3 July 2013 : Column 1203

House of Lords

Wednesday, 3 July 2013.

3 pm

Prayers—read by the Lord Bishop of Truro.



3.05 pm

Asked by The Lord Bishop of Wakefield

To ask Her Majesty’s Government what steps they are taking to encourage greater economic and political co-operation between Georgia and the European Union.

Lord Wallace of Saltaire: My Lords, the UK fully supports greater economic and political co-operation between Georgia and the European Union, particularly through regular and intensive high-level contact. Three senior Georgian Ministers have visited London in recent months and three UK Ministers and several senior officials have visited Tbilisi. We are pleased that Euro-Atlantic integration has remained a priority for the new Georgian Government, and, through involvement in the Eastern Partnership, Georgia is finalising an association agreement and a deep and comprehensive free trade area with the EU.

The Lord Bishop of Wakefield: My Lords, I am grateful to the Minister for his response and for setting out the range of co-operation between Georgia and the EU. I remain concerned that, for most Georgians, this assistance remains invisible. Do the Government accept that to avoid similar mistakes to those made with the Ukraine, the EU should take steps to explain to the wider Georgian public the benefits of the association agreement and other such co-operation measures with the EU, rather than after they have been negotiated?

Lord Wallace of Saltaire: I was briefly in Tbilisi eight weeks ago and saw that the EU is quite visible there. The EU monitoring mission is the largest external monitoring mission in Georgia, monitoring the borders with the disputed territories of Abkhazia and South Ossetia. The EU heads of mission meet regularly, and comment regularly and openly, on developments in Georgian politics. The Council of Europe and the OSCE are also active in assisting with judicial training in Georgia and elsewhere. So we are quite visible and extremely active.

Lord Anderson of Swansea: My Lords, the Minister mentioned the EU monitoring mission but failed to mention that Russia and its allies still prevent that EU monitoring mission doing its work in Abkhazia and South Ossetia. What protests are we making to Russia about that, and are we content for yet another frozen conflict in Europe to remain for a longer time?

3 July 2013 : Column 1204

Lord Wallace of Saltaire: My Lords, we are not content, but as the noble Lord knows well, the Russians are not always the easiest negotiating partners. As he will also know, a fence is being erected along the boundary of the breakaway regions and, in some cases, several hundred metres into Georgian territory beyond the breakaway regions. We continue to talk to the Russians about this. The new Georgian Government have made a number of deliberate unilateral moves to demonstrate their willingness to talk to the Russians. There have been some limited talks but so far the Russians have not given very much in return.

Baroness Falkner of Margravine: My Lords, does my noble friend agree that the greatest challenge for the EU with regard to Georgia is managing the relationship between Russia and Georgia? Can he tell the House the position of Her Majesty’s Government on Georgia’s application to join NATO, which could present some newer challenges?

Lord Wallace of Saltaire: My Lords, at Bucharest some years ago NATO agreed to accept Georgia as a candidate member. The largest non-NATO, non-British force at Helmand at the moment is two Georgian battalions. We support Georgia’s aspiration to join NATO but it will necessarily, unavoidably be a long process. There are, indeed, British military trainers in Georgia.

The Earl of Sandwich: My Lords, the right reverend Prelate mentioned Ukraine as a possible parallel. However, is not Ukraine a good deal behind Georgia politically, and therefore could not Georgia qualify much earlier, given also that the Ukrainian opposition leader is still in prison?

Lord Wallace of Saltaire: My Lords, it is entirely fair to say that Ukraine is considerably behind Georgia in many ways. There was a free and fair election in Georgia last spring which resulted in a change of Government. The Georgian Government have just announced that on 31 October this year there will be a presidential election. Of course, that is not to say that it is a perfect democracy. There are a number of issues, including cases against members of the previous Administration, about which we are concerned. However, when I was in Tbilisi I had lunch at the British embassy with MPs both from the governing party and from the opposition. There are many countries in what was formerly the Soviet Union in which one could not do that.

Lord Kilclooney: My Lords, given that the European Union accepted Cyprus as a member even though its Government did not govern the entire island of Cyprus, why does the European Union welcome Croatia and not Georgia as a member?

Lord Wallace of Saltaire: I note some of the unspoken sentiments behind the noble Lord’s question. As he knows well, the process of admission to the European Union is long and arduous. Georgia is at a very early stage in that process. Georgia’s administrative capability

3 July 2013 : Column 1205

and economic changes and the judicial, rule of law issues that it will have to go through mean that any approach to the European Union will be relatively long, but that is also true for some of the western Balkan countries.

