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House of Lords

Monday, 10 June 2013.

2.30 pm

Prayers—read by the Lord Bishop of Chester.

Airports: London


2.37 pm

Asked by Lord Spicer

To ask Her Majesty’s Government whether they plan to expedite the announcement of their policy on the future of London airports.

Earl Attlee: My Lords, the long-term question of aviation capacity is a matter of national importance. It is vital that the Airports Commission has sufficient time to carry out a thorough investigation of the options, and to build consensus around its long-term recommendations. The timetable set for its final report, by the summer of 2015, will allow this to take place, and will enable a stable, long-term solution to be found.

Lord Spicer: My Lords, does not the recommendation in the report of the Transport Select Committee that a rapid decision be made in the go-ahead for a third runway at Heathrow count for anything?

Earl Attlee: My Lords, we welcome the report of the Transport Select Committee but do not necessarily agree with all its conclusions. It is important that we have a solution that will withstand a change of government. The Crossrail and HS2 projects can withstand a change of government. We need a policy for Heathrow and the London hub that can also withstand a change of government.

Lord Soley: The noble Earl wants a thorough inquiry, but we have been having thorough inquiries since the Maplin inquiry, which was about 50 years ago, so it would be quite nice if we could finish this. Had the Government taken on board the last Government’s position, we would be there now, which would be helpful. I put it to the Minister that there is a danger of an unconsidered policy developing on this, since we now have six London airports with seven runways—or seven airports, if you include the newly renamed London Oxford Airport. I do not know how far this is going to go on until we actually get a proper policy.

Earl Attlee: The noble Lord knows very well that the issue is not about point-to-point capacity with the various London airports; it is about hub capacity.

Lord Bradshaw: On the subject of hub capacity, is it not relevant to think in terms of which airlines bring people into Heathrow who require the access to a hub?

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Many airports cater for people who are coming to the United Kingdom for short or long stays, and they do not need to interline. The announcement this morning of Birmingham Airport’s massive expansion, and the fact that it is going to be 35 minutes from the centre of London, should also be taken into account.

Earl Attlee: My noble friend makes many very good points, and I am sure that the Airport Commission will take them into consideration.

Lord Clinton-Davis: I speak as the life president of BALPA. The inordinate delay in making a decision about the siting of a major airport in London can only result in benefiting Amsterdam, Paris and Frankfurt. Any alternative to Heathrow is bound to take a huge amount of time to come into operation, whereas Heathrow, properly adapted, is ready now. Is it not the most obvious choice for any Government to enable them to make a speedy decision, which will not result in giving an advantage to other airports in Europe?

Earl Attlee: My Lords, Heathrow has one fundamental disadvantage: there are 220,000 who live within the 57 decibel noise contour, making it a very difficult problem to overcome.

Lord Mawhinney: My Lords, in his initial Answer, my noble friend talked about the importance of taking three years over this and the fact that a decision would not come until just after the next general election. Is he aware that the Government, who keep pressing for more economic growth, are in danger of being charged with dithering, given that a speedy resolution to this will do more to promote economic growth than many of the other things that we all read about in the newspapers?

Earl Attlee: My Lords, there is no point in making a decision that will not stand a change in government.

Baroness McIntosh of Hudnall: My Lords, does the noble Earl agree that one of the difficulties of this open-ended discussion, which has, as my noble friend Lord Soley has said many times, been going on for a very long time, is that a lot of areas are under constant threat and the blight that occurs in them is very damaging to the communities that live there? Is it possible for the Government at least to start ruling some things out, rather than leaving every option on the table?

Earl Attlee: As usual, the noble Baroness makes a very good point. The Airports Commission has been charged with reporting by December this year to rule out certain options.

Lord Higgins: Given that the legislation for a hub at Maplin Sands went through with comparatively few problems back in the mid-1970s, is there not a case for looking at that site again?

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Earl Attlee: My Lords, the Airports Commission will look at all sites including Maplin Sands or the Thames Estuary airport, and will then come up with a shortlist of which options need to be looked at in greater detail.

Lord Davies of Oldham: The Minister has shown great sagacity in indicating that there may be a change in government. His answers thus far have indicated that one of the two parties that form the coalition votes on one great negative—namely, no to the third runway at Heathrow—and intends to present itself before the next election with absolutely no advance in policy whatever.

Earl Attlee: It was the party opposite that came up with a policy for a third runway at Heathrow with no consensus and therefore it did not survive a change in government.

Lord Oxburgh: My Lords, can the Minister assure the House that any decision on the future of London’s airports will be taken in the light of a coherent and integrated transport policy for this country, involving both rail and road?

Earl Attlee: Absolutely, my Lords. The Airports Commission is charged with taking that into consideration, particularly as regards rail connectivity.

Lord Richard: The Minister does not exactly give the impression of a Government who are anxious to find a speedy solution to this problem. He keeps saying that the policy has to survive the next election. What consultative processes does he have in place for trying to ensure that it will survive the next election? Is he, for example, discussing it with other parties?

Earl Attlee: My Lords, currently it is planned that the final report of the Airports Commission will come out after the next election. Of course, the noble Lord, Lord Davies of Oldham, and I could have a chat before the next election but, even though he and I have solved a lot of problems together and we have rarely needed to seek the opinion of the House, I suspect that this matter will be far beyond our pay grade to determine.



2.45 pm

Asked By Baroness Cox

To ask Her Majesty’s Government what is their assessment of the situation of religious minorities in Egypt since the Arab Spring.

Lord Wallace of Saltaire: My Lords, Egypt has witnessed an upsurge in sectarian violence during the transition period. Foreign Office Ministers have been clear throughout the events in Egypt that have taken place since the revolution that the freedom of religious belief needs to be protected and that the ability to worship in peace is a vital component of a democratic society. We continue to urge the Egyptian authorities

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to promote religious tolerance and to revisit policies that discriminate against anyone on the basis of their religion. We are also in contact with representatives of the Coptic Church and other religious groups.

Baroness Cox: My Lords, I thank the Minister for his sympathetic reply. Is he aware that since the downfall of President Mubarak there have been attacks on Sufi shrines, the marginalisation of the Baha’is, hostility towards Muslim secularists and a massive escalation of assaults on Christian communities, including the Coptic cathedral, when security forces stood by doing nothing to deter the violence? In what specific ways have Her Majesty’s Government encouraged the Egyptian Government to create an environment of social cohesion, reduce tensions and promote mutual respect between adherents of different faiths so that they can live together as equal citizens in a nation that recognises their rights and values their citizenship?

Lord Wallace of Saltaire: My Lords, as we all know, it has not been an easy transition, and one could add to the noble Baroness’s list new laws that limit the role of NGOs and their ability to accept foreign funding, arrests of bloggers and restrictions on the freedom of the media. It is a messy transition, which is not entirely surprising given how long the authoritarian Government of Egypt had been in effect and given also the internal divide between a relatively liberal urban elite and a much more conservative peasant class from outside Cairo. We have intervened on a number of occasions. My noble friend Lady Warsi made a major speech at the organisation of Islamic states conference on the importance of freedom of religion and belief, and my honourable friend and colleague, Alistair Burt, has spoken to the Egyptian Government several times in Cairo and elsewhere on the importance of respect for minority rights of all sorts.

Lord Boateng: How are the lessons from Egypt being applied to Syria? Given the plight of Christian refugees in the region since the rebellion in that country, it is not clear how the removal of the arms embargo actually assists the development of a free and multifaith, tolerant Middle East.

Lord Wallace of Saltaire: That is a huge question. A free and tolerant Middle East is something that we would all love to have. At present, in Iraq as well as in Syria and a number of other countries, the question of religious minorities, be they Muslim or non-Muslim, is very much in play. We know that the conflict between what one might call moderate Sunnis and Salafi Sunnis is also acute. We do what we can, and I have to say that Muslim leaders in this country also do what they can, to influence the debate, but we recognise that the Middle East is in turmoil. Coming out of this very long period of authoritarian regimes does not make it easy to change habits immediately.

Baroness Hussein-Ece: My Lords, in Egypt the use of defamation laws to lock up people on supposed religious grounds has increased, and Article 44 of the constitution bans blasphemy. What actions are Her

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Majesty’s Government taking in the UN Human Rights Council in Geneva to ask the Egyptians to look again at these provisions?

Lord Wallace of Saltaire: My Lords, we are working through a number of multilateral and bilateral channels to argue to the Egyptian Government that they need to have a much more open attitude towards minority opinion of all sorts. Article 44, as the noble Baroness rightly says, prohibits blasphemy, but Article 45 advocates freedom of speech. Given the continuing conflict about the role of the judiciary in Egypt, it will take some time for the new Egyptian constitution to be applied in full.

The Lord Bishop of Ripon and Leeds: My Lords, will the Minister confirm that freedom of religion involves the right to change one’s religious beliefs and that Egypt and other nations need to be pressed to ensure that those who change their religious affiliations are defended in doing so? How far are the Government able to put pressure on countries to ensure that blasphemy laws do not prevent that happening?

Lord Wallace of Saltaire: My Lords, religious tolerance is something that we in the United Kingdom learnt about the hard way through religious persecution. We have to argue as vigorously as we can to all other countries that religious tolerance between a whole range of different religions is highly desirable in the development of an open and stable society.

Baroness Symons of Vernham Dean: My Lords, the Government are about to host the G8 conference and much of it will be focused on the Deauville partnership about Arab countries in transition. To revert to the specific question raised by my noble friend Lady Cox, in hosting the G8, will the Government take any specific initiatives to progress religious tolerance?

Lord Wallace of Saltaire: At the moment, I am not aware of the Government’s preparations for the G8 in this area. I shall feed that back to the Government and see what they can do.

Baroness Afshar: My Lords, is not the real problem that by focusing on faith as a means of the political arrangement in the Middle East—in Israel, in Egypt and in all areas—we are coming to the dangerous point of fanaticism taking over? People are doing things in the name of faith. Would it not be a good idea to demand of nations not to take their faith as a parameter of government? I speak about Iran as well as Israel and other countries.

Lord Wallace of Saltaire: One has to demand that of people as well as of nations. As we know, there are moderate people of faith and extremist people of faith in almost all religions one can think of, sadly, including Buddhism. We all have to work actively to promote a moderate version of faith. I am a member of the Church of England and as a Christian I have always regarded St Thomas as my favourite saint because he doubted.

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Medicine: Experimental Drugs


2.53 pm

Asked by Baroness Gardner of Parkes

To ask Her Majesty’s Government whether they will enable the use of new experimental drugs by terminally ill patients who are prepared to waive their right to sue pharmaceutical companies in order to assist the development of new drugs and ease their own condition.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, there are existing provisions under medicines legislation for access to unlicensed medicines without requiring changes to the law. The Government are committed to ensuring access to new and promising medicines for patients while ensuring that medicines continue to meet high standards of safety, efficacy and quality. This is why the Government have been taking forward work on an early access scheme, adaptive licensing and promotion of clinical trials in the UK.

Baroness Gardner of Parkes: I welcome that Answer as it means that many valuable drugs might come to the market much earlier and be available for patients. Does the Minister agree that many elderly patients with a terminal condition will definitely get treatment that they may not particularly want themselves but that hope is terribly important in all our lives? Any of the new, experimental drugs can provide this valuable ingredient of hope to such patients.

Earl Howe: My Lords, I agree with my noble friend, and it is one of the reasons why the NHS constitution contains a pledge to inform patients of research studies in which they may be eligible to participate if there is a promising new medicine in the pipeline.

Baroness Finlay of Llandaff: My Lords, in light of the proposed EU directive that is being led by MEP Glenis Willmott to facilitate clinical trials and the work done by Empower: Access to Medicine, led by Les Halpin, are the Government working with the Halpin protocol, which aims to overcome the legal barriers—real or perceived—to early access to, and development of, medicine in the UK?

Earl Howe: My Lords, the Medicine and Healthcare Products Regulatory Agency is at the forefront of the negotiations at European level to ensure that the new clinical trials regulation, which will replace the current directive, is much more conducive to companies directing their clinical trials towards Europe, in particular, we hope, the United Kingdom. This needs to happen. The trend over the past 10 years has been in the wrong direction and we want our own market share to increase; there are already signs that it is doing so.

