily and fairly settle claims outstanding under the Riot (Damages) Act 1886, particularly for uninsured claimants.
The Minister of State, Home Office (Lord Henley): My Lords, the Government are committed to dealing with all claims where property was damaged in the August disturbances. We are working closely with the affected police authorities and the insurance industry to ensure that the processes that they have in place allow claims to be made as quickly as possible.
Lord Clement-Jones: My Lords, thousands of households and businesses are still waiting for compensation from police authorities after all this time. Some £3,500 has been paid out, of the £200 million or so worth of claims, and many valid business interruption claims are being contested. Does the Minister agree, especially in the light of the Prime Minister's assurances on 11 August, that this is quite unacceptable? Will the Home Office issue firm guidance to police authorities to speed up the processing of claims and
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Lord Henley: My Lords, I accept what my noble friend says, that things have not been as speedy as they should have been. We estimate that some 5,000 claims have been received, totalling in excess of £250 million, but we must remember that a lot of those claims will include claims for loss that are not covered by the Act. We have to ensure that we do not pay out for things that the Government are not responsible for. We will try to deal with-as the noble Lord implied in his original Question-the uninsured claimants first of all, but obviously we want to deal with the insured claimants as well. That is why I stress that we are working with both the police authorities and the insurance companies to ensure that that is the case.
Baroness Sherlock: My Lords, I am grateful to hear that the Minister has offered a figure. I put down a Written Question to ask him how many payments had been made under the Riot (Damages) Act, and the Answer was three sentences long. It told me that applications for compensation were made directly to police authorities, and:
"There is no requirement for them to provide this information to the Home Office. Therefore, the precise figures of payments that have already been made to claimants will be held locally by each police authority".-[Official Report, 8/12/11; col. WA198.]
In other words, go and ask them. Does the Minister accept that the Government in fact bear responsibility for sorting this problem out? If so, will he be willing to report to the House what progress is being made?
Lord Henley: My Lords, I gave an estimate of the number of claims but I cannot give an absolute figure. That is why I stress that it is only an estimate that 5,000 have been made. One has to accept that a lot of those claims will not be valid; in certain areas there have been many more claims than one would expect. I make no further comment on that.
I will certainly keep the House fully informed about how we are getting on with these matters. We want to ensure that all claims are settled as quickly and fairly as possible, and that when we are dealing with public money it is handed out in the appropriate manner.
Lord Imbert: My Lords, does the Minister agree that the Riot (Damages) Act, which was passed in 1886 for a different society from the one that we have today, is anachronistic, outdated and unfair? The police service has had its budget cut by 20 per cent this year. How can it afford up to £200 million in compensation? The Act has the connotation of blame. If we are looking for blame for the riots, should we look at the economic policies of successive Governments in failing to provide employment?
May I draw a picture of a single mother, living on the 13th floor of a block of council flats with three teenage children? She starts work at 5 am every morning as a cleaner, does another job in the afternoon and comes home to hungry and cold children, yet we
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Lord Henley: My Lords, the noble Lord is making another point. I accept his remark that the Riot (Damages) Act 1886 is possibly past its sell-by date. For example, it does not cover motor vehicles, which had not been invented at that time. However, the Government have made it clear that we stand ready to provide financial support to police authorities and we do not see any of them losing out as a result of these claims.
Lord Cotter: My Lords, it is four months since the riots occurred and very strong assurances were given by the Government that businesses would be helped. The official report and other reports indicate that very few businesses have received the help that they expected to be given-and that we expected them to be given. I asked in September whether the Government would monitor the situation. Will the Minister give tangible figures and update us on the situation?
Lord Henley: My Lords, the Government have been monitoring the situation. My honourable friend the Minister for Policing has met representatives from the West Midlands police force, the Greater London Authority, the Met and the Greater Manchester police force. He has met the insurance companies, Kit Malthouse and a vast number of people. We are doing these things as quickly as possible. We extended the deadline by which people could make claims by 42 days. We have the whole subject under review, as I made clear in response to another question, and we will respond to those reviews in due course.
Lord Hughes of Woodside: My Lords, the Minister has been asked for figures three times. He keeps saying that the situation is under review and is being monitored. It is not monitoring that is required-it is action. Will he do something about it?
Lord Henley: My Lords, I totally reject that. I have made it clear that we estimate that there have been something of the order of 5,000 claims. We estimate that those claims total some £200 million to £250 million. That does not mean that all those claims are valid. Before we pay out public money, we want to make sure that they are valid and we will do that properly. We want to make sure that the uninsured are paid first and then deal with those who were insured, making sure that the insurance companies are repaid. That is why we are talking to the ABI.
Lord Elystan-Morgan: My Lords, I give the fullest support to the Minister's indication that the Government regard the Act as having passed its sell-by date. Taking the point of the noble Lord, Lord Imbert, may I ask the Government to look very carefully into the whole philosophy of whether it is right, in the 21st century, that claims should be made against police authorities, as opposed to a more general claim, perhaps against the Government? I also make the point that the definition of "persons" in the Act is deeply flawed, as are the definitions of "property". The Act should also be brought up to date to allow claims in respect of motor vehicles.
Lord Henley: The noble Lord is right to quote me as saying that the Act is beyond its sell-by date and needs to be reviewed. That is why it is being reviewed. I do not believe that the police forces will lose out. That is why we have made it clear that the Home Office is ready to support them. We will make sure that that is the case where appropriate. However, the important thing is that we look at the result of those reviews of the Act and then make the appropriate decisions.
The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord Freud): My Lords, the winter fuel payment is a simple to administer payment that ensures that older people can turn up their heating in the winter months without worrying about the cost. We have no plans to tax the payment. We are obliged under European law to continue paying the winter fuel payment to people who qualify for a payment in Great Britain and then move to another European Economic Area country or Switzerland.
Lord Oakeshott of Seagrove Bay: I thank the noble Lord for that reply. I am rather nervous about this Question because 674 noble Lords are entitled to receive the winter fuel payment. That is 81 per cent of us. Would I be right in guessing that the Minister, who is 61, is, like me, one of the half a million top-rate taxpayers who benefit from this farcical tax-free bung? Why cannot winter fuel payments at least be taxed like the old age pension? That would raise £220 million a year to help people in real need in our country.
Lord Freud: Yes, my Lords, like the other 81 per cent in the Chamber I have to declare an interest in this matter, although I shall keep my tax arrangements between me and HMRC. One of the issues around
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Lord Freud: My Lords, as the noble Lord knows, all money is fungible. This is a matter of psychology rather than funding. If people find it convenient to look at money as being in separate packets and give money in a particular packet to a particular charity, that is a very excellent thing to happen, particularly if it encourages charitable giving more generally.
Lord Freud: My Lords, I think it depends on what side of the country you live. I understand that the Mull of Kintyre is rather warmer than East Anglia, so I think that what the noble Lord suggests would be a pretty complicated thing to do.
Baroness Hayman: Would the noble Lord be kind enough to clarify his original Answer on overseas payments? Am I to believe that my Trinidadian born neighbour, who complained to me recently that a family member of hers who had returned to the West Indies was in receipt of the winter fuel payment, was incorrect?
Lord Freud: Yes, you can keep your winter fuel payment only if you go to another European country, so if it is being obtained by someone in Trinidad, the noble Baroness might make a call to Crimestoppers or someone.
Lord Freud: My Lords, clearly, one can look at how one treats this, but essentially it is a simple payment. It is one of the universal payments to pensioners along with the state pension, additional pension and passported benefits such as NHS prescriptions. That is how it is designed. It would be rather complicated and expensive to tax it.
Lord Kinnock: My Lords, the Minister appears to be very sympathetic to the idea of changing the system, and I am not taking into account the season of the year. Will he reconsider the possibility of a levy on higher-rate taxpayers? After all, what is good for King Wenceslas should be good enough for 81 per cent of us.
Lord Freud: My Lords, I am grateful to be told where my sympathies are but the reality is that about 500,000 people would be affected and the saving would be about £40 million a year. It would be expensive and difficult to do and, therefore, on its own, it would not be a good idea. That does not suggest where my sympathies are at all.
Lord McKenzie of Luton: My Lords, for the winter fuel allowance to be put to good effect, you have to have a home to heat. Sadly, we know that homelessness is on the increase in our country. The Minister is always keen to look at funding within fixed envelopes, but on what does he base his philosophy for supporting the retention of tax-free winter fuel allowances for higher-rate taxpayers, rather than providing more support for the homeless?
Lord Freud: My Lords, I hope that I have made it quite clear that when you have a universal benefit you pay it out on a simplified basis. Because it is a household payment, it would be enormously complicated to change that. Clearly, it could be done. There has been a small increase in homelessness but it remains at historically low levels. We are watching the figures very closely and it is a priority for this Government that we do not see an excessive rise in homelessness.
The Minister of State, Home Office (Lord Henley): My Lords, we will not. We are clear that the United Kingdom remains open for business. Our changes mean that we will continue to welcome the brightest and best who have the most to contribute to this country. At the same time, we are putting an end to the unlimited migration of recent years that has created unacceptable pressures on our public services.
Lord Taverne: My Lords, I acknowledge that there is a need for some control, but the Government seem to have indicated that they will reduce the number of non-EU migrants who wish to settle here after they have completed their studies. Will the Government take note of a powerful letter, written about a month ago to the Financial Times, by a number of very eminent academics who came here as non-EU immigrants and who would not have come if they had been told at the start that they would not be allowed to stay?
Lord Henley: My Lords, we will obviously listen to those academics but I have to say that the university sector as a whole is not complaining about what is happening. What we did was introduce a cap of just over 20,000 people, following the advice of the Migration Advisory Committee, on the number of skilled workers who were coming in. So far, in the first six months of this year, some 6,000 of those places were taken up-there is obviously a lot of slack in the system. There is no danger that any skilled workers are being denied the opportunity to come in.
Lord Hunt of Kings Heath: My Lords, on the question raised by the noble Lord, Lord Taverne, can we come back to the issue of universities and overseas students? The Minister has always maintained that the Government's restrictions were aimed at bogus colleges. If we accept that, will he acknowledge that universities are now reporting that the policy is having an impact? First-class universities are being affected by the cap and first-class students are being turned away. Surely that part of the policy ought to be reviewed.
Lord Henley: My Lords, obviously, we will keep all these matters under review as is appropriate, but the noble Lord will also accept that it is quite right that we should attack the bogus colleges, which his party took no trouble to attack over the years. That is why there was a dramatic rise in the number of people coming here allegedly to learn English or some other thing, who went to colleges where no courses were going on and virtually no one enrolled other than to get round immigration rules.
Baroness Hollis of Heigham: My Lords, does the noble Lord accept, as my noble friend said, that about 60 per cent of the non-EU migrants to this country are students and that, of those doing a proper degree course at the sort of university that my noble friend talked about, 98 per cent are compliant with immigration controls and return to their country-98 per cent? So we are losing both the opportunity of their fees coming into the university sector and the possibility of helping DfID export their skills back to their home country.