Lord Bates: My Lords, given that the eyes of the world will be on Sochi next February for the Winter Olympic Games and that Sochi is less than 100 miles from the Georgian border, will my noble friend urge the UK mission to the UN to encourage Georgian and Russian reconciliation when the Olympic Truce is presented to the United Nations General Assembly in October? Given that the Russians invaded Georgia in violation of the Beijing Olympic Truce, this might be a timely point for reconciliation.

Lord Wallace of Saltaire: I congratulate the noble Lord on the faithfulness with which he wishes to ensure that we think about the Olympic Truce. We are very conscious that the Sochi Winter Olympics are taking place extremely close to the border with Abkhazia and that that may potentially raise some security issues. There is instability in the north Caucasus as well as in the south Caucasus and we have, of course, spoken to the Russians about that.



3.13 pm

Asked by Baroness Quin

To ask Her Majesty’s Government whether they are proposing any measures to ensure that homelessness does not increase.

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Hanham): My Lords, we are currently investing £470 million over four years to prevent and tackle homelessness. In the recent spending round for 2015-16, it was announced that the Department of Health will bring forward a new £40 million hostels investment programme. We are also encouraging housing supply through expanding the private rented sector, with £10 billion in loan guarantees, the £1 billion Build to Rent fund and a new three-year affordable homes programme of £3.3 billion from 2015-16, including £400 million for new-product, affordable rent-to-buy.

Baroness Quin: My Lords, homelessness has risen sharply over the past two years, and recent government measures do not help. For example, on the BBC’s “Look North” last night, it was reported that rent arrears had shot up in Sunderland, Newcastle and north Tyneside as a result of the bedroom tax, raising fears of further evictions and homelessness. Will the Government recognise that misleading national figures about overcrowding and underoccupancy fail to appreciate the huge mismatch between these two things across the country, and that the Government should now, on an area-by-area basis, work urgently with local authorities and housing associations to stop the acute crisis in housing and homelessness getting even worse?

3 July 2013 : Column 1206

Baroness Hanham: My Lords, the Government are already working across the country with individual authorities, providing access to funding and policies that enable local authorities to make the decisions they need to make and which we have encouraged. We have changed the law to ensure that local authorities can use the private rented sector for people who are homeless or in danger of homelessness. Local authorities need to make decisions on the amount of housing and money they need to support homelessness and on their policies for dealing with homelessness. The Government are fully aware that there are discrepancies across the country and we are working with local authorities to try to help with that.

Baroness Gardner of Parkes: My Lords, does the Minister realise that many of these homeless people are dealt with by charities, rather than by local authorities? They are very difficult for anyone to manage. When I was a chairman of social services, we had homeless shelters where people used to smoke so often that you had a permanent fire hazard in the building. People who elect to sleep on the street often do not wish to be under any authority that would regulate them. What is the Government’s estimate of the proportion of homeless people dealt with by charities, as opposed to local authorities?

Baroness Hanham: My Lords, I cannot give the noble Baroness the exact proportion but, yes, a number of charities such as Centrepoint and St Mungo’s in London provide an extraordinarily important service. The Passage at Westminster Cathedral and similar organisations across the country play an enormous part in supporting and helping homeless people. The No Second Night Out initiative now takes place not only in London but across the country. It ensures that what my noble friend suggests happens does not happen. People are not on the streets for longer than one night. They are taken off and given advice, help and support to enable them to move back into proper accommodation.

Baroness Morgan of Drefelin: My Lords, official figures say that rough sleeping has increased by 31% in the past two years but experts working in the field say that the increase is double that. Do the Government have a projection for how homelessness, and rough sleeping in particular, is set to go in the future? Do the Government agree that it is essential that all rough sleepers should have access to emergency accommodation and that that needs to be planned for if we are to see this increase continuing in the future?

Baroness Hanham: My Lords, rough sleeping had gone down but I acknowledge that it is beginning to creep up again and, as I have said, that is completely undesirable. The No Second Night Out initiative ensures that people are not left on the streets for long spells of time and that they are given access and help. The £40 million I have just mentioned will come from the Department of Health. It is to build hostels and provide hostel accommodation for people who are sleeping rough and to get them off the streets. It will be very effective, particularly for the mentally ill, of whom there are more in that situation than we would wish.

3 July 2013 : Column 1207

Lord Berkeley: My Lords, alongside homelessness often goes hunger. The Minister told us yesterday that there was no government policy to encourage soup kitchens. Is starvation part of the Government’s policy, because that seems to be the only way out?

Baroness Hanham: My Lords, I will leave that to my noble friend the Minister who made the statement. Of course, starvation is not part of anyone’s policy or wish. One of the reasons for getting people off the street as quickly as possible is to ensure that they have access to food, medical help and help with accommodation.