Lord Taverne: The Minister’s Answer is encouraging. Does he agree that if one looks at the possible benefits to patients and the public from avoiding delays and extra costs, to press on with it is a no-brainer?

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Earl Howe: I do agree. There are two reasons to press on with it: the first is the benefit to patients, as my noble friend rightly emphasises; and the other is the benefit to UK plc if we can get more investment in research in this country.

Lord Campbell-Savours: The Question refers to waiving the right to sue pharmaceutical companies. What is the Minister’s response to that?

Earl Howe: My Lords, there is no need to think in those terms. There are many routes by which patients can access medicines lawfully and maintain their legal rights. We want to make sure that ethics and patient protection continue to be at the forefront of drug development. It would be wrong to give an indication to drug companies that they can throw caution to the winds in that sense.

Baroness Oppenheim-Barnes: It often takes as long as five or six years to develop a new drug. Sometimes, even after that period, when permission has been given, something is found late in the day. Therefore, does the Minister agree that we need to know what sort of period he is thinking of in accepting drugs that have not yet been approved?

Earl Howe: My Lords, this will very much depend on a case-by-case analysis of the drug in question. If there is a very promising new drug that is a breakthrough medicine, where there is no alternative treatment, there may be a case for considering that more favourably than a drug for which there is a readily suitable alternative. As I mentioned earlier, the menu of options available to us, such as an early access scheme for unlicensed medicines and an adaptive licensing scheme within European Union rules for licensed medicines, can perhaps be tailor-made to suit the drug in question.

Lord Patel: Does the Minister agree that there are two separate issues: one is doctors’ and nurses’ ability to prescribe off-label drugs, which is allowed, and for which the doctor takes responsibility; and the second is using a drug that might be promising for treatment and doing research on it, which requires research protocol to be followed? Neither is permissible under current regulations.

Earl Howe: My Lords, the noble Lord is right that the two issues are distinct. It has always been the case that a doctor can, under his or her own professional responsibility, in certain circumstances, prescribe an unlicensed medicine. However, he is also correct that clinical trials need to take place within a framework of proper ethical and organisational approval.

Lord Hunt of Kings Heath: My Lords, I refer to my health interests in the register. Will the introduction of value-based pricing inhibit or encourage early access to new medicines?

Earl Howe: My Lords, the noble Lord will have to wait, I am afraid, for the results of the current discussions that are going on with the pharmaceutical industry

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about what value-based pricing will look like in the end. Certainly, it is our ambition that the price of a medicine should more fairly reflect its benefit to the patient and society. Therefore, if doctors have greater confidence that those two things apply when they are made aware of the price of the medicine, we certainly hope that uptake will follow.

Health: Midwives


3 pm

Asked By Baroness Cumberlege

To ask Her Majesty’s Government what action they are taking to ensure that independent midwives can continue to work with clinical indemnity.

Baroness Cumberlege: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare the interests that are on the Lords’ register and, in this instance, the unremunerative position as patron of Independent Midwives UK.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, a 12-week consultation on the legislation to require regulated healthcare professionals to hold indemnity or insurance closed on 17 May. We are now analysing the responses to assess how the issues might be addressed, including those affecting independent midwives—that is, self-employed individuals in the private sector. This includes consideration of different models of service. Officials are also facilitating meetings between NHS England and representatives of independent midwives to discuss emerging commissioning issues.

Baroness Cumberlege: My Lords, I thank my noble friend for that Answer. On 26 October, when the European directive comes into force, it will preclude around 170 independent midwives from practising, and this at a time when we have a burgeoning baby boom. Many of these midwives actually work within the NHS. Is my noble friend aware that many of these independent midwives are seeking a solution but they require help, advice and support from the department and, above all, a revision of the tariff for maternity services? Will my noble friend ensure that this issue is a priority for urgent action by his colleagues, the Department of Health and the other agencies involved?

Earl Howe: My Lords, as my noble friend knows, work has been going on for a number of years, including going back to the previous Government, to see whether there are viable ways of ensuring that this small group of independent midwives can obtain suitable indemnity or insurance cover. One of the difficulties we have had is the absence of information on the potential barriers to independent midwives moving to alternative governance and delivery practices in order to obtain that cover—hence the consultation I have spoken about. As I said, we are now analysing the

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responses. However, I do not agree that there is no way through. We know that some independent practitioners have opted for a corporate or social enterprise model as a way of gaining insurance cover. We are trying to understand what the barriers are to that among those who are resisting the idea.

Lord Foulkes of Cumnock: My Lords, why cannot these people just get employment as midwives within the NHS?

Earl Howe: My Lords, some of them already do. As I understand it, we are talking about 154 individuals as compared with 41,000 midwives on the register. If they work for the NHS, there is generally no issue; they will be covered by NHS indemnity in one way or another. The issue is if they wish to practise privately as individuals. That is the point of my noble friend’s Question.

Baroness Jolly: My Lords, there is a certain element of urgency here. A woman expecting her baby in October would be half way through her pregnancy now. What plans are in place to deal with such women under the care of these midwives and indeed the midwives themselves if, come October, the situation has not been resolved?

Earl Howe: My Lords, we are working hard on this. Officials from the department have been in discussion with stakeholders, including Independent Midwives UK, on an ongoing basis for at least four years with a view to identifying potential solutions to the issue. Arising in part from these discussions, independent midwives can now obtain affordable indemnity cover for the whole of the maternity care pathway either in the NHS or in the private sector. However, it is acknowledged that this is achievable only if they operate as part of some form of social enterprise or corporate entity. That is the issue that we have to get to grips with between now and October.

Baroness Masham of Ilton: My Lords, how independent are these midwives? Are they responsible to themselves?

Earl Howe: My Lords, in terms of their practice, they are responsible to themselves and of course to their patients or clients but they are registered with the Nursing and Midwifery Council as professionals.

Immigration Act 1971 (Amendment) Bill [HL]

First Reading

3.05 pm

A Bill to make provision for amending the Immigration Act 1971.

The Bill was introduced by Lord Roberts of Llandudno, read a first time and ordered to be printed.

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Accession of Croatia (Immigration and Worker Authorisation) Regulations 2013

Extradition Act 2003 (Amendment to Designations) Order 2013

Police and Criminal Evidence Act 1984 (Application to immigration officers and designated customs officials in England and Wales) Order 2013

Motion to Approve

3.06 pm

Moved By Lord Taylor of Holbeach

That the draft regulations and orders laid before the House on 25 April and 8 May be approved.

Relevant document: 1st Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 4 June.

Motion agreed.

Elections (Fresh Signatures for Absent Voters) Regulations 2013

National Assembly for Wales (Representation of the People) (Fresh Signatures for Absent Voters) Order 2013

Motion to Approve

3.06 pm

Moved By Lord Wallace of Saltaire

That the draft regulations and order laid before the House on 25 April and 8 May be approved.

Relevant document: 1st Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 4 June.

Motion agreed.

Care Bill [HL]

Bill Main Page

Committee (2nd Day)

Relevant document: 1st Report from the Delegated Powers Committee.

3.07 pm

Clause 85 : Ensuring sufficient skilled health care workers for the health service

Amendment 13

Moved by Lord Warner

13: Clause 85, page 72, line 33, at end insert “and having regard to the promotion of integration with care and support provision required by section 88(1)(h)”

Lord Warner: My Lords, the purpose of this amendment is to require HEE to give attention to ensuring that, in educating and training staff for the NHS, it also ensures that, as far as possible, staff can

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work across the health/social care boundary in an integrated way. I welcome the fact that the Government have inserted into Clause 88(1) paragraph (h), which states that Health Education England must have regard to,

“the desirability of promoting the integration of health provision with health-related provision and care and support provision”.

That strengthens the Bill from its draft version, but the Bill should go further, hence my amendment.

I would like to ensure that when separate regulations are made under Clause 85 for particular groups of staff, Health Education England is also required to try to use particular regulations to promote integration in accordance with the Clause 88 provision. For example, if there are to be regulations on community nurses or healthcare assistants, the issue of training them or recognising qualifications or registration, Health Education England should act in a way that facilitates integration of services by enabling those staff to carry their training and qualifications across employment in as wide a range of settings as possible. In short, it is to help secure an integration through portability of training and qualifications provision.

We are very good at mouthing platitudes about integration and swearing undying fealty to that great god, but we are rather less good at removing the blockages to it. One of those blockages can be training and education that prevents staff from working in a range of settings, with qualifications that are not always recognised by a range of employers. We need to do our best when we have the opportunity to remove those blockages and secure more people who are equally at home working in a predominantly health or a predominantly social care setting and can easily move between those settings for the benefit of services users. These staff need to be alert also to the importance of integrating care for individual service users across organisational boundaries. I want to ensure that Health Education England is in no doubt that this approach is important for tomorrow’s workforce. That is what my amendment seeks to achieve.

I recognise that there may be better ways of reflecting my intentions in the Bill than the precise wording of my amendment. However, I think we should go further than the broad duty in Clause 88 and relate it specifically to regulation-making powers for particular groups of staff. I would certainly be happy to discuss other ways of achieving this in the best interest of patients. I beg to move.

Baroness Pitkeathley: My Lords, I speak in support of the amendment. It is absolutely vital from the point of view of the patient and the family that the workers with whom they come into contact have an understanding of the whole of their situation. The training and experience of such workers has to encompass that whole situation. For example, a person who is admitted to hospital quite suddenly with a stroke has contact with social care services, finance departments of local authorities, charities of all kinds, reablement services, private care providers, as well as all the health services concerned with the actual condition.

Most people in that situation have none of the hinterland that some of us in the House have. We start with knowledge that, for example, health and social

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care systems are differently funded and that there is no commonly understood framework for integration. Most people experiencing services do not have that pre-existing knowledge. If such a person is going to have the opportunity for choice, to which we are all committed, it is absolutely vital that the workers with whom they deal have the broadest range of knowledge and experience. People’s experience of health and social care does not come in discrete packages. It is vital that the experience of workers does not come in discrete packages either.

As this is the first day of Carers Week, I will add a further point about carers. The report published today by Carers UK, Prepared to Care?, shows that every day 6,000 people take on a caring responsibility, often without any preparation, information or advice. Therefore, I hope that the Minister will agree that the responsibilities of the workforce across all services should include training and awareness of the needs of carers. The promotion of integration contained in the amendment would also address that issue.

3.15 pm

Lord Campbell-Savours: My Lords, I should like to say a few words. My experience in all this is very much as a layman and as a tri-weekly visitor to see my mother in a nursing home. In discussion with health assistants working in the nursing home, I have found that there is a transfer between hospital settings and social care, and there are clearly disciplines and learning requirements that apply in both settings. Sometimes, in either setting, you see people who would have benefited from the training available in the other setting, particularly in the area of elderly care. To take nutrition, cleanliness and the changing of bedding, clearly the same standards apply. Often, simple tasks require a common training programme. I hope that the Minister takes the amendment very seriously.

Baroness Emerton: I entirely support the amendment on integration, particularly across the boundaries between acute and primary care. When we consider discharge policies and mechanisms, it is terribly important that those working in the acute sector understand what they need to look at to integrate with the services that will take over the care. There is division where, through the education programme, we need a holistic approach to the patient pathway.

Lord Sutherland of Houndwood: My Lords, I very much support the intention behind the amendment. It points us where we should be going. It is evident that the way in which professionals are trained deeply affects how they carry out their duties for the rest of their lives. That is a sign of good education. The noble Lord, Lord Warner, has been pointing the direction in which health and social care will and must go. It is essential to lay down the basis so that professionals accept that it is the shape of things to come.

Baroness Finlay of Llandaff: My Lords, for many years in medicine, there has been a move to try to ensure training in the community, but its implementation has been woeful. It has not been instigated as rapidly as people have been campaigning for over many years.

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I hope that the Government will look favourably on the spirit behind the amendment, although, in an odd way, the wording may be a little too restrictive. It is a very important move to ensure that, as more patients are moved out to be cared for in the community, community services can deliver what they need. With very sick people in the community, a different skill set will be needed from that which is currently available.