Lord Henley: My Lords, I do not accept what the noble Baroness says, but if she can provide proper evidence for that, we will certainly look at it in due course. We are not aware that universities are complaining; we are aware that a certain number of private colleges- the bogus colleges to which I referred earlier-are complaining. That is why we will want to deal with that. In the main, I think it is quite right that we
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Lord Hannay of Chiswick: My Lords, has any consideration been given, or is consideration being given, to taking students out of the immigration system? Now that the business of bogus academies has been dealt with rather effectively-I welcome that-would it not be sensible to recognise that the university sector is the most rapidly growing invisible export that this country has? It is simply not good enough to say that universities are not complaining. There may be some vestige of a lack of complaint from some body or other, but I would suggest that, if the noble Lord goes round the universities carefully, he will not find that that is the case.
Lord Henley: My Lords, I accept what the noble Lord has to say about universities being a very valuable export-we acknowledge that-but there should also be controls on students coming in. One area where we provided stricter controls is on undergraduate students bringing in families, which was seen as a form of abuse. We were quite right to tighten up on that and to keep more general matters under review, and that is what we will continue to do.
Lord Cormack: My Lords, of course my noble friend is right to maintain his attack on bogus colleges, but the point made by the noble Lord, Lord Hannay, deserves real consideration. At a recent dinner attended by the Minister for Universities and Science, Mr Willetts, at which there were eight or nine historians each from a different university, they were unanimous that this is having a deterrent and potentially disastrous effect. All we need is a little more sensitivity in the interpretation of the rules, or to put students in a separate category.
Lord Henley: My Lords, I acknowledge what my noble friend says. I am fully aware of these problems, having been the spokesman on higher education in this House, but there have been abuses. I referred to the fact of family members coming in with undergraduates. We have tightened up on that. I remember, as can many other noble Lords, that back in the early 1980s, when we first brought in fees for overseas students, we thought that we would lose out dramatically. We did not; we saw an increase in the number of overseas students coming in. I am sure that if we get this right and listen appropriately, we will continue to see a great many overseas students coming to our world-class universities.
Lord Tomlinson: My Lords, why does not the Minister agree with the sensible report that came from the House of Commons Home Affairs Committee? That raised the very issue raised by the noble Lord, Lord Hannay, that students should not be treated as migrants. We are sending out a message to all overseas students who would otherwise have come to this country-some in the public sector, some in the private sector-that they are a troublesome group who need to be controlled.
Lord Henley: The very simple reason is that some-particularly in the private sector, which is why I referred to private sector colleges-were involved in an abuse. If there is an abuse of the system, we have a duty to tackle it, and that is what we have done.
Lord Henley: My Lords, I think that I have followed what my noble friend has said. Obviously, we recognise the importance of universities-as I said in response to the question from the noble Lord, Lord Hannay, they are a major part of our exports. However, I also see what my noble friend is getting at. I have not seen the research that she refers to, which talks about the need to bring in workers from outside the EU. However, the point that I was making in my first supplementary answer was that we have a cap on the number of skilled workers, and we have not got anywhere near that cap in the first six months of this year.
Lord Patel: My Lords, I shall speak to Amendments 338 and 340, to which I have added my name in support of the noble Baroness, Lady Emerton. For those of your Lordships not familiar with the amendments, they are to do with the regulation of healthcare support workers. As many noble Lords will know, these workers were introduced into the health service just over a decade ago, and they are untrained, unqualified and unregulated. There are 300,000-plus of them in the health service, with many more working in nursing homes.
Any debate about the regulation of healthcare support workers will need to take account of current workforce trends. In April 2011, the Royal College of Nursing reported that NHS trusts were increasingly looking to reassess nursing roles in order to deliver short-term reductions in the wage bill without a full clinical assessment of the impact of this action on patients' safety and the quality of patient care. The RCN reported a notable change in the skill mix of teams, with an increased reliance on unregulated healthcare support workers.
The other workforce in nursing is trained and regulated. It is made up of registered general nurses and registered midwives, and we also used to have state-enrolled nurses. The view could be taken that it is the responsibility of employers to make sure that their workforce is adequately trained and has the skills to deliver the care, but many recent reports with which noble Lords are familiar highlight poor-quality nursing care. Some of them have appeared in the press and include the failings at Stafford Hospital, where hundreds died unnecessarily, and at Winterbourne View care home, where staff were filmed abusing vulnerable patients, as well as a series of critical reports, most recently from the Care Quality Commission, which has condemned NHS care for the elderly. Some, including regulatory authorities and particularly the Council for Healthcare Regulatory Excellence, favour the employer-led model of training of healthcare support workers or of those who are not trained yet provide nursing care. This model was introduced in Scotland. The important thing is that it has never been evaluated. That needs to be done first. Secondly, and more importantly, the ratio of trained nurses to untrained support workers is quite different in Scotland. Anyone who promotes this model needs to look at that first.
I return to some of the issues. The noble Baroness, Lady Emerton, made all the points in an excellent introductory speech. It is a pity that we did not have a continuation of the debate so that we could have heard her comments and responded to them. However, the Bill proposes that the regulators of healthcare professionals should have the ability to establish voluntary registers for currently unregulated workers and professionals who are, or have been, engaged in work that supports or otherwise relates to work engaged in by members of the profession that the body regulates.
In proposing voluntary registration, the Government have accepted that unregulated workers supporting healthcare professionals represent a risk to public protection that needs to be addressed. If they did not, why would they even consider voluntary registration? It must be because they think it is a risk. Voluntary registration for healthcare support workers carrying out tasks delegated by nurses or midwives is not sufficient to protect the public.
The other argument used is that it is the trained nurses-the registered nurses-who supervise these support workers who are not trained or regulated. How can a nurse, or two nurses, in a ward of 15 or 16 intensive care patients, supervise three or four unregulated, untrained workers, who then carry out nursing tasks? The noble Baroness, Lady Emerton, cited a real case of such a worker measuring blood pressure who did not understand why she was doing it. If one is going to have people who look after ill, frail people, one needs to make sure that they are trained properly, that their training is assessed, and that they are regulated. I understand that this cannot be done overnight, particularly as we now have nearly 400,000 such people working in the health service, but there ought to be some mission to do this in a relatively short time, maybe even in two or three years. To go after voluntary registration is not the answer.
There is currently no consistent UK-wide training standard for healthcare support workers. Courses can range from an hour-long induction up to NVQ level 3. Assistant practitioners are experienced health support workers. They are different, and they may receive training up to NHS-level band 4, which is equivalent to the level of the previous state-enrolled nurses, but, again, there is no consistency across the UK. Clause 231 gives no indication that a voluntary system will be underpinned by consistent UK-wide standards of training that will assure the public that employers who employ health support workers have the knowledge and skills that they need to practise safely. I strongly support this amendment. Whenever the noble Baroness wishes to call a vote, I will join her.
Lord MacKenzie of Culkein: My Lords, I have long been an advocate in the cause of statutory regulation and registration of healthcare support workers. When one has been around the health service for a long time, it is not unusual to see the wheels turn full circle. We went from support staff to auxiliary nurses, to nursing assistants, to state-enrolled assistant nurses. Then the word "assistant" was dropped and we had state-enrolled nurses. Then, as the noble Baroness, Lady Emerton, said earlier, the roles of the state-enrolled nurse and the registered nurse became very confused and the titles became interchangeable, which should never have happened. Then we moved to Project 2000 and the move from hospital-based training to higher education, and we are now moving from diploma to an all-degree profession, which is right and proper.
In 1999, my union, the Confederation of Health Service Employees, supported Project 2000, but we foresaw a gap that would be left by the ending of enrolled nurse training, which would lead to there being many more auxiliaries or healthcare assistants,
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Where are we now? We have an explosion in the number of support staff who have taken the place of enrolled nurses; there are far more than any of us ever envisaged at the time. As the noble Lord, Lord Patel, said, more than 300,000 support workers are now employed in various roles with a number of job titles. One figure that I saw in research produced by UNISON said that there were more than 120 different job titles for healthcare support workers, which is astonishing.
We have a situation in which the patients do not know who is caring for them. It is not just a question of uniform, although that is important. Support staff carry out many duties that were previously the role of regulated nurses. Many of those roles, such as nasal gastric tubes, cannulation, catheterisation and blood pressure, are intimate and invasive, as we have heard. Almost uncannily, in view of what the noble Baroness, Lady Emerton, spoke about, I spent some time in hospital a couple of years ago when I had my blood pressure taken sitting in a chair beside the bed and my diastolic pressure was down to 40. I said to the healthcare assistant who took that blood pressure, "I had better get back to bed and I think you'd better call a senior nurse and doctor". She said, "No, you are going down for an MRCP scan; just sit where you are". Fortunately, being a nurse, I knew what I was talking about and I was able to get a doctor and a nurse, and before very long I had massive amounts of fluid pumped into my veins to restore my blood pressure. Had I not understood the situation, that could have resulted in a serious condition. It is quite frightening. You can be trained to take blood pressure, but not trained in the skills of observation and in understanding the readings that are being taken.
With the drive to reduce costs, there is, and will be, more substitution of registered nurses by healthcare workers. In effect we have a new second level, but that new second level is not regulated and not registered and the staff are not professionally accountable for their practice. That is not good enough. That is not in the interests of patients' safety or protection. Nor will assured voluntary registration deal with the matter. Voluntary registers already exist for other professions and there are very real concerns about their inadequacies. They have no teeth, and staff can leave a voluntary register, particularly if there is any investigation for possible discipline.
The registration and regulation of healthcare support workers is supported by the Nursing and Midwifery Council, by the Royal College of Nursing, and by UNISON, although in fairness I should say that UNISON would prefer registration by the Health Professions Council. Registration is supported by the Queen's Nursing Institute, by the health committee in another place and, most importantly, by healthcare assistants themselves.
In the Nursing Times of 6 December, I was interested to see in a small article about the Mid Staffordshire NHS Foundation Trust public inquiry that Robert Francis QC spoke of 20 issues that he would consider when drawing up his recommendations, which are due to be published next year, and the regulation and training of healthcare assistants was to be first on the list. I hope that that does not mean that they will carry the can for all the problems in Mid Staffordshire because that is certainly not the case; they go to a much higher level than that. Counsel to the inquiry, Tom Kark QC, said that the lack of regulation of healthcare assistants appeared to be surprising and dangerous.
There is inexorable pressure for this matter to be dealt with-and dealt with soon. It is not something that can be put on the long finger. If there is a strong recommendation from the Mid Staffordshire inquiry, we cannot leave it to be dealt with in a future Bill because we will not be getting another health service Bill for some time. This Bill gives us the opportunity to do this and to get it right. I strongly support the amendment by the noble Baroness, Lady Emerton. Healthcare assistants who have work delegated to them by nurses should be properly regulated and registered.
Baroness Pitkeathley: My Lords, I am very sorry to take issue with the opinions of noble Lords with whom I usually agree most heartily. I remind the Committee of my role as chair of the Council for Healthcare Regulatory Excellence. I should make it clear that I am in no way taking issue with noble Lords' concerns about the practice of healthcare assistants, nor with the emphasis-given particularly by the noble Baroness-on the need for proper training. The only thing I take issue with is whether statutory regulation is the correct solution to the problem.