Baroness Maddock: Has my noble friend seen the excellent report from St Mungo’s charity, which she mentioned earlier, entitled No More: Homelessness Through the Eyes of Recent Rough Sleepers? According to the report, St Mungo’s found that most of the rough sleepers it surveyed had been in touch with the police before they slept rough, rather than with any other service. What can the Government do to encourage and assist the police to do more work with other agencies to address the problems before they escalate into homelessness?

Baroness Hanham: My Lords, there is already good co-operation between all the agencies that are involved with people who are becoming homeless. The police are often involved in the initial stages, when people have perhaps committed minor crimes, and so they come across them that way. However, there is common accord across the health service, local authorities and the police to ensure that as much help as possible is given.

Baroness Farrington of Ribbleton: My Lords, the Minister has a long and distinguished career in local government. Will she join me in expressing concern that local authorities are repeatedly being told that they are given money for this and money for that, but that global budgets are being cut? The result is that individual groups and needs often start asking for the money to be ring-fenced, when in fact local authorities are being constrained far too much by central government. I remember occasions in her distinguished career when the Minister objected to central government doing that.

Baroness Hanham: My Lords, we could now have a debate for half an hour on the financial situation and why we are in a position where we have to reduce funding across both government and local authorities. As I said before and will reiterate, local authorities need to manage the budgets that they have, and need to make the necessary adjustments to how they administer themselves and allocate their funding. The noble Baroness is right that budgets are not ring-fenced, but local authorities are given specific allocations to help with particular areas, including homelessness. However, we are where we are and in the financial situation that we are, which did not start with this Government. Therefore, we all have to play our part in trying to ensure that that is improved.

3 July 2013 : Column 1208

Health: Diabetes


3.22 pm

Asked by Lord Harrison

To ask Her Majesty’s Government what assessment they have made of the quality of healthcare available to diabetics with eye problems.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, we have set clear objectives for the NHS and Public Health England to improve the care and quality of life for people with diabetes. The public health outcomes framework includes an indicator on preventable sight loss, which will track three of the commonest causes of preventable sight loss, including diabetic retinopathy, to drive improvements in quality.

Lord Harrison: My Lords, given the decline in the regular and important annual check-up for diabetics, does the Minister acknowledge that the retinopathy screening for diabetics introduced by the previous Government is being undermined and underresourced? On cataract operations, will the Minister explain why, among our European Union colleagues, we are the most demanding regarding the threshold required to have such operations? Given the importance of cataract operations, especially for older people in retaining their vision, will the Minister meet me and other colleagues to discuss these matters and allied subjects?

Earl Howe: I would be happy to meet the noble Lord. I am aware that the whole area of the cataract threshold and, perhaps more importantly, the interpretation of that threshold, is one that NHS England is now actively looking at to ensure greater consistency around the country.

I do not agree with the noble Lord’s interpretation of the screening figures. The UK countries, I believe, lead the world in the area of diabetes eye screening. This is the first time that a population-based screening programme has been introduced on such a large scale. The latest figures show that up to March 2013, 99% of people with diabetes who were eligible for screening were offered it in the previous 12 months.

Baroness Finlay of Llandaff: My Lords, given the importance of prevention, have the Government been monitoring the progress of access to insulin pumps for children with diabetes, in order to prevent eye problems later in life, given that they have better control with insulin pumps?

Earl Howe: My Lords, that tends to be a matter for provider trusts, working in conjunction with clinical commissioning groups. I am aware that there is concern about the variability of access to insulin pumps. Of course, they are not a universal remedy for every diabetic patient, but where they are appropriate they should be commissioned. If I can give the noble Baroness the latest information on that, once I have consulted NHS England, I would be happy to do so.

3 July 2013 : Column 1209

Baroness Jolly: My Lords, the House has heard that eye screening is critical for those with diabetes. As the national screening programmes are now commissioned by NHS England on behalf of Public Health England, and while diagnostic and treatment services are commissioned by clinical commissioning groups, will my noble friend tell the House what challenges these arrangements pose to the patient when trying to assess quality?

Earl Howe: The key thing here is for NHS England, Public Health England and local commissioners to work closely together, which is indeed what they are doing, so that the patient experiences a seamless service. Essentially, the new commissioning arrangements for national screening programmes enable effective commissioning and oversight of the whole screening pathway, alongside integrating those with the diagnostic and treatment services. To ensure a quality service, local programmes are assured by NHS screening programmes’ quality assurance teams and services are measured against 19 standards.