Baroness Wheeler: My Lords, I support my noble friend Lord Warner’s amendment. There will of course be further debate on integration in the wider context of the Bill, but the amendment is important because it underlines that Health Education England must have the strategic overview and understanding of the workforce requirements across the boundaries of health and social care if it is to undertake its role effectively.

Our stakeholder meetings have shown that there is considerable concern among stakeholders on that issue. They want the links between HEE and the social care sector to be more explicit. The noble Earl’s reassurances last week in that regard concerning Clause 88 were helpful, and I look forward to hearing from him further on how HEE is to work with integrated care delivery. I hope that he will concede that my noble friend’s cross-reference in his amendment to Clause 85 is necessary, because it links the HEE’s duty in Clause 88 to have regard to promoting integration to its key role of ensuring that there are sufficient skilled healthcare workers available.

The Health Education England mandate acknowledges that the future needs of the NHS, public health and care system will require a greater emphasis on community, primary and integrated health and social care. HEE is essential in that. Staff must be trained and developed in the skills that are transferable between different care settings and in working in cross-disciplinary teams in a range of different health and support settings. It must also work closely with the social care sector by developing common standards and portable qualifications across the NHS, public health and social care systems. The local LETB role, linking up with the health and well-being boards, is particularly important in that respect.

It is worth briefly mentioning two recent reports on integration, both of which, among other things, reinforce how much awareness and understanding of each other’s roles must take place for integrated services to happen and to be delivered. The shared commitment statement under the National Collaboration for Integrated Care and Support was drawn up by an impressive mix of national partner organisations, including government departments, the HEE itself, regulatory bodies, the Association of Directors of Adult Social Services, National Voices and other stakeholder groups. It pledges to help,

“local organisations work towards providing more person-centred, coordinated care for their communities”.

There is not time to go into detail, but National Voices’ A Narrative for Person-centred Coordinated (“Integrated) Care, which sets out what integrated care and support looks like from an individual perspective, for both the cared-for and for carers, is a powerful vision for the future. It underlines how closely staff across primary, community, NHS and social care will have to work if this is to be achieved. The section of

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the narrative on communication describes professionals talking to each other, and patients always knowing who is co-ordinating their care, always being informed about what is going on, and having one point of contact. This in itself would be nirvana to most patients, service users and carers.

The recently published Nuffield Trust report, Evaluation of the first year of the Inner North West London Integrated Care Pilot, looks at developing new forms of care planning for people with diabetes and people over the age of 75. It underlines the importance of staff having a high level of commitment to the pilot and to the care planning process in particular. Initial results show that work on care planning and multidisciplinary groups resulted in improved collaboration across the different parts of the local health and social care system.

On public health, the HEE mandate itself states:

“The health of people in England will only improve in line with other comparable developed countries when the entire NHS, public health and social care workforce genuinely understands how their services together can improve the public’s health”.

Does the Minister accept that the HEE mandate supports the case for the Bill to include an explicit reference on the overall strategic context?

HEE’s role is to provide national leadership for workforce training, planning and development, ensuring that we have skilled, committed staff in the right place, in the right specialities and numbers. We need to meet these challenges of the future and of the changing face of healthcare provision. How to ensure an integrated approach to education and training across the NHS, public health and social care is a very strategic issue. I hope that the Minister will reassure the House on this by responding positively to the amendment.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, integration between health and social care is a strong theme of the Bill, and the Government take it very seriously. I very much agreed with a great deal of what the noble Lord, Lord Warner, and others said on that topic.

First, to deliver integrated care, it is important that local planning is aligned and is mutually reinforcing. That applies also to the planning of education and training. As Members of the Committee are well aware, the future needs of the NHS and the public health and social care system will require a greater emphasis on community, primary and integrated health and social care than in the past. An understanding is required of working in cross-disciplinary teams and working to break down barriers between primary and secondary care.

The mandate the Government published a couple of weeks ago gave Health Education England a clear remit to ensure that it trains and develops a workforce with skills that are transferable between these different care settings. The amendment of the noble Lord, Lord Warner, seeks to amend Clause 85 to require HEE to have,

“regard to the promotion of integration with care and support provision”,

when it performs its duty under that clause of ensuring that there are sufficient skilled healthcare workers for the purposes of the health service. As the noble Lord

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is well aware, Clause 88, which lists the matters that Health Education England must have regard to in exercising its functions in Clauses 85 and 87, already includes a requirement at subsection (1)(h) that Health Education England must support,

“integration of health provision with health-related provision and care and support provision”.

Subsection (1)(i) requires Health Education England to support staff to be able to work across different settings. These provisions were added to the Bill at the recommendation of the Joint Committee following pre-legislative scrutiny. Although Health Education England does not have a direct remit for the social care workforce, it will be expected to work closely with the social care sector at local and national level to ensure that workforce plans align with the training and development of the healthcare and public health workforce.

To support the development of this integrated approach, Health Education England needs to work with partners across health and care to develop common standards and portable qualifications. This must make it easier for staff to work and move between settings and should build on existing work, such as skills passports and national minimum training standards. Health Education England will work closely with the sector skills councils, Skills for Health and Skills for Care, nationally and through the local education and training boards, to ensure that workforce development is co-ordinated and integrated.

Lord Campbell-Savours: Let us consider a private home in the social care sector that is owned by an individual who, let us say, has 10 healthcare assistants in that home. How will this new authority be able to ensure that those people are properly trained? My noble friend’s amendment at least tries to insert into the Bill wording that would in part have covered that. How will this new body be able to ensure that those assistants are getting the necessary training?

Earl Howe: The noble Lord’s question relates specifically to private sector organisations, such as care homes, and the broad answer to it is exactly as I have tried to outline. Health Education England will make it its business to ensure, by working with the sector skills councils in social care, that the training that healthcare assistants and care assistants receive is fully aligned and consistent, and that it can more and more ensure that people can transfer from one sector to another. The issue of continuing professional development for somebody who is already working in such a setting is, of course, a separate issue, and we will come on to debate continuing professional development. However, that is the broad answer. As the noble Lord rightly said in his earlier contribution, all this will be increasingly important as more health training shifts into the community and into social care settings. We will see delivery of this training in a variety of settings, not just in the public sector.

To answer a question posed by the noble Baroness, Lady Pitkeathley, about what HEE will be doing to support the needs of carers, Clause 89(2)(c) means that HEE must ensure that it obtains,

“advice on the exercise of its functions from … carers”.

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I hope that that gives her reassurance that the role of carers will be every bit as much in the sights of HEE as its other duties.

There is a further plank to this structure, and it is one which was mentioned by the noble Baroness, Lady Wheeler, whose contribution I listened to with great respect and agreement. The Bill places a clear duty on local education and training boards to consult health and well-being boards on their education and training plans. As the vehicle for strengthened partnership working across health and the local government and public health sectors, health and well-being boards will be well placed to reflect local priorities that need to be supported through workforce education, training and development.

The importance of multidisciplinary training was highlighted in the Government’s mandate to Health Education England. Although it will always be necessary to deliver discrete training programmes for many professions, there will be an increasing need to deliver healthcare in multidisciplinary teams, and the delivery of training should reflect this. Where appropriate it should incorporate working in multiskilled teams reflecting care pathways, rather than exclusively professional or staff groupings.

I hope that, with those remarks, the noble Lord, Lord Warner, is reassured that the Government fully support the spirit of his amendment. I hope that he has also gained a sense that, more than simply the spirit, we are pursuing the letter of what everybody wants to see: a much greater degree of integration of training and education in these sectors.

3.30 pm

Lord Warner: I am grateful to the Minister for his remarks and I take them very seriously. I do not wish to be churlish, but I may be tempted along that path a little way.

Clause 85, as I understand it, is a regulation-making power. It seems to envisage that the Government of the day will from time to time make regulations that relate to very specific groups of staff. I have read the provision carefully, and it could presumably make regulations that exclude particular groups of staff. Somewhere along the way, there is a very real possibility that we will get regulations that cover particular groups of staff in a very specific manner. I am particularly interested in those groups of staff who work at the sub-professional level—the healthcare support staff. As my noble friend Lord Campbell-Savours said, these are very much the people who work across both these settings. At the moment, I cannot see why it will do harm—indeed, it is likely do some good—if we require this regulation-making power to take account of the kinds of issues which foster integration that I and other noble Lords have spoken of. The Minister mentioned the mandate. I know that mandates are extraordinarily fashionable at the moment, but mandates come and mandates go. Regulations tend to have a bit more sticking power than mandates, which might get out of date or move out of fashion.

I think that there is an issue here. I would probably be more reassured if the noble Lord could write to me,

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and send a copy to other Members who have spoken in this debate, on which groups the Government envisage covering in regulations under Clause 85(2).

Earl Howe: I would be happy to write to the noble Lord and other noble Lords on this topic. Perhaps I may add one final comment. If we were to go down the road proposed in this amendment, by providing a cross-reference to Clause 88(1)(h) in Clause 85, it could suggest that consideration of this factor alone takes priority over other factors. We want to avoid the risk of creating any perceived hierarchy in the matters to which Health Education England must have regard in the exercise of its function under Clause 85(1).

Lord Warner: I would like to reflect further on this. In the mean time, I beg leave to withdraw the amendment.

Amendment 13 withdrawn.

Amendments 14 and 15 not moved.

Clause 85 agreed.

Amendment 16

Moved by Baroness Greengross

16: After Clause 85, insert the following new Clause—

“Regulation of healthcare and care assistants

(1) HEE shall establish and maintain a register of qualified healthcare assistants and care assistants.

(2) HEE shall, from time to time—

(a) establish the standards of proficiency necessary for admission to the register being the standards it considers necessary for safe and effective practice under the register; and

(b) prescribe the requirements to be met as to evidence of good health and good character in order to satisfy HEE that an applicant is capable of safe and effective practice as a healthcare assistant or care assistant.

(3) Regulations may prescribe—

(a) access to the register;

(b) the process of application to and acceptance on the register;

(c) the process of registration and readmission;

(d) deemed registration of EEA health care assistants and care assistants;

(e) lapse of registration;

(f) approved qualifications;

(g) EEA qualifications; and

(h) fitness to practice under the register.

(4) HEE shall, before carrying out duties prescribed in subsections (1) and (2), consult—

(a) the Secretary of State;

(b) the Care Quality Commission;

(c) such other persons, or other persons of such a description, as may be prescribed; and

(d) any other person it considers appropriate.

(5) “A healthcare assistant” is an individual who provides personal care for the health service, but who is not—

(a) a carer as defined under this Act;

(b) a healthcare worker currently registered with the General Medical Council or Nursing and Midwifery Council; or

(c) any other healthcare worker as may be prescribed.

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(6) A “care assistant” is an individual who provides personal care for the purposes of adult social care, but who is not—

(a) a carer as defined under this Act;

(b) a healthcare worker currently registered with the General Medical Council or Nursing and Midwifery Council; or

(c) any other healthcare worker as may be prescribed.

(7) “Adult social care”—

(a) includes all forms of personal care and other practical assistance for individuals who, by reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs, or any other similar circumstances, are in need of such care or other assistance, but

(b) does not include anything provided by an establishment or agency for which Her Majesty’s Chief Inspector of Education, Children’s Services and Skills is the registration authority under section 5 of the Care Standards Act 2000.”

Baroness Greengross: My Lords, I bring this amendment before the Committee because, as we all know, there are huge numbers of very frail people, usually older people, often with multiple conditions, in our hospitals and care homes, and indeed in the community now. The numbers are growing. For all sorts of reasons—I think that some of them could be tracked back to the European working time directive—nurses are doing more and more complex tasks in the care that they provide, some of it electronic, that very often removes them from the day-to-day care of some of these very frail people. The same applies in care homes. The care that is provided is very often not provided by qualified nurses but by healthcare assistants or care assistants. There are many of those people who are fantastically caring. They have a natural ability to relate to the patients that they deal with or the residents in care homes. However, a lot of the dreadful cases that we read about in the newspapers take place because unqualified and unregistered care assistants are looking after people without the necessary training and without the necessary standard of care being insisted upon. This is extremely worrying.