I am not aware of any body of evidence that demonstrates that the risks of future harm presented by the practice of healthcare assistants could not be successfully managed by the existing processes and governance systems if they were applied effectively. That is the point. Healthcare assistants are already supervised by other staff who have the professional responsibility to supervise them. As we have heard, they almost always work in supervised settings, with supervision usually being the responsibility of staff who are statutorily regulated. Statutorily regulated professionals have a responsibility to ensure that the staff whom they manage offer safe care, conduct themselves professionally and are delegated only tasks that are within their technical competence. For example, the Nursing and Midwifery Council's code states:
"You must establish that anyone you delegate to is able to carry out your instructions ... You must confirm that the outcome of any delegated task meets the required standards ... You must make sure that everyone you are responsible for is supervised and supported".
In other words, we already have in place a governance system to ensure that healthcare assistants work safely and with proper delegation, supervision and support from a statutorily regulated professional. Employers are required to ensure safe systems of work, which will include providing support in delegating and supervising effectively.
Creating a list of people is not in itself an effective safeguard. Effective regulatory conditions are often much closer to home. For example, in an environment that is poorly managed and distant from scrutiny, poor standards of care can become the norm, with staff being drawn into collusion with poor care. We have seen many examples of this recently, particularly of the process of collusion, with people working in a poorly managed environment unable to resist the downward spiral of standards. The most effective way to invert the spiral is by employers properly managing the specific environment, not by establishing another structure.
Winterbourne View was referred to several times in this short debate. Perhaps it is worth reminding noble Lords that registered professionals were involved in delivering poor care there. Statutory regulation did not prevent it. We should always bear that in mind. Regulation is not necessarily the answer. Further, we cannot ignore the fact that statutory regulation would be expensive and cumbersome for a large, low-paid workforce with a high annual turnover. It is not proportionate to the risk, which can be managed by effective training, delegation and supervision.
The recent announcement by the Secretary of State about improving standards of training and the potential to develop a voluntary register of healthcare assistants is encouraging. I also welcome the Nursing and Midwifery Council's announcement that it will fully engage with the project that the Secretary of State announced, and with any further developments around assured voluntary registration for this particularly valuable group in the healthcare workforce. It is important that we make sure that we value this group, who are of such importance in the front line of the nursing and patient care environment.
Lord Warner: My Lords, I am speaking because my name is also on this amendment. We need to reflect on several aspects relating to the context of this issue. I do not think that there is much doubt that we have a problem of some significance, or any doubt that the problem has been growing over a long time. I also do not think that it is an easy fix simply to jump to statutory regulation. I went through the process when the whole issue of regulating social workers arose, and that proved extremely difficult to introduce. I do not doubt that we will end up with statutory regulation of some kind, but we might have to go through some processes before we get to that point.
I do not want to duplicate the history that other noble Lords have put forward most expertly. I came into this story as a very young civil servant at the end of the 1960s when the Salmon committee was set up. Some noble Lords may be old enough to remember the Salmon committee-I was assistant secretary to the committee. This was in the days when civil servants could not hold a job for long and were moved on at a tremendous rate. While doing this work we saw how things worked at the ward level. In those good old days of the 1960s and early 1970s there was a ward sister, state-registered staff nurses, nursing auxiliaries and state-enrolled nurses. We also had a set of arrangements in which oversight of cleaning was largely the duty of the ward sister. Furthermore, bank working was not that common.
What has happened since those "good old days" is that hospitals have become used more intensively. Bank working has meant that there is a higher flow of different people moving through the wards, and the profession, with good reason, has wanted to make itself a graduate profession. The context has changed a lot, so the dynamics of those wards has changed quite a lot.
Alongside that we have been growing another industry in the community: in nursing homes, residential care homes and-not quite as fast as one would like, within the health service-a district nursing service. One of the problems in both these areas, whether acute hospitals or the community, is that with the demand of patients for services, and the demography which has gone alongside that shift in time, the qualified and registered nursing profession has inevitably had to look for help from sub-professional groups to help carry the load. In the community there is not a strong management structure to oversee this, so to some extent it is difficult for district nurses to oversee any work done by unqualified personnel. Such oversight might be the theory but in practice it will often be difficult to achieve.
Community services are burgeoning, the hospital service has changed, and we have a problem of a growing need for more people who are not qualified and registered nurses to work alongside such nurses to provide some of the care. We are looking to the Government to produce a comprehensive review that examines the situation that we face now rather than the situation we faced 10 or 15 years ago and which was very different.
I suspect that we will have to move by interim steps towards statutory registration, and perhaps voluntary registration is an interim step. However, I am not convinced that we have a comprehensive set of answers to a continuing and serious problem. The Government need to think about how they will deal with this very serious problem.
Lord Alderdice: My Lords, I also have some scepticism about assured voluntary registration, but I will come back to that when we debate the subsequent amendment. I have some sympathy with the noble Baroness's amendment. I had not intended to speak on this amendment until I heard a number of noble Lords speak, and I take a slightly different lesson from the history of the past number of years in the development of the nursing profession.
Like the noble Lord, Lord Warner, I remember sisters, state registered nurses, state enrolled nurses, nursing auxiliaries and so on, but one of the key things was that all those professionals described themselves as nurses. Indeed, I very well remember as a young doctor that nurses would not say, "I looked after that person", or "I was on the ward when that patient came in before", but said, "I nursed that patient". There was a quality of compassion and relationship that was critical to the profession. I think that not only nursing as a profession, but many other professions went down the wrong road when they took the view that the future was in tighter registration and a graduate profession because that was not fundamentally the need. I heard my right honourable friend in another place being
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My gratitude to the noble Baroness is not for the specific terms of her amendment, and I do not think that they were the burden of her bringing the amendment forward. It is that we engage in a serious, proper debate about this issue, not just for nurses, but for other professions. There are some for whom I believe that statutory registration is the proper way ahead, but there are others for whom it does not seem to be the case that always moving to graduate professions with training and registration is the sole and most important way of dealing with these questions. It is quite clear that making nurses graduates and having registered nurses only has simply opened a door that has had to be filled with other, less qualified and, it has to be said, less expensive employees. Now we have a problem with them not measuring up to the professional standards of compassion that all of those-or at least, almost all of those-who aspired to be nurses at whatever level in the past aspired to in the best sense.
I welcome the fact that the noble Baroness has tabled this amendment; I am not quite sure it is the precise solution, but I hope we find ways to come back to the serious ongoing debate that the noble Lord, Lord Warner, has pointed to because there is a crisis in this area. I remember saying this two, three, four years ago in your Lordships' House and noble Lords who are now on the Benches on the other side thought it was simply a party-political attack. It was not-it was a genuine sense of concern that things were deteriorating. They have continued to do so, and it will not be dealt with solely by registration, training and academic qualifications because a quality of care and compassion and a culture of compassion are necessary. That is not to take away from the question of assured voluntary registration, which I wish to explore in a further amendment.
Lord Hunt of Kings Heath: My Lords, I, too, pay tribute to the noble Baroness, Lady Emerton, for her perseverance and determination in this very important area. Rather like the noble Lord, Lord Alderdice, I am clear that the role of healthcare assistants has to be seen in the context of a much more general debate about nursing care, including the compassion that he talked so eloquently about.
As the noble Baroness said to us rather earlier this afternoon, we had an excellent debate on nursing on 1 December, and we are presented with something of a paradox: on the one hand, we should not ignore the huge advances in the nursing profession over the past 20 years. There has been the move to a graduate profession and nurses have taken on much greater responsibility, including for complex care and specialist care, and I think that, overall, the public have welcomed
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The reasons for that are not clear. It is possible that nurse training is now too focused on academic performance rather than on practical nurse training. It is also at least possible that the drive for specialist nurses and modern matrons has taken from the ward the many experienced nurses who, in retrospect, might be better placed in leading their ward as ward manager or senior sister. What is not in doubt is the need for serious thinking about how we can enhance the overall quality in standards of basic care that nurses give.
That brings us to the role of healthcare assistants. Again, in our debate on 1 December, the noble Earl, Lord Howe, in responding, referred to the concerns that had been expressed about nursing in the acute sector in particular. He said he felt that that,
"Wherever there is a multidisciplinary team of regulated professionals and unregulated healthcare workers, appropriate delegation and supervision is vitally important. This is an area ripe for formal review".
I am sure that those actions by the Government are very generally welcomed. The question before us is whether they are sufficient. From what the noble Baroness, Lady Emerton, has said, it is clear that she does not think that they are. Powerful support for that argument has been received from the Nursing and Midwifery Council, which argues that a system of regulation for healthcare support workers should contain provisions for consistent UK-wide standards of training and practice that would assure the public and employers that they have the knowledge and skills to practice safely. It further suggests a mandatory register to ensure that workers who have been struck off the nursing and midwifery register are not re-employed in a healthcare support role, which has been the subject of some concerns. It is also notable that the House of Commons Health Committee supports mandatory statutory regulation of healthcare assistants, which it believes is the only approach that would maximise public protection.
However, we have heard from my noble friend Lady Pitkeathley, chair of the Council for Healthcare Regulatory Excellence, who has put a different view. It will be interesting to hear the response of the noble Baroness, Lady Emerton, on why she thinks that a voluntary register for healthcare assistants is the way forward. I should like to ask her whether she would support NHS bodies which require healthcare assistants to be
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I have no doubt that NHS employers could be encouraged to make it mandatory but the problem with that is that too many people could slip through the net. I would also ask the noble Baroness to respond to my noble friend Lord Warner. I share his view that, clearly, we are crying out for a fundamental review of these issues around nursing quality and care, compassion, and dignity of care being given to patients, and that relationship to healthcare assistants. If the Government are not prepared to move on this and on the point about only going as far as a voluntary register, can they at least give some comfort and assurance that they recognise that this matter needs close attention?
I am not a great believer in royal commissions-I think it was Harold Wilson who said that they could be established in a minute but take years-but there is a strong case for a fundamental review of the nursing profession, embracing healthcare assistants. Would the Government be prepared to give us some comfort on this?
Baroness Northover: My Lords, these amendments seek to extend compulsory statutory regulation to healthcare support workers. I thank noble Lords for the amendments because they raise important issues about the ways in which we assure the quality and safety of those who work in support of our regulated health professionals. The Government are publishing a fact sheet on this issue that will contain further details about their proposals, which I hope will be helpful to noble Lords.
There are more than 200,000 nursing assistants and approximately a further 1 million people working in similar jobs in adult social care in England alone. The majority of support workers give the highest quality of care. However, a minority let patients down. This is rightly a cause for concern, although as a former historian I have to say that I do not fully recognise the notion of everything having been perfect in earlier periods but everything breaking down at this point. One needs only to look at what has been said from Florence Nightingale onwards about what happened during the interwar periods, during times of war and so on. This has always been more varied than perhaps noble Lords are allowing for. Nevertheless, it is extremely important that we try to drive up quality and ensure that quality holds good right across the health service and social care. It is right that there is discussion and debate about the best way of ensuring that high standards of care are delivered at all times.