Lord Low of Dalston: My Lords, I declare my interest as vice-president of RNIB. The Minister will be aware that NICE has recently approved the use of Lucentis as a treatment for those suffering from diabetic macular oedema. We are hearing reports from various parts of the country of queues building up of people requiring treatment for diabetic macular oedema. Will the Minister undertake to do his best to ensure that the necessary resources are put in place to relieve these backlogs and enable people to benefit from this new treatment that has now become available?

Earl Howe: My Lords, I am aware of the issue that the noble Lord raises. He will know that NHS commissioners are statutorily required to fund clinically appropriate drugs and treatments which have been recommended by NICE. The Centre for Workforce Intelligence has been commissioned to review the ophthalmology medical workforce after discussions were held between the royal college and Health Education England earlier this year. That review is due to report in the summer and the results of it should, I hope, point the way to a resolution of the issue that the noble Lord has raised.

Lord Collins of Highbury: My Lords, as a type 2 diabetic, I benefit from annual retinal check-ups at UCH; it is an excellent service. However, despite there being a national screening programme, there is a large variation in take-up, which in some areas is as low as 65%. What steps are the Government taking to ensure a higher and more consistent take-up?

Earl Howe: In the end, accepting the offer of screening is a matter for each individual. There are some people who, for personal reasons, will choose not to take up the offer. However, as part of the process of continuous improvement, we would expect the gap between the number of people offered and the number of people receiving screening to reduce, and for there to be greater consistency in numbers offered and received across local screening programmes.

3 July 2013 : Column 1210

Cyclists: Safety


3.28 pm

Asked by Lord Greaves

To ask Her Majesty’s Government, in the light of the Department for Transport’s figures on road casualties in 2012, what steps they are considering to increase the safety of cyclists on the roads.

Earl Attlee: My Lords, as I said on Monday, we take cycle safety very seriously. Earlier this year, we announced £40 million, including local contributions, for 78 junction safety schemes. In addition, the majority of schemes in the £600 million local sustainable transport fund include cycling. We have made it easier for councils to introduce 20 mph speed limits and install Trixi mirrors. We are considering the recommendations of the All-Party Parliamentary Cycling Group inquiry and will respond shortly.

Lord Greaves: My Lords, over the past two years, the number of cyclists killed on the roads has gone up from 111 to 118 per annum and the number seriously injured, perhaps more worryingly, from 2,660 to 3,222. One of the main problems that cyclists have is their interaction with heavy vehicles. It is welcome that the Minister for Road Safety announced, I think last week, the setting up of the cycle-lorry safety working group, jointly between the Transport Department and Transport for London. Can the Minister say when this working group will start work; who will be involved and particularly whether cycling organisations will be able to give evidence to it; and which specific aspects of cycle lorry safety will it look at?

Earl Attlee: My Lords, my noble friend has asked me quite a lot of detailed questions and I think it would be better if I wrote to him. I agree that HGVs are a disproportionate problem. HGVs do not have any more accidents with cycles than do cars. However, when they do have an accident, the result is generally much more serious. It is quite right that we pay special attention to HGVs.

Lord Campbell-Savours: My Lords, the use of mobile phones by motorists is illegal, because it is unsafe. Surely the use of audio headgear by cyclists is equally unsafe and should be made illegal?

Earl Attlee: My Lords, I agree with the noble Lord that it is extremely unwise to cover one’s ears when riding a cycle, because you cannot hear traffic approaching or someone sounding their horn. I am not sure that it is necessary to make it illegal.

Baroness Sharples: Would my noble friend agree that cyclists should wear some form of identification? I was nearly knocked over outside Millbank. I shouted at the cyclist—I did not swipe him—but please could we have some identification on them?

3 July 2013 : Column 1211

Earl Attlee: My Lords, we want to do everything we can to increase the level of cycling because of the health benefits. To require someone to carry identification when riding a cycle would be an unnecessary burden. There can be incidents with pedestrians, for instance, when it would be good if they carried identity, but we do not require them to do so, so we do not see why a cyclist should carry identity either.

The Earl of Listowel: My Lords, what is being done to encourage children to wear helmets? Is the Minister aware of the particular fragility of the skulls of young children?

Earl Attlee: My Lords, we are acutely aware of this problem. We strongly encourage children to wear helmets. However, again because of the difficulty of enforcing the wearing of helmets for children, we do not want to make it compulsory—a legal requirement—but we strongly encourage children to wear helmets and we think it is a very good idea for adults to wear helmets as well.

Lord Winston: My Lords, does the Minister agree that the health benefits of cycling may not be as great as he imagines, given that in London the pollution from slow-moving traffic is about 10 times the legal limit in Europe?