We have heard a lot about dehydration or malnutrition and about a lack of dignity and respect. That is terrible, whoever is providing the care, but it is even worse somehow if the care is provided by people who are neither registered nor trained adequately and cannot be blamed for the fact that complex and difficult care situations are thrust upon them and they are landed with residents that they do not know how to care for adequately.

The amendment asks HEE to establish and maintain a register of qualified healthcare assistants and care assistants. If we could get there, we would then begin to have a remedy for some of the awful cases that we read about. We would know that people were fit to practise under the register and that there would likely be fewer cases of what can, unfortunately, amount to abuse.

When this system goes wrong in our country, we often learn that it is due to people who are not trained, qualified or registered being given enormous responsibilities. I would be pleased to know if the Minister agrees with me that this amendment would be of enormous benefit to patients and residents.

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Baroness Cumberlege: My Lords, I congratulate the noble Baroness on the enormous amount of work that has clearly gone into this amendment and on the way that she introduced it, drawing on a lifetime’s experience in this field. My one reservation is about having to consider what the fundamental purpose of Health Education England is. As I see it, if HEE works well, then in future it will be the engine that delivers a better healthcare workforce in England, thereby improving the quality of care for patients. It is responsible for the education, training and personal development of all NHS staff and for recruiting, from our schools and into our universities, suitable people to carry on these tasks within the NHS. It is employer-led and it is there to provide the right workforce with the right skills and values, in the right place and at the right time, to better meet the needs and wants of patients.

The NHS has more than 300 different specific jobs and more than 1,000 employers nationwide, and the workforce needs to be educated and trained to exacting standards. Its task now is to prepare students for a very different NHS in the future: more care out of hospitals, more focus on long-term conditions, greater integration of health and social care, and new technology and techniques, all of which require planning and changes to curricula, as well as more of a focus on student choice towards NHS needs. It has an enormously difficult and comprehensive job to do. As I understand it, Health Education England accepts and supports the concept of mandatory training for healthcare assistants and the introduction of some sort of certification scheme that would allow HCAs to prove that they had attained the required levels of education and training.

It is a matter for Parliament to decide a view on regulation that goes beyond that recommended by the Government, but I do not believe that Health Education England would be an appropriate regulator. It is not created to have such a role, and that would not sit effectively with its core role of education and training. Therefore, although I very much understand the spirit of the noble Baroness’s amendment and appreciate the knowledge that she brings to the subject, I do not think that HEE is actually the tool to do this with.

Lord Turnberg: My Lords, I, too, welcome the principle behind the noble Baroness’s Amendment 16 but I agree with the noble Baroness, Lady Cumberlege, that Health Education England may not be the right place for this. At various times in our debates I have banged on about the regulation of healthcare assistants, because not only would it reassure employers and patients that standards were being met but being on a register gives individuals a degree of self-respect and sense of identity and it boosts their morale. In a way, it is a pity that we got rid of state enrolled nurses some time ago when we moved to university-educated nurses. In effect, that has been very successful and nurses have done very well—they do a marvellous job—but we have left a gap where the SENs were.

Amendment 23, which moves slightly along this same route, may be as far as we can go but, if we do have mandatory training, that will inevitably mean that someone has to produce a register of those who

10 Jun 2013 : Column 1416

have received such training. This may not be quite the right place for it but we might get there by another route.

Lord Patel: My Lords, I rise briefly to support my noble friend Lady Greengross. It is not that her sentiments about registration are not right but we debated this at great length during the passage of the Health and Social Care Bill and to a degree I felt that we lost the battle about registration then. What is now important is Amendment 23A, which, with all due respect, is a better amendment because it focuses much more on training and the responsibility of the employer. I agree with the noble Baroness, Lady Cumberlege, that HEE is not the right organisation to be a regulator of registration.

Baroness Browning: My Lords, I refer to the register and my charitable interests. I am also the named carer for an adult with a direct payments care package.

I support the amendment of the noble Baroness, Lady Greengross, although I must tell her that I have listened very carefully and I share some of the concerns about which is the right body. However, the argument for the principle of her amendment is well made.

The Bill gives Health Education England responsibilities for ensuring that the health workforce has the necessary skills to meet the needs of patients. That is valuable but there is a key omission concerning the registration of healthcare assistants and care assistants. Although those doing this work provide the vast majority of personal care to people receiving health and social care services and are fundamental to promoting and protecting service users’ dignity and respect, there have been—as we have debated on many occasions in this Chamber—far too many concerning reports in the recent past. These reports have indicated that something needs to be done at all levels and in all structures in healthcare, whether in hospitals, care homes or people’s own homes.

The Francis report clearly showed the failings at Mid Staffordshire Hospital and, while it identified the trust management as responsible for the shocking quality of care, it outlined incidences of poor care and inaction by healthcare assistants in reporting concerns. At Winterbourne View, people with severe learning disabilities were treated with an appalling lack of dignity by care assistants and nursing staff, some of whom have since been given prison sentences. A number of reports looking at dementia care in hospitals have found unacceptable variations in practice and high levels of dissatisfaction, alongside incidences of unacceptable care. A number of reports looking at home care provided to older people, including the Alzheimer’s Society reports Support. Stay. Save. and Home Truths, as well as an inquiry by the Equality and Human Rights Commission, indicate that care assistants lack the time to provide good-quality care to service users. There continue to be isolated incidences of reported poor care and abuse of older people in care homes. I shall not continue the list. Sadly, it goes on, and we see new reports in newspapers even today. It is so frustrating that we raise these issues and try to do things about them but they still continue.

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3.45 pm

I say to the Minister that I understand that the Government do not like to be seen as a regulator, particularly an overregulator, but one of the beefs I have had with Governments of all political persuasions in the past decade has been that for some reason as legislators we often appear to legislate for things that we should actually leave well alone and that do not need regulating, but then there are glaring omissions, such as this, where there is an obvious need to regulate, yet we say that we do not want to be seen as regulators and therefore do not take the necessary action. I say “Courage” to my noble friend. The time is now to regulate in this area. We have talked about it long enough and I hope that he will have the courage to take this forward. He is the ideal person to do so. I have seen his courage in many other areas of healthcare over the years, so I am convinced that he could do it.

We tend to focus on the elderly, but more and more people look to have care packages within the environment of their own home. There are thousands of people who are not elderly but who are just as vulnerable. People with learning disabilities, autism, chronic mental health conditions or chronic physical conditions have packages of care in their home. The grey line between what is healthcare and what is social care merges even more as these packages become much more complex and as technology and medication enable more people to maintain a degree of supported independent living at home. We tend to think in boxes. When people living at home in these circumstances need to engage the help of care assistants, whether for healthcare or social care, those assistants come through the statutory services or through agencies, and we like to think—as a sort of comfort cushion—that all the checks have been made to ensure not only that these people have been trained but that they are fit to do such a job. There are also a lot of people and their carers who have to employ others directly to carry out these services for them.

In conclusion, we saw appalling cases at Winterbourne View and we know that some of those people are currently serving prison sentences. When they come out of prison, I want to know that if you are suddenly seeking for the first time to employ someone to look after your mother, father or adult child, although there are Criminal Records Bureau checks, you are not going to find that people who left the service for being cruel and carrying out illegal acts on previous patients are back in the system and that you and your loved ones are vulnerable to them. For that purpose, in particular, whether this amendment finds favour with Health Education England or another body—the Nursing and Midwifery Council, for example—I urge my noble friend to consider that now is the time for registration and regulation to ensure that people are safe in their own homes and in areas where they are feeling extremely vulnerable.

Baroness Emerton: My Lords, I will make a few comments on the contributions made so far by noble Lords. During the passage of the Health and Social Care Act I was very strongly in favour of the regulation of healthcare support workers. We have moved on in time, and in terms of the setting up of Health Education

10 Jun 2013 : Column 1418

England and the role that the other bodies are taking. There is no doubt about all the points made by my noble friend Lady Greengross, and those about Winterbourne View and people being given prison sentences; most of them were registered nurses, not support workers. We want to ensure the safety of patients. For various reasons the Government now take the view that regulation is not possible through the Nursing and Midwifery Council. Regulation is possibly a step too far at this stage.

The Francis report recommended the creation of a registration system, under which no unregistered person should deliver care to a patient, whether that be in the community or in hospital. I agree that we need to have some form of certification, and some form of safeguard that will ensure that anyone delivering care will be able to be examined. Amendment 23A, which is grouped with Amendment 23, further sets out my view, which is shared by the noble Lords, Lord Willis of Knaresborough and Lord Patel, that basic training should be given with certification, and that it is important that employers take that into account.

Lord Campbell-Savours: My Lords, from what I hear and from what I have been told, the problem seems to be that no one wants to do this job. A number of organisations have been approached, and many of them have made it clear that registration would be an impossible task. However, when you talk to healthcare assistants in nursing homes or wherever, you find that among them are some who strongly believe in it, because they want to see weeded out the people who they believe should not be practising. If they want it, and they believe that it potentially defends their professional position, why can they not be given some organisation, some kind of structure to which they can belong and be registered with, which would give them confidence within their working conditions?

I understand that the Government’s response will be the vetting and barring scheme. However, despite that scheme, there is still strong support for the principle of a registration scheme. Perhaps the Minister might give his response to that, setting out the reasons why some people do not have confidence in this vetting and barring system.

Finally, in the event that we do not make progress on this matter during the course of this Bill, the best way to deal with it might be to refer it to the Liaison Committee when it is next considering applications for ad hoc committees. Perhaps those who are interested in this subject can make a joint application to the Liaison Committee to set up a House of Lords inquiry into what the blockage has been historically, what the benefits would be, and to look at the way forward in the future.

Lord Sutherland of Houndwood: My Lords, as has been claimed in the course of this short debate, this amendment should be seen in the same context as Amendments 23 and 23A. However, together they have one common difficulty, which I think has been highlighted. The first point they make is that there should be proper training and education in this area, which is absolutely right; it should be a matter for Health Education England. Secondly, there is still a

10 Jun 2013 : Column 1419

residual concern, which is very real, that the presence of training does not always guarantee that the care will be of the level and quality that we reasonably expect. So there may be a separate question about imposing some degree of regulation on employers. It is hinted at in Amendments 23 and 23A that employers could suffer a liability were they to put into the field, be they agencies or statutory employers, someone who evidently is unable to provide a decent quality of care. So the separation of these two issues is what I propose.

Baroness Masham of Ilton: I would like to ask the Minister a question. I do so agree with the noble Baroness, Lady Browning, over Winterbourne; we do not want any more Winterbourne Views—and they can happen in any part of the country.

My question to the Minister is whether he would agree with me that, when it comes to crisis intervention and physical restraint techniques, all front-line staff should receive a national standard of training to deliver the best possible quality care and health services. Undermining best practice in this area is driven by three elements: a fragmented, unregulated training provider sector; procurement pressures, and commissioners’ and regulators’ roles in quality monitoring; and practice application. The people who have to be restrained are very vulnerable and, usually, mentally ill in some way. Is it really suitable for untrained people to do this job?

Lord Hunt of Kings Heath: My Lords, the noble Baroness takes us back to our debates last year on the regulation of health and social care support workers. We had some excellent discussions but, as the noble Baroness, Lady Browning, said, the Government set their face against the statutory approach without convincingly explaining to the House why they did not favour such a move. As far as I can see, the Government’s main objection appears to be cost; they are relying on better training and a voluntary register. But as the noble Baroness, Lady Greengross, pointed out, this may not be sufficient. As she says, unqualified care assistants are looking after very vulnerable people without the necessary training and support, and are being placed in a very vulnerable position. This is probably not the time to debate the loss of state-enrolled nurses, but my noble friend Lord Turnberg is absolutely right to say that the essential removal of the SEN grade has left a gap which needs to be filled.

My noble friend Lord Campbell-Savours points out that we are absolutely reliant on support workers to provide care. Many or most of them are actually very dedicated, but they are not being given sufficient tools to do the job effectively. One has to have great sympathy with the noble Baroness in her amendment.