As the noble Baroness, Lady Pitkeathley, pointed out, there are already existing tiers of regulation that protect patients and service users. Professionals struck off by their regulator or sacked by an employer who pose a risk to vulnerable adults or children should be referred to the Independent Safeguarding Authority, which has been very clear that it expects this to happen.
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An individual being on a list does not alter this and would not remove employers' responsibility to undertake a range of checks on the suitability of any persons who they appoint, including qualifications, relevant registrations, employment history and reference checks to ensure that an individual is competent for a specific role. Equally, appropriate delegation and supervision is a necessity within teams made up of both regulated and unregulated professionals and workers. Guidance by the Nursing and Midwifery Council is being updated so that nursing staff know how to delegate appropriately and safely.
We are not ruling out compulsory statutory regulation for healthcare support workers, but our view is that the case has not yet been made for imposing further compulsory statutory regulation, given the tiers of existing regulation and the duties on regulated professionals. There is no solid evidence that demonstrates that healthcare support workers and adult social care workers should be subject to compulsory statutory regulation. Research by King's College London concluded that little evidence could be deployed to show that regulation of healthcare support workers would reduce the risk to the public, although it was clear that some healthcare workers were undertaking roles that had traditionally been done by nurses. The point is that quality is not always what is delivered. Therefore, we have to try to tackle that concern and not simply assume that regulation will deal with it. As the noble Baroness, Lady Pitkeathley, mentioned, there are regulated professions which are in some instances letting us down. We must focus on the real problem and figure out ways of tackling it.
The Government's view is that high standards for healthcare support workers and other professional occupational groups can be assured without imposing compulsory statutory regulation. That is why, in the wider context of supporting providers, we are creating through the Bill a system of external quality assurance for voluntary registers. To pick up the point made by the noble Lord, Lord MacKenzie, there are various examples of voluntary registration for groups of professionals. We are proposing a quality-assured voluntary approach, looking at how those registers are set up and operated and what training is offered and so on. A quality-assured voluntary register will set standards for training, conduct, competence and ethics that all registrants must meet.
Lord Hunt of Kings Heath: My Lords, if the Government are putting so much faith in the quality-assured voluntary register, surely the evidence from King's College would show that that was not necessary.
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Baroness Northover: Regulation and training are often put as two words in one sentence. Regulation may indeed include training; assured voluntary registers may also include training. The noble Baroness, Lady Emerton, talked about that. Perhaps I may come on to it, because it is potentially relevant here.
I am particularly grateful to the noble Baroness for her contribution to this debate, not only today but throughout her time in the House of Lords. We agree that common standards of training are needed for those working in both health and social care, as well as more role-specific training, and that this will lead to a more capable and flexible group of support workers. As we seek to integrate health and social care more effectively, this area deserves a lot of scrutiny.
We expect work on the standards to begin by April 2012 in terms of training, and for them to be agreed ahead of the establishment of voluntary registers for healthcare support workers and adult social care workers, which could be operational from 2013. This will allow unregulated workers to demonstrate that they meet a set of minimum standards for training and are committed to a code of conduct.
Lord Hunt of Kings Heath: My Lords, I still do not understand this. If it is so important that the voluntary registers are established, for the reasons that the Minister has given, why on earth not go the full hog and make registration compulsory? If the Government do not think that it is important, they would not be pursuing the voluntary register approach. However, by taking that approach, they will leave lots of people outside the net.
Baroness Northover: As the noble Baroness, Lady Pitkeathley, and others have indicated, one has to be proportionate about this and not think that simply going down the route of regulation is going to crack it. Nevertheless, training and making sure that people are well prepared for the work that they are doing is clearly of great importance. We would expect a voluntary register, quality assured in the way that I have described, to provide a way for employers to assure what they are offering in terms of staff. There will therefore be greater take-up. Those who are on the quality-assured register will find themselves more employable, which will move things forward. Meanwhile, if, as we continue to debate this, voluntary registration does not seem sufficient and regulation seems the route to go down, the Government do not rule that out. However, it is extremely important to focus on the end point, which is to try to drive up quality, and not simply be deflected by thinking that this would crack it.
I assure noble Lords that we will keep this issue under constant review. We are well aware of people's concerns and that standards need to be driven up in a much more even way across the board. As I say, we are developing the education and training which I hope will go some way towards this.
Lord Patel: I wish to pick up on one point. Can the noble Baroness reassure us on what it is she will keep under constant review? I understood her to say that the Government will rely on employers to ensure that these support workers have some kind of training. There will be no national training standards and, once the employers are satisfied that these people have some kind of training, they will be entitled to go on a voluntary register. As I understand it, the logical thing here is first to establish a national standard of training; then to ensure that those national standards are implemented; and then to allow people to register. If they register, the next step would be regulation. The first step is not immediate regulation but national standards of training and assessment that those standards are being met, before people can go through any kind of registration. What is the noble Baroness agreeing to keep under review?
Baroness Northover: I should perhaps explain that more precisely. This issue will be constantly under review so that if there are concerns in this area they will be flagged up. The Government will of course continually consider how best to respond and make sure that standards are of the quality that we need. The noble Lord is right: national standards of training are indeed the start. Then people are admitted to a register and so on. A voluntary-assured register would demand that kind of national level of standards in training. I hope that in that regard I can at least reassure the noble Lord.
Lord Warner: One question has puzzled me more and more as the noble Baroness has progressed. My noble friend Lady Pitkeathley laid great stress on the position of the regulated nurses and the fact that they will have to ensure that people working in the healthcare assistant type of roles under their supervision do not take on roles that they are not competent to fulfil. Going back to my description of the way the NHS works in reality, particularly in acute hospitals, there is a constant flow of different people on these wards-regulated and registered staff, agency or bank staff, are there particularly in the evenings, for unsocial hours and at weekends. We have heard a lot about employers. I am still puzzled about how the statutory regulated nurses satisfy themselves about the competence of the healthcare assistants working under their direction. They seem to be the people most exposed-at least theoretically-to cop it from their regulatory body if they have not made extensive inquiries about the competence of these healthcare assistants. How does the noble Baroness square that particular circle if we do not have much knowledge of the training of these people and they have not even registered on a voluntary basis?
Baroness Northover: The noble Lord will be familiar with being on wards at changeover time and when there is a pooling of information about who is on the ward and what the problems are. Issues are flagged up and one team passes information on to the next.
Baroness Northover: I have seen many, many changeovers. The proposal is being brought forward so that registered, regulated nurses have a better idea of when and how to delegate, and that is extremely important for the reasons that the noble Lord has just indicated. As I have indicated, the training and national standards of healthcare workers, to which the noble Lord, Lord Patel, referred, are also important-as is taking that forward so that the registered nurses are aware of the kind of training that those healthcare workers have had. I want to pick up on the case that the noble Baroness, Lady Emerton, mentioned about the healthcare worker who was taking a patient's blood pressure but did not know what the reading meant. Surely, it was for the person to whom that was reported to take action on the significance of that. That information was to be passed on to somebody else to read, understand and interpret.
Lord MacKenzie of Culkein: But if that healthcare assistant does not have the basic training or an understanding of the reading that she or he has just taken, they may not see the importance of reporting it to another nurse.
Baroness Emerton: My Lords, perhaps I could be helpful at this stage. I am grateful to noble Lords who have contributed to this debate. A large number of issues have been brought forward; I shall start with the title "nurse". As noble Lords have mentioned, a person who is nursed-and feels that they have been nursed-experiences care, compassion, respect and dignity. There has been a lot of discussion among the public, and indeed in this House, about registered nurses becoming graduates and whether they will be too posh to wash, to put it colloquially. To me, a nurse who is a graduate would be only too grateful to be able to attend to the basic needs of patients, because that is part of holistic care. When you do various intimate things for patients, you learn a great deal about their condition.
The point that has been raised about the nurse is very important. We talk about support workers but we cannot talk about support nurses, because the term "nurse" is completely left for the statutory requirement of a regulated nurse. We are looking for a support worker who is able to do tasks which they understand, with the skills of the graduate nurse-because by 2013, we will be producing all-graduate nurses-within holistic care. That is the point I was trying to make this morning: it is the holistic care we are looking for in the delivery of care. However, it is not only holistic care in the acute sector; we are looking at the holistic care which is integrated with social care, because we are now looking at patients going into the community. Indeed, people working in the acute sector need to understand that the patients they are discharging are going into the community, which is a different scene and which may require not only a nurse but social care support. Therefore, somewhere in our education we need to bring together a basic core of understanding healthcare, nursing care and social care.
The point that the noble Lord, Lord Warner, made is very important. We need to conduct this review. On the other hand, the research evidence shows us that as regards highly qualified registered staff, the higher the proportion, the less likely it is that patients will have a longer stay in hospital. They will have a better clinical outcome. I hope that the Government are not going to ignore that research. If possible, we should carry out a truly safe cost-benefit analysis into increasing the number of trained staff, seeing where they are needed, rather than having a higher proportion of support workers.
The Royal College of Nursing has been resolute in putting forward the regulation of healthcare support workers because it feels that that is the way to ensure that they are answerable to a registered nurse. We talk about employers but I am not sure who the employers are going to be-social workers, managers or the nursing profession. This whole issue needs to be taken away and looked at, and perhaps we could return to it. I do not know whether these comments are helpful but I feel strongly about this issue, as noble Lords may have gathered. I pass it back to the Minister.
Baroness Northover: I hear what the noble Baroness says. She is extremely well informed, as ever, and I hope that she will continue to engage as we take this forward, as she has done up to now. However, at this point I hope that she will withdraw her amendment.
"(ba) regulating the clinical physiology profession in England,".
"(bc) regulating clinical physiologists in England who appear to require regulation in pursuance of this section,"."
Baroness Thornton: My Lords, I shall speak also to Amendments 338ZB, 338F and 339ZB. We return to a regulatory issue. Amendments 338ZA and 339ZB are new clauses relating to the power to regulate clinical physiologists in England. Amendment 338ZB is a new clause requiring clinical physiologists to be registered by the Health Professions Council. Amendment 338F says that the Health Professions Council, in exercising its functions, shall co-operate with the regulation of clinical physiology in England and with the provision, supervision or management of services of people engaging in clinical physiology in England. The noble Baroness, Lady Finlay, has an amendment in this group and we support what she is proposing.
I am sure that other noble Lords have received the helpful briefing note from the Registration Council for Clinical Physiologists, which highlights that the Government's current approach-a preference for voluntary registration, as the Minister outlined in the previous debate-has been applied to clinical physiologists, despite a recommendation from the Health Professions Council in 2004 for statutory regulation. The RCCP has a substantial amount of evidence suggesting that, in the case of clinical physiologists, voluntary self-regulation is not as effective as statutory regulation.