Earl Attlee: My Lords, the noble Lord raises an interesting point. The noble Baroness, Lady King of Bow, has raised this matter with me and I have had a meeting with her about it. We are doing everything we can to improve the air quality in London, but it is difficult to get to where we want to be.

Lord Taverne: My Lords, the most radical and probably most effective measures proposed by the cycling organisations, such as the Go Dutch campaign, would be quite expensive. However, does the Minister not agree that the benefits would be very substantial? There would be less pollution, less congestion in cities and a better urban environment—and, of course, as the Minister has acknowledged, anyone who gets on a bike instead of sitting in a car will be much healthier, whatever their age.

Earl Attlee: My Lords, I entirely agree with my noble friend. I was a little bit worried when he started talking about expensive solutions, but I do agree with him.

Baroness Butler-Sloss: My Lords, I am concerned about the safety of pedestrians, as has already been mentioned. Cyclists ride with mobiles to their ear, with ear things otherwise filled with music, turning right across the traffic when the light is red against them. What are the Government going to do to tell cyclists to obey the red signs?

Noble Lords: Hear, hear!

Earl Attlee: My Lords, I think that I agree with the whole House that it is important that cyclists adhere to all the rules in the Highway Code, in particular by not using a mobile phone while riding and not covering up their ears, in order to avoid unnecessary accidents.

3 July 2013 : Column 1212

Lord Davies of Oldham: My Lords, of course cyclists should obey the Highway Code, but the Question with which we started reflected on the fact that deaths and serious injuries for cyclists have increased during the past three years. Several months ago, the Times newspaper launched a campaign on cities fit for cycling and established eight points which have been largely endorsed by the cycling organisations. Are the Government supportive of those points and, if so, what action on them have they taken?

Earl Attlee: My Lords, we are generally supportive of the Times campaign; I have the list of all its suggestions here and we are measuring our performance against them. Not every single one can be adopted, but we are trying as hard as we can to reduce the casualties.

Lord Tebbit: My Lords, how many cyclists actually pay the fixed-penalty tickets which are issued to them for offences such as riding on the pavement to the danger of pedestrians? My noble friend may know that they habitually give false names and addresses; there is no way for the police officer issuing the penalty notice to know that. What are we going to do? Are we going to compel cyclists to have some form of identification so that, if issued with a penalty ticket, they are required to pay it instead of just scoffing at the law?

Earl Attlee: My Lords, it is up to the police to decide how they enforce road traffic law, and they have the necessary tools to do so. I gently say to my noble friend that the police look at where they can deploy their resources to reduce casualties. Although it is extremely annoying for noble Lords to see cyclists riding on the pavement, and although it does cause accidents, it does not cause fatal accidents.

Press Regulation

Private Notice Question

3.37 pm

Asked by Lord Fowler

To ask Her Majesty’s Government how it will ensure that the relative merits of the two proposed royal charters on press regulation will be properly compared with one another given that it has been reported today that the relevant Privy Council meetings are likely to be months apart.

Lord Gardiner of Kimble: My Lords, the charter published on 18 March continues to have the support of the three main political parties. The Press Standards Board of Finance has petitioned with an alternative charter and this is being given proper, legally robust consideration in line with the Privy Council process. That will need to include consideration of the merits of the petition in the light of all relevant facts. The Secretary of State for Culture, Media and Sport will update the other House on these matters very shortly.

3 July 2013 : Column 1213

Lord Fowler: In thanking my noble friend for that response, perhaps I may ask him two questions. First, am I right in saying that the effective decision on the press’s proposal for its royal charter will be taken by a group of Ministers who happen to be privy counsellors? It is four months since the beginning of this royal charter process. Why has it taken so long? Given that the Government and Parliament have already rejected the press’s proposals, why do they need until October to give even further consideration to them? Secondly, is the Minister aware that press proprietors are now in the process of setting up their own body in any event and that one story is that they are to begin recruiting staff? Can the Minister therefore tell me just when we will get round to deciding the royal charter which was overwhelmingly approved by Parliament in March? Surely it is that charter, the charter approved by Parliament, which is pre-eminent and the one that we want to see considered and implemented?

Lord Gardiner of Kimble: A number of questions were asked, my Lords. We have to undertake due processes as regards the PressBoF charter application. One reason for the timing of that is that none of the detailed preliminary work with the relevant government departments and other interested parties that normally precedes a formal petition of the Privy Council has been undertaken. Indeed, that period of openness has resulted in 19,000 responses. Due processes have to be undertaken. That is the legal advice to which it is important to adhere. As for the Government’s charter, work is continuing on the outstanding points. I will perhaps go into them in further detail later, but work is being undertaken on the Government’s proposals. As for the press proprietors’ considerations, this is a matter for the Privy Council, not a matter for the press proprietors. The Privy Council will go through the due processes that are required. They may be lengthy or arcane to some, but they must be undertaken.