Some noble Lords have said that it is not readily apparent why Health Education England ought to be the regulator. I certainly sympathise with that point, but no doubt the noble Baroness could easily substitute either the NMC or the HPC. We could no doubt come back to the question of which regulator it should be. The HPC has been somewhat acquisitive in past years in adding professions to its register, and would no doubt be keen to add healthcare and social care support

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workers to the large number of people whom it registers at the moment. As for the NMC, we understand that it has been through some difficulties in leadership and has a backlog of cases to be heard by its regulatory committees. But it has new leadership, and I am confident that it will be able to get through those problems—and, if it was chosen, it could also register health and support care assistants if that were to be required. So I do not think that there is an organisational issue in terms of difficulty in organising the regulation of support workers.

The Francis report has been mentioned by a number of noble Lords. This compelling report says:

“A voluntary register has little or no advantage for the public. Employers will not be compelled to employ only those on the register although they could be incentivised to do so”.

It concludes:

“It is not generally those who would seek voluntary registration who are the concern. It is those who will or would not seek voluntary registration but are still able to obtain employment who will be in contact with vulnerable patients”,

and those patients may not be appropriately protected. The Francis report says that this,

“need not be costly and can be self-financing”.

Amendments 23 and 23A, which we are going to come to, are very helpful but they do not do the job of regulation. Does the noble Earl think that the Government should reconsider their position in the light of the Francis report and of today’s debate?

4 pm

Earl Howe: My Lords, like my noble friend Lady Cumberlege, I pay tribute to the noble Baroness, Lady Greengross, for her very carefully crafted amendment. It seeks to extend compulsory statutory regulation to healthcare assistants and care assistants and to make further amendments to legislation to account for this. I want first to acknowledge the crucial role played by healthcare and care support workers in the delivery of high-quality care to patients and service users throughout the country. That much is a given. The vast majority of workers give the very highest quality of care and are relied on and valued for the way they improve people’s lives. However, we have all seen evidence that a minority let patients down. This is a cause for concern and it is right that there is discussion about how we can ensure consistent, high standards of care.

My noble friend Lady Cumberlege made some very compelling points on the terms of the amendment but on the wider issue of principle the Government do not believe that the case for regulation is proven. Compulsory statutory regulation is not, of itself, an effective way to assure the quality of care by these workers and it can detract from the essential responsibility of employers to ensure that any person they appoint is suitably trained and competent for the role.

There are already existing tiers of regulation that protect service users, including the standards set by the Care Quality Commission and the Disclosure and Barring Service. We also need to be clear that professional regulation is not a panacea. It is no substitute for good leadership at every level and proper management of services. It can also constrain innovation and the availability of services. Experience clearly demonstrates that a small number of those workers who are subject

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to compulsory statutory regulation from time to time fail to ensure that their practice is up to date and delivered to the standard that we expect. In these circumstances it is too often the case that regulation can react only after the event.

The placing of hundreds of thousands of individuals on a list would not, of itself, ensure that we never again see the appalling failings in care highlighted by the Francis report into Mid Staffordshire or, indeed, Winterbourne View. Strong and effective leadership of the workforce is where the focus for improvement should lie. Employers and managers who are closest to the point of care must take responsibility for ensuring standards.

We also recognise that we need to facilitate employers to appropriately employ, delegate to and supervise health and social care assistants. To this end, as I have previously mentioned, we commissioned Skills for Health and Skills for Care to develop a code of conduct and minimum training standards for these groups in England.

In addition, we have announced the Cavendish review to consider what can be done to ensure that all people using services are treated with care and compassion by healthcare and care assistants in NHS and social care settings. The Nursing and Care Quality Forum has been established to help all those involved in providing nursing and care in all care settings to deliver the fundamental elements of good care and achieve their ambition of providing the very highest quality of care. That is in part an answer to the point made very powerfully by the noble Baroness, Lady Masham.

The noble Lord, Lord Hunt, suggested that these workers are not being given the tools to upskill themselves. We want to ensure that all healthcare assistants provide safe, effective and compassionate care, and we have already announced a number of measures to support this, including a £13 million innovation fund for the training and education of unregulated health professionals, the publication of a code of conduct and minimum training standards for healthcare and care assistants, and a review of induction training by the CQC. This is work in progress.

Having made these points, I want to reassure in particular the noble Baroness, Lady Greengross, that we have an open mind as to the range of measures that need to be put in place. However, before we can take a rounded view of what those measures should be, we need to take account of the recommendations that flow from the Cavendish review. I suggest to the noble Baroness that that is the most sensible approach.

Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Earl for giving way, but the terms of reference of the Cavendish review do not cover the regulation of healthcare support workers.

Earl Howe: No, the terms of reference encompass the core concern of the noble Baroness, Lady Greengross, which is the competence and skills of this sector of the workforce. That gets to the heart of the concerns of my noble friend Lady Browning around safety and the rest. The Cavendish review will point the way to a number of ideas that can move us in a positive direction.

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Lord Warner: My Lords, perhaps I may ask the noble Earl a question before he sits down because I am getting increasingly puzzled by this debate. I agree with him that a list does not of itself do very much to protect the public, particularly if it is a list of apples, oranges, bananas, pears, cherries or whatever—and this is a list of people with different qualifications or experiences. However, the whole point about HEE is that it is meant to be a game-changer and to standardise some of the training for particular groups. Is it the Government’s view that the term “healthcare assistant” will start to mean the same in Cornwall as in Cumbria, because HEE has defined the training for those covered by that terminology to be the same wherever the person is trained?

Earl Howe: That indeed is the ambition whereby there should be consistency of standards throughout the country and people should know precisely what those standards are. The problem with this sector of the workforce is that the standards have not properly been defined until now—hence the work that Skills for Health and Skills for Care are doing. However, we will see from that work and the work of Camilla Cavendish where the gaps are and where we need to focus our attention. The noble Lord is certainly right to say that once we have these standards in place, Health Education England will be responsible for ensuring that they are properly promulgated and rolled out.

Lord Sutherland of Houndwood: My Lords, I thank the Minister for giving way. I appreciate his point about the responsibility of employers. They are immensely important. However, would he be prepared to extend the language of responsibility to liability, either of a fiscal, legal or right-to-practise nature? I am not asking for a detailed answer, but it would be a shift that many of us feel would be moving in the right direction.

Earl Howe: As a result of the Francis report, we are indeed looking at the whole question of the liability of employers in the NHS as much as anywhere else. No doubt we shall be debating those issues when we reach Part 2 of the Bill. However, I can reassure the noble Lord on that point. We have here a vital segment of our health and social care workforce. I hope that the noble Baroness, Lady Greengross—

Lord Campbell-Savours: I am sure the Minister will be very frank with the Committee. Is he aware of concerns being expressed about the operation of the vetting and barring scheme? Is he aware of any complaints?

Earl Howe: I am not aware of those concerns, and I apologise to the noble Lord as I meant to pick that up. I was slightly taken aback by his comment. Of course, I shall take advice on that point and I would be very happy to talk to the noble Lord outside the Committee on this matter. I have certainly not been made aware that that service is deficient in any material way, but that it operates effectively to protect patients and the public.

Does the noble Baroness, Lady Emerton, wish to intervene?

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Baroness Emerton: No, my Lord.

Earl Howe: I conclude by saying to the noble Baroness, Lady Greengross, that I hope she takes some encouragement from the work that is in train, and that she agrees with me that it is right to take stock after we see the recommendations flowing from the Cavendish review later in the year. No doubt that can inform our deliberations on Report. I hope that, in the mean time, she will feel able to withdraw the amendment.

Baroness Greengross: My Lords, I thank all noble Lords who have spoken for accepting that the principle that I was arguing about is correct and that there is a need for something to be done. I think we all recognise that, too often, people receive rather poor care. It is very hard to pin down what is going on because we do not have the mechanism to do so.

I also thank the noble Baroness, Lady Cumberlege, for saying that the principle of what I said was right. I thank the noble Baroness, Lady Browning, and all noble Lords who have spoken for agreeing that something really needs to be done. In my rather simplistic way of looking at things, I think that training leads to a qualification that will lead to a registration. It is as simple as that. Getting the training right would eventually lead to a professional approach of which people could be more proud and which would give them the self-respect that they need and, in the majority of cases, deserve. That would also give us the knowledge that, when things go wrong, there is a mechanism that will stop them from getting worse.

I also agree with the Minister that the Cavendish review could be the way forward and perhaps this is pre-empting something that we will have to wait a while to achieve. I feel very strongly that this has gone on for far too long; the anxieties are really great and something must be done. I hope I can work with my noble friend Lady Emerton so that somehow we can speed things up a little. In the mean time, I thank the Minister for his comments and beg leave to withdraw the amendment.

Amendment 16 withdrawn.

4.15 pm

Clause 86 : Quality improvement in education and training, etc.

Amendment 17

Moved by Lord Turnberg

17: Clause 86, page 73, line 5, leave out paragraph (b) and insert—

“(b) the use of research evidence to ensure the rapid uptake of innovations into practice”

Lord Turnberg: This group of amendments, to which I have attached my name, is all about putting into practice the brave words we have heard about the need to place research at the centre of what the NHS does.

We have had the important and impressive inclusion in the NHS mandate to NHS England and CCGs of the duty to promote research, and we have had the recent publication of the Association of Medical Research

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Charities of a vision for research in the NHS with its three proposals. First, every patient should be offered the opportunity to be involved in research. Secondly, all NHS staff should be made aware of the importance of research. Thirdly, the NHS should conduct high-quality research and adopt innovation in healthcare rapidly. All the good intentions were spelt out in the earlier Bill and subsequently, but we seem to have lost sight of that in the current Bill.

Amendment 17 simply makes clearer what seems to be rather vague and perhaps less forceful in the current wording about accepting research evidence and putting innovations into practice. The Bill states that HEE must promote, which is a good word,

“the use in those activities of evidence obtained from the research”.

That has to be read several times to be understood. My amendment suggests something rather clearer, and what I hope is intended, which is,

“the use of research evidence to ensure the rapid uptake of innovations into practice”.

Amendments 20 and 32 aim to ensure that Health Education England also makes it clear that all who work in the NHS should understand and be able to play a part in research and innovation by including a new responsibility, to ensure that research and innovation are incorporated into the Bill. Amendments 37 and 39 point to similar responsibilities for the LETBs. My name is attached to these amendments, which are in the name of the noble Lord, Lord Willis, who unfortunately cannot be with us today because he is unwell. We wish him well. There is considerable danger that the LETBs in particular, dominated by local provider interests, will not unnaturally focus on their need to provide a clinical service and their requirement for sufficient numbers to fill their workforce needs. In so doing, they may not see that a service that is constantly evolving and changing needs a workforce that is fully switched on to the research agenda. They may not see that the future leaders of change—those who can undertake research and introduce new and better treatments year in, year out need to have their training needs met, too.

There are at least two types of need. The first is that of future academic clinicians, professors, senior lecturers, lecturers and the like in medicine, surgery, obstetrics and so on. The second is the need of all practising clinicians, be they doctors, nurses or technicians, if they are to integrate innovations and change into their practices. The academics need training programmes that are sufficiently flexible so that they can do their clinical training for some of the time and their research at others. They will almost certainly need to take three or more years out to do their PhDs, and they often need to do their purely clinical training over a longer period than others, as they slot periods of research into their clinical training.

Those going on to straight clinical practice—always the majority—need to understand what research entails, and will need to have some contact with research. Some may even take full time out for research, and in that way can appreciate new research findings as they come along. All those factors need to be considered by those in charge of education and training locally. I fear that unless something to that effect, as proposed

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in the amendments, is incorporated into the Bill, it will be so easy for it to slip out of view under the considerable pressure simply to provide services for today, with no thought for the needs of tomorrow.

I am not encouraged by the Department of Health’s document which is the mandate from the Government to Health Education England, in which the section headed “Flexible Workforce, receptive to research and innovation”—a brave heading—spells out what is intended. There is little here about how the intention of encouraging the development of a research-receptive workforce will be carried out. There is much about generalism, flexibility across service divisions and so on—all highly desirable—but nothing about producing those capable of doing the research and engaging in the clinical trials needed to make innovation possible. I hope these amendments will help to fill those gaps.