In the Command Paper Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff, the Government stated that statutory regulation would be considered for those professions where a compelling patient safety case could be made and be supported by an evidence-based cost-benefit risk analysis. Ten months later, though, no such risk assessment has been undertaken, and the RCCP continues to believe that clinical physiologists should be statutorily regulated.
The disciplines that are covered by clinical physiology are audiology, cardiology, gastrointestinal physiology, neurophysiology and respiratory physiology. Clinical physiologists work directly with patients, performing sensitive procedures such as assessments of pacemakers, testing lung function and assessing and diagnosing hearing loss. Many of the procedures performed by clinical physiologists in the UK are performed by statutorily regulated professionals in much of western Europe and by clinicians in the United States.
A body that I have mentioned, the Registration Council for Clinical Physiologists, maintains a voluntary register of clinical physiologists in the UK and Northern Ireland. It has more than 5,000 registrants across a number of different disciplines in clinical physiology. These professionals play an integral part in the process of diagnosis and treatment, undertaking procedures such as ECGs, which pose significant risks to patients. That, really, is the point here.
While the profession as a whole enjoys an excellent reputation and high standards of working practice, the continued lack of statutory regulation for its registrants means that there will continue to be gaps in its oversight, which comes with inherent risks to patients. Therefore, we believe that the Government's preference for regulation through assured voluntary registration is not sufficient for this particular group of healthcare workers. They need to be statutorily protected; a voluntary scheme is not sufficient and there is a threat to patient safety. I hope that the Government will consider this a reasonable request on the profession's part. I have to say that I fail to understand why this has not been taken forward and I hope that the Minister will be able to explain to the Committee why clinical physiology cannot have statutory regulation in the context of patient protection. I beg to move.
Baroness Masham of Ilton: My Lords, I should just like to add my support for this amendment. Clinical physiologists, who perform some very invasive procedures, feel that they need statutory regulation. They have had a voluntary scheme, which they say is not adequate.
Lord Walton of Detchant: My Lords, I should like to ask the Minister to clarify a point of some importance. Many years ago, in the early stages of my neurological career, I was involved in interpreting electroence- phalograms. Subsequently, I was heavily involved in the pursuit of electromyography-a technique for measuring the electrical activity of the muscles in health and disease-and in measuring nerve conduction velocity. I also looked at evoked nerve potentials. A group of individuals grew up in that field originally; it was called the EEG Society. Then there was the Electrophysiological Technologists' Association-the EPTA-of which I was briefly president. Eventually they came together to form the association of clinical neurophysiologists.
The Health Professions Council regulates 15 health professions, including biomedical scientists and clinical scientists. My understanding is that clinical neurophysiologists, like other clinical physiologists, are not included in or embraced by the term "clinical scientist". However, I wish to know whether they are covered by the Health Professions Council. If they are not, it is important that they should be regulated. For that reason, if they are not included at present under the terms of the Health Professions Council, I strongly support this amendment.
Lord Rea: My Lords, in supporting this amendment I declare an interest. Not only my former patients but I, as a patient, have received skilled help from clinical physiologists. The pacing unit at St Mary's Hospital, which is run by clinical physiologists, has monitored my pacemaker since it was fitted four and a half years ago. My life has literally been in their hands while they periodically adjust my heartbeat to get the best setting.
The Registration Council for Clinical Physiologists, which has been described, has been trying to persuade the Department of Health to include the profession in the mandatory regulatory framework for health professionals for the best part of a decade. The Health Professions Council recommended in 2004 that clinical physiologists should be included in its regulatory regime, as well as other clinical scientists whose work involves a potential impact on patient safety. The then Secretary of State accepted this recommendation but still no action was taken and has since not been taken despite frequent reminders from me, among others. On my count, 30 parliamentary Questions have been tabled on this issue. It has also been raised in your Lordships' House in a debate on an order to do with the Health Professions Council. I hope that this amendment will serve to speed up the process by focusing the Government's attention on an overdue step that we feel needs to be taken.
Baroness Finlay of Llandaff: My Lords, this group of amendments is very interesting as it reveals the enormous number of people involved in healthcare who literally hold the lives of others in their hands and are not subject to any statutory regulation but are voluntarily registered. I have an amendment in this group which seeks to establish,
Physicians' assistants in anaesthesia already have a voluntary register in place and they applied to the Health Professions Council for registration and had their application accepted. However, that all went on hold with the emergence of this Bill. The Royal College of Anaesthetists does not allow physicians' assistants in anaesthesia to become associates as they are not registered with the General Medical Council, but it permits them to have affiliate membership. However, the college does not have a regulatory role as such; it is tied up with education and standards.
Physicians' assistants in anaesthesia urgently need statutory regulation, given the range of invasive, and potentially life-threatening, procedures that they perform and the knowledge and autonomy of practice required in the roles that they carry out. These practitioners perform tasks that, in the UK, were previously carried out only by doctors. They cannot get indemnity insurance for their practice or apply for prescribing rights, even though they sometimes have to be able to respond in a matter of seconds, not minutes, if something goes catastrophically wrong with an anaesthetised patient while the anaesthetist is outside the theatre for whatever reason. They are on a voluntary register, which provides some reassurance for patients and employers, but that cannot realistically be seen as an alternative to statutory regulation. I think that in 2009 they were identified by the Department of Health as being urgently in need of registration. The Health Professions Council felt that these assistants fulfilled sufficient of its criteria to warrant the recommendation for statutory regulation being accepted.
Irrespective of whether Members of this House have undergone a procedure requiring anaesthesia, would they consent to being rendered unconscious by an individual who was neither bound by a stringent professional code of conduct nor properly registered to practise? After all, we would not get into an aeroplane if we did not know that both the pilot and the co-pilot were appropriately qualified to a very high degree, with ongoing continuing professional registration. We trust them just as we trust these physicians' assistants, but if something goes wrong in theatre it does so with catastrophic rapidity. When I did my training in anaesthesia, on more than one occasion I saw these physicians' assistants recognise problems arising before the trainee anaesthetists had done so. They carry enormous responsibility during complex procedures.
I have included other healthcare professionals in my amendment as I am well aware that the Government do not like to have enormous lists in a Bill. My amendment would therefore leave the door open to include clinical perfusion scientists-the other group involved in theatre-whose role is primarily to maintain a patient's circulation during open-heart surgery, during a period of surgical repair when the heart has been stopped. They were recommended in 2003 for statutory regulation.
There have been two high-profile cases involving clinical perfusion scientists. The first fatality, in 1999, led the Southwark coroner to recommend the immediate statutory regulation of clinical perfusion scientists. The second fatality, in 2005, was attributed to inappropriate drug administration by a clinical perfusion
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More recently, there have been fatalities that have led to clinical perfusion scientists' actions being questioned by coroners-the most recent of these incidents occurring in 2010 at Nottingham City Hospital.
I do not want to scare people from going in for surgery and I do not want to scare Members of this House who may be going in for surgery, but in the current climate people need to know that these very critical roles are being undertaken by people who are on a voluntary register but do not enjoy indemnity, as they would if they were on a statutory register and subject to the rigours of being statutorily regulated.
Baroness Pitkeathley: My Lords, I do not want to sound like a broken record in always resisting more statutory regulation or in disagreeing with colleagues with whom I normally agree, but I want to emphasise the application of light-touch regulation. We should use only the minimum regulatory force to achieve the desired result. Therefore, we should be considering extending regulation only where the risks to patient safety and public protection are such that other mechanisms such as those I previously mentioned-employer's guidance, clinical governance, appropriate delegation and multidisciplinary teamworking-are unable to manage those risks.
When the Council for Healthcare Regulatory Excellence becomes the Professional Standards Authority for Health and Social Care, it will be accrediting voluntary registers as a more proportionate and targeted approach to developing high standards of care for people working in health and social care who are not statutorily regulated. I remind your Lordships that statutory regulation can be expensive and it is important that we explore and develop a range of options for maintaining and improving the quality of care delivered by people working in health and social care. It may be more proportionate, for instance, to promote greater co-operation and sharing of good practice. We seek to find the most efficient and common-sense solutions to the kind of problems that your Lordships have identified.
Baroness Oppenheim-Barnes: What proportion of voluntary persons employed in operating theatres are expected to be affected? Is it not the case that the great proportion of them are specialists who are subject to statutory regulation?
Lord Alderdice: My Lords, I should like to press this question in the context of the amendments in this group. What is the Government's rationale for making a difference between statutory registration and quality-assured voluntary registration? The noble Baroness, Lady Pitkeathley, has used terms such as "light-touch", "proportionate", "appropriate", "not so expensive" and so on. However, I have difficulty in seeing consistency here.
On the one hand, we can see that there are very small groups such as clinical perfusion scientists who are employed in only a few centres where open-heart surgery is being done. One could see that there may be a degree of expense in setting up a whole scheme of statutory registration. However, when it comes to groups such as clinical scientists and physiologists, there is a much larger number, but almost all of them are employed in the National Health Service. I understand the argument that they are all, or almost all, operating under the supervision of people who are statutorily registered and are operating in the context of the NHS, which deals with financial claims and so on.
However, as noble Lords will know, I have raised repeatedly-perhaps even tiresomely-the question of statutory registration of psychotherapists and counsellors. When I raised it again not so long ago with the Minister, he responded that, no, the Government did not want to go ahead on that front; they wanted quality-assured voluntary registers. The same kind of rules do not apply. Why? First, there is a huge number of these people-certainly enough for it not to be a financial question, as small contributions from all of them would be enough to set up a statutory registration scheme. Secondly, the majority of psychotherapists and counsellors work outside of, and therefore are not subject to the kind of regulation that takes place in, the National Health Service. On top of that, a large proportion of them work on their own, so they are not supervised by statutorily registered colleagues and they are not employed by employers who, Ministers have assured us, would consider their qualifications and supervision.
Although, in the context of the current crop of amendments, the argument has been made on the basis of expense and on the basis that these people operate within and are employed by the health service-and are therefore under the supervision of statutorily registered senior colleagues-none of those arguments applies to those who are working in the private sector on their own account. Such people are employed only by the patients who are consulting them, and there is a large number of them.
What requirements help Her Majesty's Government to judge whether a profession has statutory registration or quality-assured voluntary registration? None of the arguments that have been adduced is applied consistently.
Lord Walton of Detchant: What is troubling me about this whole exercise is that, under the Health Professions Council, statutory regulation applies to art therapists, biomedical scientists, chiropodists, clinical scientists, dieticians, hearing-aid dispensers, occupational
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Lord Alderdice: It may seem a little unclear to the noble Lord, but it is not so unclear. Psychologists are qualified as psychologists, not as psychotherapists or as counsellors-they belong to a different professional body and have different qualifications and requirements. Psychologists themselves campaigned for many years for statutory regulation and finally got it through the Health Professions Council. Arts therapists and so on went through the HPC because many of them were occupational therapists, but try as I might-and I have been doing so for well over a decade-I cannot get successive Governments to address the question of psychotherapists and counsellors, despite the fact that they constitute a far larger number of people.