Lord Soley: Is it not glaringly obvious to everybody that the press is playing for time in order to avoid their responsibilities? Is it not time that we faced up to this? May I offer my assistance to the Minister, having had some experience of Bills of this nature from 20-odd years ago? I suggest that a group of Members, whether in the House of Commons or the House of Lords or jointly, see the Culture Secretary with proposals for a Bill promoting Leveson’s recommendations. It might take into account some of the other factors that have come to light, but we could have proper regulation fairly soon by putting a Bill through Parliament and ceasing to play for time with royal commissions.

Lord Gardiner of Kimble: My Lords, I understand your Lordships’ frustration about timing. Indeed, already two elements of Acts of Parliament with cross-party agreement deal with some of the Leveson recommendations. Obviously, I will pass on to the Secretary of State the noble Lord’s suggestion. However, I repeat—and I am sorry for doing so—that we have to go through the due process. The legal advice on these matters has been given to the leaders of all the political parties and I know that the Leader of the Opposition is in possession of that. That is why we are going through the necessary procedures.

3 July 2013 : Column 1214

Baroness Bonham-Carter of Yarnbury: How much support does the Minister think there is for the PressBoF charter other than from a certain powerful interest group? The fact is that its proposal would not create a self-regulator that is genuinely independent or impartial. On Monday, I quoted Sir Tom Stoppard and I want to quote him again.

“The resistance to a statutory monitor suggests that the dream of self-regulation persists in some quarters. Well, they had that, and . . . they blew it”.

Does not my noble friend agree with one of our greatest defenders of the freedom of the press?

Lord Gardiner of Kimble: We are in the position we are because wrongdoing took place, and we have had to decide how best to ensure that this does not happen again. That is why the cross-party royal charter commands the support of all the political parties. Indeed, it is why at PMQs today, my right honourable friend the Prime Minister made very clear his views on the PressBoF proposal and his continuing support for the cross-party royal charter.

Lord Stevenson of Balmacara: My Lords, when the noble Lord answered the question on Monday, he said,

“it is not appropriate for the Privy Council to consider more than one royal charter at a time on the same issue”.—[

Official Report,

1/7/13; col. 976.]

Why is the Privy Council uniquely incapable of multitasking? I bet it is a man who is running it. Yes it is—it is the Deputy Prime Minister.

As I am sure noble Lords are aware, there are about 500 members of the full council. I bet there are more than enough in the Chamber this afternoon. Indeed, the noble Lord who asked the question is a member of the Privy Council, as are all the others sitting next to him. We could have a meeting now in the Moses Room. Could the Minister agree that this would be a desirable thing to do so that we can begin to do what the victims want and what Parliament has decided?

Lord Gardiner of Kimble: The noble Lord makes some very tempting suggestions but there is going to be an update by the Secretary of State very shortly—although I am not sure what “very shortly” means. I hope that it will be helpful to your Lordships. Clearly, we all want to make progress.

Lord Low of Dalston: My Lords, what proposals do the Government have for dealing with the situation which may arise when, having gone through due process, two charters have the approval of the Privy Council?

Lord Gardiner of Kimble: Oh dear. The truth is that there will be this due process in which the PressBoF charter is considered. Obviously, I cannot prejudge that because that is part of the due process that will need to be undertaken. Once that is considered, clearly, the cross-party charter would come up for consideration. As we speak, work is going on to ensure that the fine-tuning of that is complete, and that involves Scotland compliance following the vote of the Scottish Parliament on 30 April, and discussions with the Commissioner for Public Appointments.

3 July 2013 : Column 1215

Lord Tebbit: My Lords, for the sake of clarity, will my noble friend explain to the noble Lord opposite the difference between a meeting of Privy Counsellors and a meeting of the Privy Council? He does not seem to understand the difference.

Lord Gardiner of Kimble: I defer to the many Privy Counsellors in your Lordships’ Chamber. Not being one, I have not yet attended a meeting, so I am not in a position to comment fully, but I entirely understand the point that my noble friend is making.

Baroness Symons of Vernham Dean: The Minister said that wrongdoing took place, so can he explain the Government's retreat from the position that the victims of that wrongdoing had to be satisfied by the outcome of what is now before the Privy Council? Will he please explain to those victims that retreat and the delay in giving them the satisfaction that was promised?

Lord Gardiner of Kimble: The important thing is to make sure that this is done properly and correctly, and that is what is being done. I do not quite understand what the noble Baroness means in so far as we are going through the current process because of the need to ensure that this does not happen again.