Lord Patel: My Lords, I support these amendments. My name is attached to Amendments 17, 20 and 32 in the name of the noble Lord, Lord Turnberg, and to Amendments 37 and 39 in the name of the noble Lord, Lord Willis of Knaresborough, who, as we have heard, was taken to hospital yesterday. I spoke to him in his hospital bed just before we started and he was beginning to feel better. I am sure we will want to wish him well.

I strongly support the amendment because, through the Health and Social Care Act, we gave prominence to the need to promote research and innovation in the health service, and it is right that we did that. It would be a pity now if the only gap in that duty would be for it not to apply to the key body, Health Education England, and the local education and training board committees. As the noble Lord, Lord Turnberg, so eloquently put it, the amendments are about education and training by research, and about making sure that LETBs also have a responsibility to make sure that they conform to the functions of the HEE. They are all related to research, training, innovation, continuing training and research and supporting research. They cannot be wrong and I hope the Minister will accept them. They are well meaning and promote research further.

Baroness Jolly: My Lords, I thank the noble Lords, Lord Turnberg and Lord Patel, for helping me with these amendments. The noble Lord, Lord Willis of Knaresborough, is unwell and may not be returning to us in time to help with the Bill. His twin passions are training and research, and Amendments 37 and 39 to Clause 90, which are all about the functions of LETBs, completely underpin that. I would be doing him a disservice if I did not ask the Minister to explore these areas when he sums up.

It is critical not only at a national level, with HEE, but at a local level, with the LETBs, that this area is not forgotten. Staff must understand not only the implications but all aspects of research. That must be plugged in at HEE and, with these amendments to Clause 90, at the LETB level.

Baroness Wheeler: I strongly support this group of amendments, the case for which has been ably made by my noble friend Lord Turnberg, the noble Lord, Lord Patel, and the noble Baroness, Lady Jolly.

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The importance to the NHS of research and innovation has come under close scrutiny and debate in the House in recent times, under the Health and Social Care Bill, in the powerful debate of the noble Lord, Lord Saatchi, earlier this year, and in the debate that we almost had in the name of the noble Lord, Lord Kakkar, on the life sciences industry’s important contribution to healthcare and to our economy.

Under the Health and Social Care Act, Labour fully supported placing duties on the Secretary of State, the NCB and CCGs to promote research. Indeed, my noble friends Lady Thornton and Lord Hunt proposed amendments to that Bill reinforcing the importance of research, and we were pleased to work with noble Lords across the House in strengthening these provisions. That is why amendments to Clause 86, which deals with quality improvement in education and training, are so important.

Amendment 17 deletes the current reference to HEE needing to promote,

“the use in those activities of evidence obtained from the research”,

and replaces it with a proactive reference to using this,

“evidence to ensure the rapid uptake of innovations into practice”.

Amendment 20 underlines the need for HEE,

“to secure that research and innovation are incorporated into education and training”.

This was a recommendation of the Joint Committee, which we fully support. All NHS staff should be equipped with the tools to understand and support research and to assess and use evidence to inform their decisions when caring for patients or supporting clinical staff. They also need to be able to make use of research throughout their careers—a point that my noble friend Lord Turnberg made strongly—and be familiar with the NHS research infrastructure, which can provide further help and support.

The recent survey by the Association of Medical Research Charities showed the challenges to be phased in in this regard. Some 91% of staff surveyed, including doctors and nurses, identified the barriers that they had experienced to taking part in research. Lack of time was the predominant reason given by respondents. Other reasons included funding, practical support and difficulties in navigating regulation. GPs are an important gateway for getting patients involved in research, but although a majority of GPs believes that it is important for the NHS to support research into treatments for their patients, only 32% felt that it was important for them personally to be involved. As AMRC emphasises, we still have a long way to go if the Government’s goal of every clinician being a researcher and every willing patient a research participant is to be achieved.

Amendment 32 to Clause 87 adds promoting innovation and research in clinical practice to the matters that the HEE should have regard to—a logical and crucial next step in our support for innovation and research under HEE’s national functions. Amendment 37 on the local functions that LETBs exercise on behalf of HEE makes the important cross-reference between Clause 90 and Clause 86, rather than Clause 84, on the issue of ensuring that there are sufficient skilled healthcare workers promoting research and the use of research evidence in the health service. We believe that if LETBs are performing other duties

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of behalf of HEE under Clause 90, there is no reason why they should not also promote research, obviously within the LETB area. Amendment 39 would confirm in legislation that HEE’s research duty applies to LETBs as a main function, and we strongly support that.

Throughout the debates on innovation and research, we heard continued concerns and frustrations at the often painfully slow, complex and bureaucratic process of getting innovation in care and treatment adopted in the NHS. There was frustration, too, that existing processes and pathways, such as conditional approval in the named patient schemes and the opportunities under existing legislation, are not being fully used. In the January debate, the Minister reminded us that it took an estimated 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice. That is why these amendments to ensure that HEE actively promotes innovation and research and carries that through in the education and training of healthcare workers needs to be supported by the Government. I look forward to the Minister’s response.

4.30 pm

Earl Howe: My Lords, there is no doubt that education and training can play an important role in creating a workforce that is research literate and innovative, with the skills required to diffuse the latest ideas and innovations. The noble Lord, Lord Turnberg, has focused our minds on some important goals in this area.

Through our investment in the education and training of health professionals, we must seek to ensure that our future practitioners know how to access evidence, use evidence and contribute to the national research enterprise. Developing a flexible workforce that is responsive to research and innovation is one of the key priorities that the Government have set for the Health Education England special health authority in its mandate. To answer the question posed by the noble Lord, Lord Turnberg, Section 63(1) sets out an objective for Heath Education England to support clinical academic careers.

Amendment 17 would require Health Education England to promote the use of research evidence to ensure the rapid uptake of innovations into practice. Amendment 20 would require it to exercise its functions to secure that research and innovation are incorporated into education and training. Amendment 32 would require it to have regard to the desirability of promoting research and innovation in clinical practice when performing its duties under Clause 85(1) to ensure sufficient skilled workers and Clause 87(4) when setting its objectives, priorities and outcomes for education and training.

The Government recognise very clearly the importance of promoting research and innovation. That is why Clause 86(2) of the Bill requires Health Education England, in exercising its functions, to promote research and the use of evidence from research in education and training activity. In response to stakeholder views in consultation and a recommendation from the Joint Committee that examined the draft Bill, we have strengthened the wording so that it is a duty to promote research. This has been welcomed by stakeholders

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such as the Academy of Medical Sciences and the Association of Medical Research Charities. It also reflects, incidentally, the equivalent duties to promote research already placed on the Secretary of State, NHS England and clinical commissioning groups by the Health and Social Care Act 2012.

The duty requires Health Education England to promote research activity in relation to its education and training functions, and the use of evidence obtained from that research, to secure continuous improvement in the quality of education and training. Those are pretty powerful provisions. I hope that noble Lords will appreciate from what I have said that Health Education England already has the necessary powers under Clause 86(2) to secure that research and innovation are fully incorporated into education and training.

I can reassure the noble Lord, Lord Turnberg, that Health Education England and the local education and training boards will work closely with research and innovation partners such as the academic health science centres and academic health science networks to deliver the duty to promote research. I can also reassure him that Health Education England will ensure that local education and training boards support this agenda and delivery of the duty to promote research. I hope that the noble Lord will feel sufficiently reassured by that to withdraw the amendment.

I shall now respond to the two other amendments to which noble Lords have spoken. Amendment 37 would add to a local education and training board’s main functions the promotion of research and the use of research evidence in the health service. Amendment 39 would require a local education and training board to support Health Education England in exercising its function to promote research into matters relating to social care services, primary care services and other health services so far as it is exercisable. I wholeheartedly agree that the local education and training boards need to take a strong interest in research and the use of research evidence when planning, commissioning and quality assuring the delivery of education and training. As noble Lords know, we have placed the primary duty to promote research on Health Education England but, as committees of Health Education England, the LETBs will be required to support the national body in delivering the duty through their workforce planning and education and training functions. Therefore, we do not see that the amendment is necessary in that sense. Health Education England will ensure that the LETBs support the delivery of key national duties, such as those in Clause 86, to promote research, support the NHS constitution and improve the quality of education and training. I also point out in this context that the appointment criteria that the Health Education England special health authority has used to appoint the existing 13 local education and training boards require the LETB to demonstrate effective mechanisms for partnership working with academic health science centres and academic health sciences networks.

I am sure that noble Lords will also be glad to know that Health Education England and the LETBs are working with the National Institute for Health Research, headed by Professor Dame Sally Davies, to ensure

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appropriate investment in education and training to develop clinical academic careers and increase the number of staff accessing academic careers programmes across all clinical and public health professions.

I hope that noble Lords will feel reassured that the spirit of the amendments is one which we have already grasped and which is reflected in the Bill and that they will therefore feel able not to press the amendments.

Lord Turnberg: My Lords, as always, the noble Earl gave some very reassuring words on this topic. I am not absolutely convinced that we do not need to strengthen the Bill a little more to reflect what he has enunciated, but, for the moment, I beg leave to withdraw the amendment.

Amendment 17 withdrawn.

Amendments 18 to 21 not moved.

House resumed.

Government Communications Headquarters


4.37 pm

Lord Wallace of Saltaire: My Lords, with the leave of the House, I will repeat a Statement which my right honourable friend the Foreign Secretary has just been making in the House of Commons. The Statement is as follows.

“Mr Speaker, with permission, I will make a Statement on the work of the Government Communications Headquarters, GCHQ, its legal framework and recent publicity about it. As Foreign Secretary, I am responsible for the work of GCHQ and the Secret Intelligence Service, SIS, under the overall authority of the Prime Minister. My right honourable friend the Home Secretary is responsible for the work of the Security Service, MI5.

Over the past few days there have been a series of media disclosures of classified US documents relating to the collection of intelligence by US agencies, and questions about the role of GCHQ. The US Administration has begun a review into the circumstances of these leaks in conjunction with the Justice Department and the US intelligence community.

President Obama has been clear that US work in this area is fully overseen and authorised by Congress and relevant judicial bodies, and that his Administration is committed to respecting the civil liberties and privacy of its citizens.

The Government deplore the leaking of any classified information wherever it occurs. Such leaks can make the work of maintaining the security of our country and that of our allies more difficult. By providing a partial and potentially misleading picture, they give rise to public concerns.

It has been the policy of successive British Governments not to comment on the detail of intelligence operations. The House will therefore understand that I will not be drawn into confirming or denying any aspect of leaked information. I will be as informative as possible to give reassurance to the public and Parliament. We want the

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British people to have confidence in the work of our intelligence agencies and in their adherence to the law and our democratic values. But I also wish to be very clear that I will take great care in this Statement and in answering questions to say nothing that gives any clue or comfort to terrorists, criminals and foreign intelligence services as they seek to do harm to this country and its people.

Three issues have arisen in recent days which I wish to address. First, I will describe the action the Government are taking in response to recent events; secondly, I will set out how our intelligence agencies work in accordance with UK law and subject to democratic oversight; and thirdly, I will describe how the law is upheld with respect to intelligence co-operation with the United States, and deal with specific questions that have been raised about the operation of GCHQ.

First, in respect of the action we have taken, the Intelligence and Security Committee has already received some information from GCHQ, and will receive a full report tomorrow. My right honourable friend the Member for Kensington, who chairs the ISC, is travelling to the United States on a long-planned visit with the rest of the committee, including Members of this House. As he has said, the Committee will be free to decide what, if any, further action it should take in the light of that report. The Government and the agencies will co-operate fully with the committee, and I pay tribute to its members and their predecessors on all sides of both Houses.

Secondly, the ISC’s work is one part of the strong framework of democratic accountability and oversight that governs the use of secret intelligence in the United Kingdom, which successive Governments have worked to strengthen. At its heart are two Acts of Parliament: the Intelligence Services Act 1994 and the Regulation of Investigatory Powers Act 2000. The Acts require GCHQ and the other agencies to seek authorisation for their operations from a Secretary of State, normally the Foreign Secretary or the Home Secretary.