My dilemma with the current set of propositions is that, of the arguments adduced to try to persuade noble Lords that a quality-assured voluntary registration scheme is appropriate because the people referred to-the physiologists, the perfusion scientists and so on-are operating within the health service under supervision, are employed there and are smallish in number, none of them applies to this other group of people, for whom I have had precisely the same reply from the Minister. Therefore, I am keen to hear from the Government what the set of criteria is. Is it simply that this Government are not keen to pursue anything in the way of regulation except at the most modest level? If so, that is a legitimate argument but it needs to be made. If not, then I do not quite see the consistency of the current application.
Baroness Finlay of Llandaff: Perhaps I may add a small point. I do not know how many physicians in anaesthesia are employed in operating theatres in private hospitals, where an enormous amount of private surgery is done. One of the main reasons for people going to a private hospital is for surgery-particularly elective orthopaedic surgery. Therefore, although I cannot put any figures on this, I do not think that it is correct to assume that these people are necessarily operating only in the NHS and are subject to current NHS structures.
In the new world where we will have a broad range of providers, it will become even more important to know that there is a minimum standard and that all the people at each step of the way will be answerable. The patient may well choose to go to an organisation where these people are employed but the patient will not know that. No one gives him a list and says, "Of all these people looking after you, these will be statutorily registered but these may or may not be on a voluntary register". If we are thinking about patients taking informed decisions regarding their future, I suggest that the coroners' reports that we have had to date should already be sounding alarm bells.
I am looking at some information sent in an open letter from the Registration Council for Clinical Physiologists to Anne Milton, the Parliamentary Under-Secretary of State in another place. Interestingly, in that open letter the registration council, which operates a voluntary register, takes the view that the council is rather toothless. It says that the professions covered by clinical physiologists will continue to be,
It says it is evident that those administering the current inadequate voluntary registration process are being threatened with civil action by those whom they are forced to reprimand. It is a pretty poor state of affairs when those who are trying to enforce professional standards are themselves threatened with legal action.
I know from talking to people involved with the registration council that people leave the register when disciplinary issues come to the fore. I gather that in one instance a person left the register when faced with discipline, emigrated to Australia, continued to practise and got in trouble there. As I understand it, the Australian statutory body that exists for clinical physiologists was astonished to discover that there was no statutory regulation in force in this country.
I do not think that we can continue with this so-called voluntary system and light touch. We need to do what other countries do and have statutory responsibilities and statutory training and registration for these very important groups of staff.
Baroness Northover: My Lords, these amendments seek to extend compulsory statutory regulation to physicians' assistants in anaesthesia and clinical physiologists and to make changes to legislation to further provide for the compulsory statutory regulation of clinical physiologists.
I make it clear at the start that healthcare scientists such as clinical physiologists play an important and highly valued role as part of clinical teams, and this is also true of physicians' assistants. It is a testament to their professionalism that the Department of Health is not aware of any general concerns about the standards of practice of either group. Furthermore, we need to be absolutely clear that the purpose of regulation is to protect the public, not to support the development of a profession.
Given the wider systems of assurance in place such as the Care Quality Commission's registration requirements, and the vetting and barring scheme, the Government do not consider that the case for compulsory statutory regulation of these groups of healthcare scientists not already subject to regulation, and physicians' assistants, has been made. However, we agree that there need to be processes to ensure high standards of care, and assured voluntary registration overseen by the Professional Standards Authority for Health and Social Care has the potential to provide this. It will
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The noble Baroness, Lady Thornton, asked why we were not taking forward the regulation of clinical physiologists as recommended by the Health Professions Council. The recommendations of the Health Professions Council were not based on an assessment of the risk presented by a profession, but rather on whether that profession had already developed processes of assurance which prepared them for professional regulation. There is therefore no evidence that compulsory statutory regulation is necessary to mitigate the risks posed by the professions recommended for such regulation by the Health Professions Council. This is probably why the previous Government did not decide to regulate, although this is an issue that has been flagged up for a number of years. The professions recommended by the Health Professions Council for compulsory statutory regulation will be well placed to join the system of assured voluntary registration that we are proposing.
The noble Baroness, Lady Thornton, asked about research in terms of regulating clinical physiologists. We are not planning on commissioning research into the case for regulating them, but we will review the case for introducing compulsory statutory regulation for clinical physiologists and, obviously, others in the light of experience of assured voluntary registration, and the evidence about risks available.
Baroness Thornton: Perhaps the Minister could tell us what sort of timescale she envisages for this, or whether it will have to wait until an accident happens like the noble Baroness, Lady Finlay, recorded and then the Government will deal with it.
Baroness Northover: The noble Baroness will be fully aware, because she was a health Minister, that if there is no evidence of there being a risk then you do not choose to regulate. That is presumably why the previous Government chose not to.
The noble Baroness, Lady Finlay, flagged up the position of anaesthetists' assistants. I had interesting discussions yesterday with an anaesthetist and an anaesthetist's assistant, and it was very enlightening. As the noble Baroness will know, the anaesthetist is of course ultimately responsible. Assistants must always be supervised by a consultant who needs to be available within two minutes. The issue that the noble Baroness raises is one of quality assurance. As she knows, the Royal College of Anaesthetists runs the training and the registration for those assistants. After they have done a science degree, generally it is 27 months of practice. If the Royal College of Anaesthetists judges that that is inadequate, on the basis of the kind of concerns that the noble Baroness raises, then it is clearly for it to say that there are risks, it has encountered risks, and that needs to be addressed. If this system
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Baroness Thornton: The health Minister Anne Milton said that those professions in which a patient safety case can be made, including that of clinical physiologists, will be considered for statutory regulation subject to a cost-benefit risk analysis. Will the Government carry out that analysis and, if so, when and in what time? I do not particularly want an answer about what my Government may or may not have done or may or may not have decided. The noble Baroness's own Minister has pronounced on this matter since the general election so it seems to me that she needs to answer the question: when will they do the risk analysis?
Baroness Northover: I have already mentioned to the noble Baroness-she is probably totally familiar with this-that the Department of Health does not have evidence of there being a risk in this regard. Clearly, as I mentioned on the earlier group, these issues will always be kept under review. If the concerns that she has flagged up and if the association, which is particularly encouraging the regulation of clinical physiologists-that is fine; it is all part of professionalisation-flags up particular concerns that emerge from other evidence, then of course the department will take that very seriously. However, things need to be proportionate.
Baroness Finlay of Llandaff: I have listened very carefully to what has been said about the assistants relating to anaesthesia, but I also used the more catch-all phrase about the clinical perfusion scientists. I would be grateful if, after this debate, the noble Baroness would write to me and explain why coroner recommendations in relation to clinical perfusion scientists are not considered to be enough of a risk to take action. If one is trying to assess this on a risk spectrum, it would be helpful to understand why a coroner's decision to recommend that this small, contained group of clinical perfusion scientists should be regulated does not constitute enough of a risk to go down that route to regulate them and to have them on a statutory register.
We expect the assured voluntary registration to be up and running by 2012. Therefore, afterwards that would need to be assessed to see whether anything further is required, as noble Lords have figured might be the case. We are hoping to see how it all works.
The noble Lord, Lord Walton, flagged up various groups which were regulated and he could not quite see why others were not. Given that I used to bump into the noble Lord, Lord Walton, in the Wellcome Library for the History and Understanding of Medicine, I think he will fully understand that the way in which regulation has grown up has not necessarily been logical or consistent. Therefore, I flag up the 2005 Hampton review on regulation which says that it should be proportionate to the risks that it seeks to mitigate and various other provisions. That is what we are seeking to do. Of course, we shall keep under review what we are doing to see whether it is adequate. In the mean time, I hope that the noble Baroness will be willing to withdraw the amendment.
Baroness Thornton: My Lords, I thank the Minister, but this is not yet a satisfactory situation. We might be moving towards one but we are not there by any means. If I were on the register of clinical physiologists I would find it slightly offensive for the Minister to suggest that I was asking for statutory regulation as a kind of professional development of the organisation. Physiologists are very clear in all of their briefings that they think that this is important for patient safety. That is why they want statutory regulation and that is why we need to listen to them very carefully.
Baroness Thornton: I thank the noble Baroness for that. The noble Baroness, Lady Finlay, made a graphic and powerful case. I thank my noble friend Lord Rea, the noble Baroness, Lady Masham, and the noble Lord, Lord Walton, for their support for the amendment. My noble friend Lady Pitkeathley and the Minister are coming at it from a different point of view. It is entirely possible that an arbitrary decision was taken, quite possibly by my Government, that there was enough statutory regulation. It is possible that this Government need to think that that was an arbitrary decision in the history of regulation and that exceptions need to be made.
There are questions about the limits of assured voluntary registration. Do clinical physiologists carry out invasive procedures that could harm patients? Yes, they do. Are clinical physiologists incentivised to join the voluntary register? No, they are not. A small number of NHS and private employers notionally require applicants to be on their register but there is no mandatory requirement for this. Are professionals incentivised to maintain the voluntary register? No, their activities are carried out on a voluntary basis by the chair and other officers. Does the voluntary register empower patients to make formal complaints? No. While the Health Professions Council operates a system whereby anyone can make a complaint about the fitness to practise of a professional on its register, in most instances members of the public are not aware of the existence of voluntary registers. Finally, does the voluntary register have any powers of enforcement? No, it does not. The RCCP operates a disciplinary code and procedure but it cannot protect patients
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"Mr Speaker, the Government are proposing the most far-reaching reforms of British banking in our modern history. Our objective is to make sure that what happened in Britain never happens again, that taxpayers are protected and that customers get a better service.
Last year the Business Secretary and I set up the Independent Commission on Banking to look at what I called the 'British dilemma': how Britain can be home to one of the world's leading financial centres without exposing British taxpayers to the massive costs of those banks failing. In the years leading up to the financial crisis, a failure of regulation contributed to the build-up of a debt-fuelled boom. Banks borrowed too much and took on risks they did not understand. When the bubble burst these banks turned out to be too big to fail and the previous Government had to spend billions of pounds bailing them out.
Of course, major financial institutions in other countries were bailed out by their taxpayers, but the British bailouts were on a different scale. The Royal Bank of Scotland bailout was the biggest in the world. The FSA's recent report into the failure of RBS attributed this to 'poor decisions made by the RBS management and Board' against a backdrop of a regulatory regime that failed to stop them. The politicians responsible are named in the report.
This Government are determined to do better at protecting British taxpayers from the cost of failing banks while at the same time acknowledging the importance of the financial sector to our country. Britain should remain home to one of the world's leading financial centres and the home of global banks. However, the strength of this industry is also a potential weakness to the economy if not properly regulated. The sector supports nearly 1.4 million jobs, not just in the City but across the whole of the UK. The balance sheet of our banking system is close to 500 per cent of our GDP, compared to 100 per cent in the US and 300 per cent in Germany and France. So while a European and international regulatory response to the crisis is important, we cannot rely on this response alone to make our banking system safe.
We in this Parliament have to take action, and under this Government, we are. We are putting the Bank of England back in charge of prudential regulation.