Baroness Symons of Vernham Dean: What about the victims?

Lord Gardiner of Kimble: I understood that. The victims are precisely why we are here. It is to ensure that this does not happen again. That is the final objective that we need to secure.

Baroness O'Neill of Bengarve: Is the Minister still committed to securing a royal charter that will underpin self-regulation but not self-interested regulation?

Lord Gardiner of Kimble: The intention with the cross-party charter is precisely to ensure that there is independent regulation of the press. As I said earlier, we need a free press but we need a responsible press. We need to secure a lasting settlement on both of those.

Reserve Forces


3.47 pm

The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Astor of Hever): My Lords, with the leave of the House, I shall repeat a Statement made in the other place. The Statement is as follows:

“With permission, Mr Speaker, I wish to make a Statement on the future of our Reserve Forces. In November last year, I announced a formal consultation which lasted until January this year. I am grateful for the more than 3,000 responses we received. I have placed copies of the summary of consultation findings in the Library of the House.

3 July 2013 : Column 1216

More than 25,000 reservists from all three services have deployed on operations over the past 10 years. Sadly, 30 have paid the ultimate price, and I know that the whole House will want to join me in saluting their sacrifice.

In 2011, the Future Reserves 2020 Commission reported that our reserves were in serious decline. The Government responded by committing to revitalise our Reserve Forces as part of Future Force 2020, reversing the decline of the recent past, growing their trained strength to 35,000 by 2018 and investing an additional £1.8 billion in them over 10 years.

We recognise the extraordinary commitment reservists make and, in return, we commit to deliver the reservist a challenging and rewarding experience, combined with an enhanced remuneration and support package and an improved deal for employers, but to recruit the reserves we need and train and equip them to be fit for purpose in Future Force 2020 requires substantial change.

I am today publishing a White Paper setting out our vision for the Reserve Forces and the detail of how we will make reserve service more attractive. It also confirms our intention to change the name of the Territorial Army to Army Reserve—better to reflect the future role. Alongside the White Paper, I am publishing the first report of the independent External Scrutiny Group which I announced last year to oversee and report on our progress in delivering Future Reserves 2020.

The White Paper reiterates our commitment to improve access to modern equipment and provide better training as part of the £1.8 billion package. Two hundred million pounds will be invested in equipment for the Army Reserve and to kick start that programme I can announce today that we will bring forward to this year £40 million of investment in new dismounted close combat equipment—meaning upgraded weapons and sights, night vision systems, and GPS capabilities will start to be delivered to reserve units before the end of the year.

The integration of regulars and reserves is key to Future Force 2020. That integration prompts a closer alignment of the structure of remuneration across the Armed Forces. We have therefore decided to increase reservists’ total remuneration in two ways: through the provision, for the first time, of a paid annual leave entitlement in respect of training days and through the accrual of pension entitlements under the new future armed forces pension scheme 2015, for time spent on training as well as when mobilised. These two measures represent a substantial percentage increase in total reserve remuneration.

The White Paper sets out details of an improved package of occupational health support for reservists to underpin operational fitness. We will also ensure that effective welfare support is delivered to reservists and their families. Welfare officers are being recruited now for Army Reserve units. Additionally, we have already implemented measures to streamline and incentivise the process by which those leaving the Regular Forces can transfer to the volunteer reserve, with accelerated processing, passporting of medical and security clearances and retention of rank, as well as a signing-on bounty of £5,000 for ex-regulars and for direct entry officers joining the Army Reserve.

3 July 2013 : Column 1217

The support of employers is crucial to delivering the future Reserve Forces. We seek to strengthen Defence’s relationships with employers so that they are open and predictable. The White Paper sets out how we will make liability for call up more predictable; make it easier for them to claim the financial assistance that is already available; increase financial support for SMEs by introducing a £500 per month per reservist financial award to small and medium enterprises when their reservist employees are mobilised; and improve civilian-recognised training accreditation to help employers to benefit from reserve training and skills.

The White Paper signals a step change in Defence’s offer to employers. I urge them to take up this challenge. In turn, by building on the Armed Forces covenant with the introduction of the corporate covenant, we will ensure that reservist employers get the recognition they deserve. However, while Defence is fully committed to an open and collaborative relationship with employers, it is essential that the interests of reservists are protected. Dismissal of reservists on the grounds of their mobilised reserve service is already illegal. We will legislate in the forthcoming defence reform Bill to ensure access to employment tribunals in claims for unfair dismissal on grounds of reserve service without a qualifying employment period.