As Foreign Secretary, I receive hundreds of operational proposals from SIS and GCHQ every year. The proposals are detailed. They set out the planned operation, the potential risks and the intended benefits of the intelligence. They include comprehensive legal advice describing the basis for the operation and comments from senior Foreign Office officials and lawyers. To intercept the content of any individual’s communications within the UK requires a warrant signed personally by me, by the Home Secretary or by another Secretary of State. This is no casual process. Every decision is based on extensive legal and policy advice. Warrants are legally required to be necessary, proportionate and carefully targeted, and we judge them on that basis.

Considerations of privacy are also at the forefront of our minds, as I believe they will have been in the minds of our predecessors. We take great care to balance individual privacy with our duty to safeguard the public and UK national security. These are often difficult and finely judged decisions, and we do not approve every proposal put before us by the agencies.

All the authorisations the Home Secretary and I do give are subject to independent review by an Intelligence Services Commissioner and an Interception of Communications Commissioner, both of whom must

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have held high judicial office and who report directly to the Prime Minister. They review the way that these decisions are made to ensure that they are fully compliant with the law. They have full access to all the information they need to carry out their responsibilities, and their reports are publicly available.

It is vital that we have this framework of democratic accountability and scrutiny. But I also have nothing but praise for the professionalism, dedication and integrity of the men and women of GCHQ. I know from my work with them how seriously they take their obligations under UK and international law. Indeed, in his most recent report the Intelligence Services Commissioner said: ‘it is my belief that… GCHQ staff conduct themselves with the highest levels of integrity and legal compliance’.

This combination of needing a warrant from one of the most senior members of the Government, decided on the basis of detailed legal advice, with such decisions reviewed by independent commissioners and implemented by agencies with strong legal and ethical frameworks, with the addition of parliamentary scrutiny by the ISC, whose powers are being increased, provides one of the strongest systems of checks and balances and democratic accountability for secret intelligence anywhere in the world.

Thirdly, I want to set out how UK law is upheld in respect of information received from the United States and to address the specific questions about the role of GCHQ. Since the 1940s GCHQ and its American equivalent, now the National Security Agency, have had a relationship that is unique in the world. This relationship has been and remains essential to the security of both nations. It has stopped many terrorist and espionage plots against this country, and has saved many lives. The basic principles by which that co-operation operates have not changed over time. Indeed, I wish to emphasise to the House that while we have experienced an extremely busy period in intelligence and diplomacy in the last three years, the arrangements for oversight and the general framework for exchanging information with the United States are the same as under previous Governments.

The growing and diffuse nature of threats from terrorists, criminals or espionage has only increased the importance of the intelligence relationship with the United States. This was particularly the case in the run-up to the Olympics. The House will not be surprised that our activity to counter terrorism intensified and rose to a peak in the summer of last year. It has been suggested that GCHQ uses our partnership with the United States to get around UK law, obtaining information that it cannot legally obtain in the UK. I wish to be absolutely clear that this accusation is baseless. Any data obtained by us from the US involving UK nationals are subject to proper UK statutory controls and safeguards, including the relevant sections of the Intelligence Services Act, the Human Rights Act and RIPA. Our intelligence-sharing work with the United States is subject to ministerial and independent oversight and to scrutiny by the Intelligence and Security Committee. Our agencies practise and uphold UK laws at all times, even when dealing with information from outside the UK.

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The combination of a robust legal framework, ministerial responsibility, scrutiny by the Intelligence Services Commissioners and parliamentary accountability through the Intelligence and Security Committee, should give a high level of confidence that the system works as intended. This does not mean that we do not have to work to strengthen public confidence wherever we can, while maintaining the secrecy necessary to intelligence work. We have strengthened the role of the ISC through the Justice and Security Act 2013 to include oversight of the agencies’ operations as well as their policy, administration and finances, and we have introduced the National Security Council so that intelligence is weighed and assessed alongside all other sources of information available to us as a Government, including diplomatic reporting and the insights of other government departments, and so that all this information is judged carefully in deciding the Government’s overall strategy and objectives.

There is no doubt that secret intelligence, including the work of GCHQ, is vital to our country. It enables us to detect threats against our country ranging from nuclear proliferation to cyberattack. Our agencies work to prevent serious and organised crime, and to protect our economy against those trying to steal intellectual property. They disrupt complex plots against our country, such as when individuals travel abroad to gain terrorist training and prepare attacks. They support the work of our Armed Forces overseas and help to protect the lives of our men and women in uniform, and they work to help other countries lawfully to build the capacity and willingness to investigate and disrupt terrorists in their countries, before threats reach us within the United Kingdom. We should never forget that threats are launched at us secretly, that new weapons systems and tactics are developed secretly, and that countries or terrorist groups that plan attacks or operations against us do so in secrecy. So the methods we use to combat these threats must be secret, just as they must always be lawful.

If the citizens of this country could see the time and care taken in making these decisions, the carefully targeted nature of all our interventions and the strict controls in place to ensure that the law and our democratic values are upheld, and if they could witness the integrity and professionalism of the men and women of the intelligence agencies, who are among the very finest public servants our nation has, then I believe that they would be reassured by how we go about this difficult but essential work. The British people can be confident in the way that our agencies work to keep them safe, but would-be terrorists—those seeking to spy against this country or those who are the centre of organised crime—should be aware that this country has the capability and partnerships to protect its citizens against the full range of threats in the 21st century, and that we will always do so in accordance with our laws and values but with constant resolve and determination.”

My Lords, that concludes the statement.

4.50 pm

Lord Triesman: My Lords, I thank the Minister for repeating the Statement made in the other place. It is important to start with some clarity over the precise subject that we are discussing today and we do so on

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this side against a background of agreement that I think is shared in both Houses, and across all sides of both Houses, about the values that are expressed in the Statement and the importance of protecting the United Kingdom and those values. It is clear that that is absolutely common ground.

The Guardian newspaper has revealed information obtained from Mr Edward Snowden, a former CIA contractor, that the National Security Agency in the United States has, so far as we understand it, collected huge quantities of information on telephone calls, e-mails and other online information. Some, but by no means all, of this surveillance has been focused on United States citizens. Much is said to have come from Google, Yahoo, Facebook, Skype and other digital sources. It will therefore include surveillance of people who are not US citizens.

While the United States Administration have acknowledged the truth of the telephone surveillance, the technology companies have denied that any online information has been provided that was not covered by a federal court warrant before it was handed to the US Government.

I do not want, and it is not my place, to comment on United States policy on this matter or on the extent to which the Patriot Act makes such actions in the US legal. Those are matters for US politicians and US courts. However, I accept what the Foreign Secretary has said—that all the surveillance is directed not just against terrorists but against many different kinds of criminals, such as cybercriminals, paedophiles and people who wish to steal intellectual property.

We need to focus on the issues for the United Kingdom and to allay the plain anxieties of UK citizens and the UK media about the extent of UK involvement, its character and the legal basis for anything that has happened in our country. As Douglas Alexander put it on the “Today” programme this morning in response to Simon McCoy, “We need to be able to reassure the public ... there is an understandable level of public concern, given the reports in the newspapers over the last couple of days, and given how much we all rely on the intelligence agencies here in the United Kingdom to keep us safe”. There have been assertions and counterassertions. Today we begin the process of understanding what has happened from the United Kingdom’s point of view.

First, I will deal with what might be called the straw dogs. I want, for complete avoidance of doubt, to be clear about what we are not saying today. I do not doubt for one second that in the complex battle with terrorism or organised crime we need to collect data. It is an intrusive but entirely essential task for our security services. I will not accept from these Benches that we would ever willingly or knowingly put UK citizens or others at risk. We, too, will give no comfort or inadvertent assistance to terrorists, as the Foreign Secretary said.

Secondly, we have no doubt whatever that this means that there will be co-operation between friendly states trying to achieve the same objectives.

Thirdly, the balance between surveillance and privacy is a very hard one to strike. Perhaps it is impossible to get it entirely right as circumstances change. The Foreign

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Secretary said, in replying to questions on the Statement, that mistakes will always be made. I am not even saying that mistakes have been made, but this is obviously something that we will all want to keep in mind. Privacy will be compromised to some extent, whatever balance we agree. However, there has to be a proper balance if we regard the proper privacy of citizens as important—important not at the risk of their life and limb but important none the less in a democratic society where we enjoy private life within the law. The United Kingdom would never have settled for a Stasi-style state. This weekend, the Foreign Secretary described his approach as “necessary” and “proportionate”. That is a matter of the balance. We try to enshrine the balance as best we can in law, and I must return to this point in seeking clarification from the Minister. We need better to understand the terms that the Foreign Secretary has used.

Fourthly, every Minister who has dealt with the intelligence services, including GCHQ—and I am proud to have been one of them—knows that we are dealing with people of the greatest integrity, and it is not any part of my submission to your Lordships that we have grounds for suspicion. They are excellent as a group and are outstanding in their service to the United Kingdom. I believe that the noble Lord, Lord Carlile, made essentially the same point on television over the weekend, and it is a view that I share.

Fifthly, I hear the expression that law-abiding British citizens have “nothing to fear”. We have probably all used that kind of phrase on one occasion or another, but it often conceals more than it reveals. Of course those acting within the law should not fear oversight but most of us also value our privacy, at least to some extent, and can value it without wishing to commit any acts of terrorism. I am never happy about the extent to which search engines inspect my tastes, purchases, and whereabouts and so on in pursuit of business, even when I do not want them to. Prism is therefore a concern for honest reasons, not dishonest ones. How we use it or perhaps contribute to it is also a concern for honest reasons, not dishonest ones.

On the “Today” programme this morning, Sir Malcolm Rifkind said that no access surveillance data of the kinds that I have described could be collected without explicit ministerial approval. I think that that was reflected in the Statement but I want to check. As I understand it, Sir Malcolm was referring either to material that the UK’s intelligence agencies may wish to collect for themselves or to material collected by a foreign agency that the intelligence services here might wish to access. He said, “The law is actually quite clear. If the British intelligence agencies are seeking to know the content of e-mails about people living in the UK then they actually have to get lawful authority. Normally that means ministerial authority”. I understand that the foreign agency might offer material out of mutual friendship and concern for the well-being of our or other citizens, and I repeat that this has an unavoidable impact on privacy but is very important for our safety. However, Sir Malcolm’s point was that there is an explicit law on permissions. He was not making the point that we should never try to catch terrorists by such means—quite the contrary.

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Therefore, none of my questions is intended to help any terrorist. I have thought carefully about these questions, which in the past I would have been able to answer or would have been inclined to say I could not answer before your Lordships in this House for security reasons. These questions are not hostile; rather, they are exploratory. I ask them against the clear background of saying that we want the criminals whose attacks may be directed towards this country and who are never constrained by the question of any international border to be prevented from causing us harm and brought to justice.

How many instances of data acquisition by our intelligence services have taken place in the past three years in the ways that have been alleged by the Guardian? What precisely is the legal framework, what are the procedures and what are the protocols under which a United Kingdom Minister could ask for information from American agencies?

Did Ministers authorise each and every one of these applications for data? I suspect that there will be a yes or no answer. The assurance of legality can be made clear today by answering that question. It will not aid a terrorist in any respect to know the answer but it should be a source of reassurance to honest, law-abiding citizens of the UK.

Would it be lawful for GCHQ to request information from Prism and for this to fall outside the scrutiny of any UK Act, including the Intelligence Services Act and the Regulation of Investigatory Powers Act? Mr Hague appears to have said in the Statement that that could not happen, but I would welcome confirmation.

What is the status of the request to search United States data? Would that be covered by a proper warrant just as would requests to obtain that information in this country?

Did the Intelligence Services Commissioner and the Interception of Communications Commissioner have oversight of the process that they exercised? I do not mean “Do they?” in a general sense but “Did they in these circumstances?”.