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The commission made three main recommendations: first, that everyday high-street banking services should be separated from wholesale and investment banking activities, and that this be done via a ring-fence; secondly, that banks be required to have bigger cushions to absorb losses without recourse to the taxpayer; and thirdly, that competition in the banking sector be strengthened by increasing the number of banks on the high street and the power of customers to switch accounts. When its final report was published in September, I made it clear that I welcomed these recommendations in principle, and would return to the House by the end of the year. Today I fulfil that commitment.
Let me now set out in detail how the Government plan to respond and invite further views before we publish a White Paper next spring. First, the Government will separate retail and investment banking through a ring-fence. It is important to know that this ring-fence will not prevent banks failing, but it does mean that if banks get into trouble, those elements of the banking system that are vital for families, businesses and for the whole economy can continue without resort to the taxpayer. So the following will be in newly ring-fenced banks: the deposits of individuals; their overdrafts too; and the deposits and overdrafts of small and medium-sized businesses. They will all be kept separate from riskier wholesale and investment banking-which will have to be outside the ring-fence.
Larger corporate deposits and lending, and private banking, can either be in the ring-fence or outside. The ring-fenced bank will be legally and operationally independent. It will be able to finance itself independently, have its own board and there will be limits on the amount it can lend to the rest of the group. The commission's interim report proposed a de minimis exemption for small banks that were clearly not systemic and we invite opinion on whether to proceed with this.
Secondly, we will make sure that banks have bigger cushions, so they are better able to withstand losses. The international Basel III requirement-which the UK was instrumental in negotiating-requires banks to hold minimum equity capital of 7 per cent, and there is a top-up for systemically important banks. We
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I can also confirm that this Government will introduce the principle of depositor preference. In other words, the principle that unsecured lenders to banks, who are better placed to monitor the risks that banks are taking on, should have to take losses ahead of ordinary depositors. We seek further views on the best way to implement this principle. This comes on top of the guaranteed protection that the Financial Services Compensation Scheme offers, which covers 100 per cent of eligible deposits up to £85,000.
All these proposals on loss absorbency will also strengthen the European single market. One of the greatest distortions to the single market in banking is the perceived implicit taxpayer guarantee for all European banks. Through these proposals the UK is setting out a plan to remove this distortion for UK banks. The European Commission has indicated plans to consider what it can do to reconcile that distortion at an EU level. I welcome that, and the UK will engage actively in the debate.
This House and other member states have objected to the European Commission's proposals to impose maximum standards for bank capital. These proposals undermine efforts we and others are making to improve financial stability and the single market. In the view of bodies like the IMF, the European Commission's proposals also water down the international Basel III agreement, giving exemptions to globally active banks in certain European countries. We will be seeking, with others, changes to ensure that the EU faithfully implements international agreements.
Thirdly, the Government will take action to increase competition in the banking sector. The disappearance of banks such as Bradford & Bingley and the decisions taken by the previous Government on the merger of Lloyds and HBOS mean the banking sector is dominated by a handful of large banks. Last year, just four banks took 70 per cent of the market share. We need new banks to enter the market to provide consumers and businesses with more choice. The Government announced the sale of Northern Rock to Virgin Money last month, creating a new competitor in our retail banking sector.
In the coalition agreement, we made clear we wished to foster diversity in financial services, including promoting mutuals. We welcome last week's announcement that Lloyds has identified the Co-op as preferred bidder for the divestment of more than 600 branches to create a strong challenger in the high street. We will also make it easier for people to switch their current accounts. This recommendation from the commission has received less attention from the media, but could be of huge benefit to millions of customers. The idea is that individuals and small businesses can switch to another bank within seven days and all the direct debits and
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We will also support the Treasury Select Committee's proposal to bring the Payments Council within the scope of regulation and I can confirm that our financial services legislation next year will specify that one of the objectives of the Financial Conduct Authority is to promote effective competition in the interests of consumers. A new statutory competition remit will provide the FCA with a clear mandate for swifter, more effective action to address competition problems in financial services. So within months of the ICB report, legislation to bring this change into force will be introduced.
This brings me to timing. Some have questioned whether the Government will seek to delay implementation of these reforms-questions that come from people who never even contemplated reform when they were in office. In fact the reverse is true. On the advice of Sir John Vickers and others, I will be bringing forward separate legislation to implement the ring-fence. The Government's intention is that implementation should proceed in stages, with the final changes related to loss absorbency fully completed by the beginning of 2019 in line with the Basel agreement. But I can confirm to the House today that primary and secondary legislation related to the ring-fence will be completed by the end of this Parliament in May 2015 and banks will be expected to comply as soon as practically possible thereafter. The Government will work with the banks to develop a reasonable transition timetable.
Of course, there are both costs and benefits to these reforms. The Government estimate the total costs to UK banks to be between £3.5 billion and £8 billion, broadly in line with the commission's estimate. Most of this reflects the cost to them of removing the subsidy that comes from any perceived implicit taxpayer guarantee, which is precisely what we intended. The cost to GDP is estimated by the Government at just £0.8 billion to £1.8 billion-slightly lower than the commission's estimate. These are far outweighed by the benefits of the ICB's recommendations. Even a relatively modest reduction in the likelihood or impact of future financial crises would yield an incremental economic benefit of £9.5 billion per year. Such is the cost of financial crises to the economy. Since the wholesale arms of non-UK banks would be unaffected by these reforms and the principal recommendations relate to UK retail banking, the competitiveness of the City of London as a location for international banking will not be affected.
We are fixing the banking system to protect taxpayers in the future. But we also need to clear up the mistakes of the past. I have already mentioned Northern Rock and Lloyds but the biggest call on the taxpayer was the bailout of RBS. The FSA's recent report was a damning indictment of all that went wrong in this crisis. Those responsible are clearly identified in it. We need to deal with the mess that they created.
Despite promises from the previous Government that taxpayers would profit from the RBS bailout, the Government's shareholding is now worth around £27 billion less. We are already reforming the regulatory
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RBS itself has also made significant changes since 2008, including reducing the size of its investment bank by half. But I believe RBS needs to go further and the management agrees. We are the largest shareholders. Let me set out our view: RBS has already announced that it will further shift its business strategy towards its personal and SME customers and its corporate banking business which serves UK and international companies. We believe that RBS's future is as a major UK bank, with the majority of its business in the UK and in personal, SME and corporate banking.
Investment banking will continue to support RBS's corporate lending business but RBS will make further significant reductions in the investment bank, scaling back riskier activities that are heavy users of capital or funding. RBS should emerge a stronger, safer bank, able to maintain lending to businesses and consumers, and which in time can be returned to full private sector ownership.
The British people are angry about what happened in our banks and angry at the politicians who let it happen. This coalition Government see two parties working together to clear up the mess of the past and to create a banking system that protects taxpayers and serves customers better. Today, we present the most far-reaching changes to banking in our modern history so we can build an economy that works for everyone. I commend this Statement to the House".
Lord Eatwell: My Lords, I am most grateful to the noble Lord for repeating the Statement made by the Chancellor of the Exchequer in another place. However, I regret that effective scrutiny by this House has been limited by the Government providing the 80-page response only half an hour before the noble Lord got to his feet.
As the Statement makes clear, banking policy in this country has two potentially conflicting goals: first, to ensure that a stable domestic financial system supports the real economy with a steady and reliable flow of appropriately priced credit, together with other domestic and international banking services; and secondly, there is the goal to sustain the City of London and other UK centres as the world's premier offshore financial centre, providing a wide range of financial services that transform and repackage saving flows from all around the world. This was the core conflict highlighted by the Independent Commission on Banking-the trading activities of the offshore centre can inflict instability and contagion on the domestic economy. The proposal of the ring-fence that the Government are endorsing today is a response to that core conflict. It is an inadequate response, but perhaps something is better than nothing.
Why is it an inadequate response? Noble Lords may be surprised to learn that more than three years on and contrary to the assertions of the ICB in its final report, nothing in these policy proposals would have prevented the collapse of Northern Rock. The reason is that there are two serious flaws in the ICB approach. First, there is the belief, echoed by the noble Lord, that moving to a 10 per cent capital to risk-weighted assets ratio will provide the resilience to the banking sector required to head off a serious crisis. This belief is a fantasy without empirical foundation. For example, Allied Irish Bank had capital in excess of the maximum now being proposed by the Government prior to its collapse. It was not enough. In a real financial crisis, no feasible capital ratio will be enough. While on the subject of risk-weighted assets, do the Government intend to maintain the Basel II approach that leaves the calculation of these risk-weights to the banks themselves? With respect to other primary loss-absorbing capacity, what is the Government's view of the buoyancy of the market for these instruments on which they put so much weight and which do not at present exist?
Secondly, the report maintains the outdated and indeed discredited approach of focusing on the asset position of the banks and has very little to say about the liabilities side of the balance sheet. Hence, the ring-fencing proposals are all about what is done with depositors' assets and the capital needs are related to that dubious measure of risk-weighted assets. But in the case of Northern Rock, the collapse was entirely attributable to what was happening on the liabilities side of the balance sheet. It was the inability to turn over short-term funding that resulted in the taxpayer needing to provide a £30 billion rescue. The ICB's claim that current liquidity proposals could have prevented this is, I believe, wishful thinking. By the way, in the glance that I have been able to give the Government's response, I would suggest that the illustrative diagrams of balance sheets on page 28 are profoundly misleading as the boxes do not represent the proportions of liabilities and assets as they are presumed to do. I shall return to the issue of the liabilities side of the balance sheet later. For the moment, I give one cheer to the Government's endorsement of the ICB's approach. At least it is better than nothing. Ring-fencing is the right thing to do even if they put the fence in the wrong place.
Crucial to the entire approach will of course be the construction and policing of the ring-fence. Can the noble Lord tell the House whether the Government have accepted all-I stress, all-of the ICB's proposals on the construction of the ring-fence? In particular, the Government seem to suggest that ring-fenced banks will be permitted to hedge risks to which they are exposed in derivative markets. If they are allowed to hedge, how is the line to be drawn between hedging and speculation, and who is to draw that line? A major hole in the ring-fence as it now stands-or perhaps it is a flexible thing as it now waves in the wind-is that banking activity for large companies can take place either within or without the ring-fence. This means that organisations that produce well over half the UK's GDP will have banking services outside the ring-fence. In that case, will not banking operations
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More generally, it is a well known outcome of regulatory activities that they stimulate a creative response from the banks, creative in the sense that they work out ways to circumvent and/or evade the regulations. Hence there will be a need to keep the operations of the ring-fence under continuous review. How do the Government intend to do that? The response states:
What does this mean-it sounds like a fine opportunity for lobbying to me-and who will determine the location of this "flexible" fence? Would it not be appropriate to keep the ICB in being and charge it with the task of reviewing regularly the performance of the ring-fence?
One of the declared objectives of the ring-fence, which the noble Lord repeated, is to protect the assets of depositors from the casino operations of the investment banking divisions of the banks. Where a ring-fenced bank is the wholly owned subsidiary of a bank holding company and that holding company fails, perhaps due to casino-style activities, will its creditors have access to the assets of the ring-fenced bank? If not, why not? If so, what is the value of the ring-fence?