Will the Foreign Secretary be willing to discuss all these matters in detail in an appropriately confidential meeting of the Intelligence and Security Committee? Will the ISC be put in a position where it can add to the assurance that the public seeks without disclosing anything at all that may assist anybody who intends us harm? Will the Foreign Secretary set out for Parliament any concerns that he may have about the surveillance of United Kingdom citizens, or, if he has none, will he explain how he reaches a conclusion on that matter? He cannot regard this as something within the reach of the “nothing to fear” answer. How rapidly could the Government respond to these deeper questions which have been brought to the surface by these events?

I ask these questions in exactly the sense in which I started when responding to the Statement. We are as committed as anybody to the effectiveness of an intelligence service which, from experience, I know is among the best in the world, operated by the best civil servants this country could hope to have. The public are not often exposed to the nature of the service’s

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work—this is perhaps a necessary fact about that kind of work. However, some clarity on these questions will give real reassurance.

5 pm

Lord Wallace of Saltaire: My Lords, I thank the noble Lord for the general support he has given the Government and for his very constructive remarks on the necessary and excellent role of our agencies. He will understand that I cannot give him precise answers on some of the questions that he asked. As the Foreign Secretary said in his Statement, a preliminary report has already gone to the Intelligence and Security Committee, a fuller report will go to it and the committee will have the opportunity to examine the Foreign Secretary and a great many others on the reports that have come out. I hope that the noble Lord will allow me to leave it at that.

I simply add that the transmission of global communications is part of the context in which we all have to operate, as is the transmission of human movement. Someone may have been in London yesterday, is in Lagos today and could be in Aleppo in three days’ time. That person might be a citizen of two or three countries, one of which might be the UK. That is part of the problem. When the noble Lord says “within the UK”, what is within the UK is a great deal less clear than it was a few years ago. For all I know, the server which might hold the noble Lord’s private information from his Facebook account could be in Washington state—possibly even in southern China. Therefore, we are moving away from the ability to handle some of these issues entirely within the framework of the single nation state.

There are some extremely large questions here on data-sharing and data protection, some of which we will have to return to. Clearly data protection has to be on a European and global scale and cannot be purely domestic. That is the context in which we face all these challenges. We need different ways of attempting to keep up with criminals, terrorists and others from those we see in television series about the 1930s and 1920s, when detectives and security agencies steamed open the envelopes of letters, which were the main means of communication in those days.

5.03 pm

Lord King of Bridgwater: My Lords, do we not now face a much more dangerous world in which we know that certain organisations are determined to commit acts of terror against this country in a more positive and direct way than we have perhaps faced before? Combine that with an explosion in systems of communication which did not exist before, and the graphic illustration that the Minister just gave about London, Lagos and Aleppo, and there is a globalisation and dependence on other countries for intelligence. The front line in the defence of our country is intelligence. From my previous experience, I pay tribute—as has already been done—to those who serve in our intelligence agencies. However, the challenges they now face are very real, and protecting the rule of law and following the orders under which they operate against the threats that our country faces involve very high standards indeed.

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The real core of this Statement is that we need the ISC. We have to have some impartial outside body, and it will not surprise the Minister when I say that we must preserve the credibility of the ISC. Sir Malcolm Rifkind and his colleagues, including two Members of this House, face a challenging job. A very serious accusation has been made and we must get to the truth about it. I have absolutely no criticism of Sir Malcolm Rifkind, and have fortunately been long enough out of post. In preserving that credibility, we have to watch that we do not appoint people who have just had ministerial responsibility for the areas that they may be asked to investigate. A continual challenge is ensuring that we have experienced people who can contribute to what is now a very important job for the ISC.

Lord Wallace of Saltaire: I thank the noble Lord for those comments. I am not sure that in some ways we are in a more dangerous world than we were in 100 or more years ago when international anarchist groups succeeded in assassinating the heads of state of two or three European countries. However, he is absolutely right about the explosion of communications and the speed of communications. The general increase in the educated population of the world means that, when you are looking for terrorist groups, you are not able to look for a small group within each city but are looking at a much larger number of possible suspects. That is why agencies have to adapt the way they look at these sources.

Lord Lloyd of Berwick: I understand extremely well that the Minister cannot at this stage tell us very much, but I hope that he can at least confirm what appears to be the case—that the 197 Prism reports said to have been passed on to GCHQ last year all relate to communications data and not to the contents of any intercepted communication. If he can give us that confirmation—I hope he can and can see no reason why he should not if it be the case—it would be much less serious and would allay certain anxieties that otherwise we must all feel. If it is the case that it relates solely to communications data, will he say who gave the authorisation under Section 21 of RIPA, which is the relevant section, not Chapter 1, and whether the authorisation was specific to this case or was a general authorisation?

Lord Wallace of Saltaire: The noble and learned Lord would like me to go into specifics on specific cases, and I am going to resist that for reasons he will fully understand, while recognising the importance of the distinction made between communications data and the details of communications, which is one that we all recognise.

Lord Reid of Cardowan: My Lords, first, in all humility, I advise the Minister that it would be useful to distinguish between published opinion and public opinion. He may never be able to reassure some elements of published opinion that the security services are not being overzealous until there is some great incident, and it will then accuse the security services of not having done enough. That is the experience.

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Secondly, to reassure public opinion, will he confirm that the regulatory legal framework is among the best, if not the strongest, among western democracies, not only the legal framework he mentioned of the Intelligence Services Act and RIPA but ministerial oversight, independent scrutiny and parliamentary accountability through the ISC? I tell him from my own interests—I declare them as registered—not only as a former Home Secretary but in the private sector and the academic sector that there is astonishment among many colleagues in Europe and the western democracies at just how far we go to ensure that oversight.

Will the Minister confirm the simple point that international terrorism is by definition international, that the means of communication in the world wide web is by definition worldwide and that therefore, if we are to protect the lives of the citizens of this country, we have to operate on an international basis? Almost every single plot that has threatened the public, many of which they have not heard about, has involved at least two or three countries, and in some cases more than 20. Therefore, within the legal framework, the security services, operating and sharing information on counterterrorism with our close allies throughout the world, have saved literally thousands of lives in this country over the past 15 years. The whole House should note that and congratulate our security services on it.

Lord Wallace of Saltaire: I thank the noble Lord for those very helpful words. However, it is not only all terrorism that is by definition international. When I was covering the Home Office brief and spent some time with the West Yorkshire Police I came to the conclusion that all serious organised crime is now international. We therefore operate in a world in which co-operation, not just with the United States but with our European partners and others, is nevertheless essential in order to combat this global phenomenon—and, of course, some of those with whom we have to co-operate are not the easiest of partners. The noble Lord will know well that some of the websites which those who have been radicalised in this country have had access to are operated out of very distant countries.

The difference between public opinion and published opinion is, of course, that public opinion very often wants different and contradictory things. The public want security and privacy, they want the state off their backs, but at the same time they want the state to protect them. That is part of what politicians have to deal with. It is one of the reasons why referendums are not always a terribly good idea, because the way public opinion flies depends on which week the referendum is held. Attitudes to privacy among the young are much more relaxed than among the old. Whether as the young get older they become more concerned about privacy is something we shall slowly discover as we go on.

Baroness Falkner of Margravine: My Lords, the Foreign Secretary’s Statement will have gone far to reassure people that our very high standards of oversight are being upheld. However, the problem for people is not so much about our own legal standards and standards of oversight, but what happens internationally, in

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other countries, and whether their standards are as high. In light of that, will my noble friend tell us what attention Her Majesty’s Government are giving, in the borderless cyberworld, not just to the full implementation of the 2006 data retention directive, but also to aspiring to have high common standards as we go forward into negotiations with the United States on the transatlantic treaty? Will that subject be covered in those talks?

Lord Wallace of Saltaire: My Lords, I am not entirely sure that I understand the full transition to cloud computing. A very small number of people in this House understand it, and I run to them from time to time to ask for their advice. Certainly, we will find that the new global standards on attempts to regulate cloud computing will be thrashed out in negotiations between the United States and the European Union in the context of the transatlantic negotiations. So far we are a long way from discovering how those will turn out. I read in the New York Times the other day that one of the differences across the Atlantic is that in the United States most people distrust the state much more than they distrust companies, whereas in Europe more people trust the state and distrust companies. That raises implications for what sort of regulation people really want. Clearly there will be some extremely difficult negotiations, first on the EU data protection directive, and then within the transatlantic negotiations.

Lord Elystan-Morgan: My Lords, in quoting the words of Sir Malcolm Rifkind, the chairman of the security committee, the Minister referred to a statement by him which said that normally only information which had been the subject of specific ministerial request would be used. The word “normally” suggests to me that there may be exceptional circumstances. Can the Minister, without embarrassment, suggest the sort of situation in which that might operate? It is a constructive and relevant question, which I am sure the House would wish to have an answer to, if possible.

Lord Wallace of Saltaire: The noble Lord tempts me to go down a lane which I think that I would prefer not to go down. It is, of course, the case that, in moments of absolute crisis, a short cut may possibly be taken, but this country attempts in all circumstances to go through the correct procedures and hold to the legal framework.

Lord Carlile of Berriew: Would my noble friend agree that one of the duties of the security services is to obtain relevant information in accordance with the constraints imposed by British law? Would he further agree that there is absolutely no evidence that GCHQ has deliberately circumvented British law to obtain information that might be available to the American authorities under quite different American law? Thirdly, would he agree that it is to be hoped that the free flow of important information between the United Kingdom’s security services and the Americans will continue, particularly if that information indicates that lives might be saved if the information is acted on? Would he further agree that it would be completely unacceptable

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for the British authorities to ignore information coming from abroad, wherever it comes from, if acting on that information might save lives?

Lord Wallace of Saltaire: I can confirm most of the questions asked by the noble Lord, but I had better not go into too much detail. An enormous amount of information is flowing into the United Kingdom on any day of the week from a range of other intelligence services. Naturally, we trust the Americans far more than we trust some other countries. But one has to listen to countries that may in many ways be hostile to the United Kingdom but with which we may share some real security interests. That is all part of the very delicate world in which we live and have to operate. None of this is easy, but maintaining British security and, at the same time, maintaining an open society is our underlying intention.

Lord West of Spithead: Would the Minister agree that it is somewhat ironic that the so-called whistleblower chose Hong Kong, which is close to and alongside China, as the place to make this statement, bearing in mind its systematic control of the internet within its own country, the way in which it looks intrusively at its own population, and the fact that it has probably been in among the computers of a large number of us here, let alone organisations in this country?

Lord Wallace of Saltaire: I confirm that, and congratulate the noble Lord on asking a question that did not mention the Royal Navy for the first time in some considerable period.

Lord Lucas: My Lords, will my noble friend confirm that at least one of the organisations with oversight over the security services would have it drawn to their attention if we started to get a large flow of communications content information from the United States, as opposed to communications data?

Lord Wallace of Saltaire: My Lords, lawyers have come in at a very early stage in this. I was briefed by FCO lawyers as well as by FCO officials this morning. Oversight is a continuing process, so any unusual change in pattern would naturally feed up towards the scrutiny and accountability process.

Lord Strasburger: My Lords, I apologise for arriving during the reading of this Statement but, in my defence, I was late because I was listening to it from the horse’s mouth, from the Foreign Secretary in another place.

In the USA, it would seem that politicians have been asleep at the wheel while their security and intelligence services have helped themselves to anyone’s private data without any meaningful oversight. Happily, in this county we have much better checks and balances on our security services, and the Government to their credit have been much more robust in resisting calls for security at any cost from the proponents of the disproportionate and unnecessary communications data Bill, which was accurately given the soubriquet the “snoopers’ charter”.

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My question has been asked already today, but I ask my noble friend to try to address it. On the 197 occasions in the past year when GCHQ has stated that it obtained data from the Prism system in the States, was the data acquisition authorised by a Minister on each occasion? That is not about the content or the cases involved but simply about the process and legality.

Lord Wallace of Saltaire: My Lords, that is one of the issues which will be investigated by the ISC. The noble Lord and I may differ on what we think about the history and current role of the US agencies, but there is quite a large issue about US companies—Google and others—which we have assumed to be extremely benevolent but which are collecting a great deal of personal information on a very large number of people. That raises long-term issues which we will, no doubt, have to debate in future Sessions along with both domestic and international regulations to cope with them.