I turn to the liabilities side of the balance sheet. Am I right in saying that the Government have no intention of limiting the wholesale funding of the balance sheet other than through the imposition of a leverage collar that fails to discriminate between deposits and wholesale funding? Why are the Government therefore intent on penalising banks that have a strong deposit base-banks that proved to be the most resilient during the financial crisis? Of course, the FSA's proposals on liquidity and a leverage collar will improve the situation, but surely they are not enough. Why do the Government not take note of the research that demonstrates that deposits by families and firms are "sticky", while wholesale deposits embody greater risk? On the other hand, what is to be the role of the interbank market within the ring-fence?
On competition, the noble Lord made it clear that the higher levels of capital and loss absorbency will apply just to UK banks. What of the branches of non-UK banks operating in the UK, such as Deutsche Bank? What is the Government's assessment of the competitive impact on UK banks of branches of European or other banks operating in the UK not being required, as the response states, to have the same levels of loss absorbency?
On timing, the ICB said that the ring-fence should be in place as soon as possible and well before the Basel III deadline. The Statement refers to compliance with the legislation on ring-fencing being as soon as "practically possible". Who is to determine what is practically possible and what are the criteria for that determination?
What do the Government expect to be the impact of these recommendations on the supply of credit? Given the abject failure of the Government's Project Merlin and the desperate need to increase lending at reasonable rates to UK SMEs, the Bank of England's
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I welcome the Government's announcement on the Royal Bank of Scotland. These are changes that we on this side have urged for some time. This is a taxpayer-owned bank and it should pursue the taxpayer interest.
Lord Sassoon: My Lords, I suppose I should be grateful that we got one cheer from the noble Lord, Lord Eatwell, who is a hard man to please. I am sorry that he finds serious flaws in the ICB's analysis where most other commentators have not found flaws with what is widely recognised as an impressive and important analysis and one that is being looked at well outside the UK for the light that it sheds on continuing issues that other countries have around their banking systems.
I shall take a number of the noble Lord's many questions. First, he asked about risk weights and the loss-absorbing capacity. The ICB did a detailed analysis of almost 40 banks. Its key chart is picked up in the Government's document today. Of the 40 banks that suffered significant losses that the ICB looked at, the noble Lord, Lord Eatwell, highlighted the Anglo Irish Bank as the only one where the loss exceeded the 17 per cent-I think he referred to 10 per cent-loss absorbency which the ICB recommends for big banks. As my right honourable friend the Chancellor of the Exchequer made clear, this is not about making sure that no banks will fail but about a combination of things, including loss absorbency, that will make our banking system much more resilient in the face of the range of losses that are likely.
The noble Lord also asked whether the Government have accepted all the ICB's proposals on the ring-fence. A detailed discussion of ring-fencing issues takes up one chapter, or some 15 pages, of our response today. A number of outstanding technical considerations are clearly set out in the discussion. As I have already said in repeating the Statement, this is the first round of a sequence of consultation and draft legislation, both primary and secondary, to get this right. I make no apology for not having answers to all the very detailed questions at the moment. We are putting out this 70-plus-page document today as the start of the discussion that must go on.
The noble Lord then questioned what activities should be inside and outside the ring-fence. On the question of where the ring-fence is located, he picked up on the adjective "flexible", which is advisedly used in the Government's response document. The key driver about what should be inside and outside the ring-fence in the ICB's analysis is whether it is an essential banking service, the interruption of which would cause great difficulty. For individual and SME deposits and overdrafts it is quite clear that interruption
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The noble Lord, Lord Eatwell, then raised questions about the situation of branches of a European bank in this country. It is certainly the case, as he recognises, that branch activity of a European bank would not fall within the provisions of this ring-fence. They cannot and should not do so under the arrangements for the single market. However, in relation to branch activities in this country, the supervisors-the FSA and, in future, the Bank of England-will of course have regard to subsidiarisation in relation to the scale of activities that are carried out through foreign bank branches.
Lastly, the noble Lord asked about implementation and timing. As I have said, both the primary and secondary legislation will be completed in the course of this Parliament. The final part of the proposals in line with the ICB's timetable-on loss absorbency and with regard to capital-will be in place on the same timescale as the Basle III implementation in 2019, but between now and then we expect to see the ring-fence itself put in place. As I have said in repeating my right honourable friend's Statement, we will work with the banks on what is judged by the Government to be a practical implementation timetable. That, I emphatically say, will, along with all the rest of it, be a decision for the Government and, where appropriate, for the legislation that will come before Parliament in due course. We have been fast on the case to respond to what has been an enormously detailed report and, as I say, we will get the legislation through in the course of this Parliament.
Lord Newby: My Lords, I warmly welcome these proposals because we have been advocating many of them for a number of years. I have two questions. First, on timing, the noble Lord has made it clear that the aim is that primary and secondary legislation will be completed by 2015. Can he confirm that, given that there will be a lot of secondary legislation, the Government intend that the primary legislation will be introduced in the 2012-2013 Session, so that we can get that through and then get all the secondary legislation through well in advance of an election in 2015?
Secondly, on bonuses, the Minister made it clear that the Government wish the bonus pool in respect of RBS and Lloyds to be lower next year. Can he confirm that the Government have done more than express a view on this, and have in fact instructed UKFI that the bonus pool, particularly in respect of RBS, shall be significantly less than it was last year and that we have not a vague aspiration but a very firm steer from the Government?
Lord Sassoon: My Lords, I am grateful to my noble friend for welcoming the Government's response to the ICB. On his question about timing, I cannot go further than what I said already: that we will bring out a White Paper in the spring, followed by the draft legislation and that we will get all the draft legislation, primary and secondary, through in this Parliament. There is a detailed table in the response document published today of all the ICB recommendations and whether they require legislation or could be put in place by regulatory action. There are other things which are already proceeding, particularly on competition, and there are other matters where regulatory action can take place.
Lord Lawson of Blaby: My Lords, I warmly welcome the Government's determination to press ahead without equivocation with the radical proposals in the Vickers commission report. My noble friend will be aware that ever since the banking crash of 2008 I have been campaigning for a complete structural separation of retail and investment banking. The proposals go a long way towards that, although not all the way.
I realise that there is a problem, which the Vickers commission recognised, that full enforced structural separation is probably contrary to European law, but, as I am sure that my Liberal Democrat friends would agree, that is not something that we should allow to stand in our way.
My concern is twofold. First, the top management of banks may be deficient in judgment and in some cases may be deficient morally, but they are certainly not deficient in well advised ingenuity. There is a real risk that they may find ways around the ring-fence if there is not full structural separation. Secondly, what we need is a cultural separation. We need to have a culture of prudence back again in retail banking, unlike the culture of adventure, if I may call it that, in investment banking.
I confess to my noble friend that I am concerned about the difficulty of having two totally separate cultures in one organisation. When this is in place it will be necessary, as the noble Lord, Lord Eatwell, said, at least to keep it under review all the time, although I think he is wrong in saying that we should keep the Vickers commission alive to do it. We should charge the Bank of England and the organisations that have been set up under the new regime with the responsibility of keeping this under close monitoring all the time, so we may need to go to full separation.
Finally, on the timing-I will confine myself to the ring-fencing-I am very glad that the ring-fencing legislation is going to come forward first, but there is bound to be a time lag because not only is the legislation complex but the banks will then need time to change and reorganise themselves to implement whatever the final decision of Parliament is in that legislation. I urge my noble friend to introduce the legislation not merely in this Parliament but in its next Session.
Lord Sassoon: My Lords, I well recognise the consistency, firmness and clarity with which my noble friend has held his views on separation from very early on in this debate; we discussed it three years ago. However, the Government agree with the ICB that full separation is not the route to go down. I say to him that having independent directors on the boards of the ring-fenced banks will go a long way towards making up for, as he puts it, possible deficiencies of top management and their ability to get around these things. Having independent directors of ring-fenced subsidiaries is a model that has worked well in utility companies. As he says, it is right that the Bank of England will be watching this in its new role of supervising the system.
Lord McFall of Alcluith: My Lords, when Sir John Vickers appeared before the Draft Financial Services Bill Joint Committee, it was clear that his report would not solve the "too big to fail" issue. What was required was a good regulatory structure, and no regulator globally succeeded in that.
In the draft Financial Services Bill report there were a number of issues relating to the governance of the Bank of England, and I should like an assurance from the Minister that the Government will take these all-party proposals very seriously. As a previous speaker said, culture is more important than architecture. I think that will be one of the main recommendations of our report.
The Minister mentioned the issue of switching current accounts. Will he accept that the portability of current account numbers is the key? That revolutionised the mobile phone industry. Only with the portability of current account numbers will we see a revolution in switching accounts in the banking industry.
Lord Sassoon: My Lords, I can confirm to the noble Lord, Lord McFall of Alcluith, that the Joint Committee's report, which was published only today, will be taken very seriously on governance and all the other matters that are contained in it. As to switching accounts, I hear what he says about number portability, which is not at all an easy issue, as he well knows. All I would say is that the ability for seven-day switching, including all direct debits, credits and standing orders-which we now have the banks' agreement will be implemented by September 2013-is a significant advance that will help millions of consumers.
Lord Higgins: My Lords, the report by the ICB is very large, comprehensive and detailed. It says that it would be desirable for the Government to express a view on it as soon as possible, which they have done. However, the Statement appears also to include one or two items that-I think I am right in saying-are not in the report. In particular, I understood my noble friend to say that there would be a tightening up of the Basel proposals, or that the Government would propose that. Secondly, he said that there would be depositor preference, which does not appear in the report unless I am mistaken. Will that require primary legislation and, if so, when are we likely to have that? Overall, it seems that we have just had another Statement, which
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Finally, on timing, there are two things. I agree very much with my noble friend Lord Lawson about the timing of the legislation. The banks need to know what is in the legislation. We should get that through the House at the earliest possible moment. Saying that we will do it in the course of this Parliament means that it will take far too long. Waiting until 2019 for the overall implementation is absurd. To suppose that there will be no financial crisis that is related to these proposals until 2019 would be the height of optimism. We have to get it through before then.
Lord Sassoon: My Lords, on the tightening up of Basel III, as my noble friend puts it, the provisions around loss absorbency of 17 per cent and the bailing provisions are items that go beyond Basel. They are welcomed on a global basis. We now have to make sure that the way in which the EU implements Basel III is not only compatible with Basel III itself but allows the UK to go further for as long as the global community is entirely comfortable with that. Depositor preference requires primary legislation. In relation to primary legislation, discussion of all this and the process, the next major stage will be a White Paper, setting out in greater detail how the remaining important detailed matters will be handled in the draft legislation. The draft legislation will then come. I believe that there will be plenty of opportunity, in a staged way, for noble Lords to consider all the detail.
Lord Lea of Crondall: My Lords, is this what one might call the final stage in a number of statements about reform of the banking industry, following what has happened over the past four years? Is the Minister aware of the concern about this up and down the country? I welcome the Statement, with the sort of qualifications given by my noble friend Lord Eatwell.
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