The job that we are asking our reservists to do is changing, and the way in which we organise and train them will also have to change. That will impact on both force structure, and basing laydown. The force structures and roles of the maritime and air reserves will remain broadly similar to now, although increased in size and capability. The Army, however, has had substantially to redesign its reserve component to ensure regular and reserve capabilities seamlessly complement each other in an integrated structure designed for the future role. That redesigned structure has been driven primarily by the changed function and roles of the Army Reserve and the need to reach critical mass for effective sub-unit training.

The details of the future Army Reserve structure are complex and beyond what could coherently be explained in an Oral Statement. I have therefore laid a Written Ministerial Statement, supported by detailed documents which have been placed in the Library of the House, showing the complete revised order of battle of the reserve component of Army 2020.

This restructuring will require changes to the current basing laydown of the Army Reserve. The TA currently operates from 334 individual sites around the United Kingdom, including a number of locations with small detachments of fewer than 30 personnel. Some of these sites are seriously under-recruited. To maximise the potential for future recruitment, the Army is determined that, as it translates its revised structure into a basing laydown, it should take the opportunity to rationalise its presence by merging small, poorly recruited sub-units into larger sites in the same conurbation or in neighbouring communities. As part of this exercise, the Army Reserve will open or reopen nine additional reserve sites.

However, the consolidation of all poorly recruited units would have led to a significant reduction in basing footprint and a significant loss of presence in

3 July 2013 : Column 1218

some, particularly rural, areas. I have decided that that would not be appropriate as we embark on a major recruitment campaign. We will therefore retain a significant number of small and under-recruited sites that the Army considers could become viable through effective recruiting. The units on those sites will be challenged to recruit up to strength in the years ahead. Over the next couple of years, we will work with local communities, through the Army’s regional chain of command, to target recruitment into those units. I know that honourable and right honourable Members will want to lead their local communities in rising to this challenge.

The result of the decisions I am announcing today is that the overall number of Army Reserve bases will reduce from the current total of 334 to 308, a net reduction of 26 sites. With your permission, Mr Speaker, I am distributing a summary sheet which identifies the reserve locations being opened and those being vacated.

The White Paper and the WMS on structure and basing together set the conditions to grow and sustain our reserves as we invest an additional £1.8 billion over 10 years in our vision for the integrated reserves of Future Force 2020. That vision means an even bigger contribution from our reservists and from employers as we expand the Reserve Forces. I am confident that both will rise to the challenge.

For the first time in 20 years, the reserves are on an upward trajectory. Those of us who are neither reservists nor employers can none the less provide vital support and encouragement to our fellow citizens who make such a valuable contribution to delivering our national security, and I know that Members on all sides of the House will want to take the lead in urging our communities to get behind the reserves and the recruiting drive that will build their strength to the target level over the next five years. I commend this Statement to the House”.

My Lords, that concludes the Statement.

3.58 pm

Lord Rosser: My Lords, I thank the Minister for repeating the Statement made earlier in the House of Commons by the Secretary of State. The Minister will be aware that the information on the hardly insignificant issue of the net reduction of 26 sites that will be lost was not available when the Secretary of State made his Statement. The Speaker in the Commons described that as “woefully inadequate” and reminded the Secretary of State that he was responsible for his department. The information on the sites is now available but will the Minister confirm that, in future, when the Secretary of State makes a Statement, he—the Secretary of State —will provide both it and the supporting documentation at the normally accepted time?

Before I go any further, I should say that we support an enhanced role for our Reserve Forces working alongside our regulars. We pay tribute to those who have served, particularly the 30 reservists who have died in the service of our country over the last 10 years and the much larger number who have been wounded. We welcome much of today’s announcement, not least those parts dealing with increased training alongside regulars, investment in equipment, the changed nature of Reserve Forces, improved occupational healthcare and welfare arrangements—including, presumably, for mental health

3 July 2013 : Column 1219

problems—and the intentions to address the issues surrounding potential discrimination against members of our future Reserve Forces in their civilian employment.

We want the increase in the number of our reserves to be achieved, not least because the Government appear to be putting all their eggs in one basket on this issue; there appears to be no plan B. Today’s Statement and White Paper follow on from previous Statements and the consultation document Future Reserves 2020. In the foreword to that document, the Secretary of State said that it marked,

“a significant step forward in our plans to build the effective reserves our Armed Forces require to provide security for the Nation in future”.

The paper also said that our Reserve Forces,

“will be an integral and integrated element of our Armed Forces”,

will be,

“routinely involved in most military deployments”,

and that our Armed Forces will,

“increasingly rely on the Reserve Forces to achieve the full range of tasks set to Defence”.

On the basis of the Government’s own words, the reserves will not simply be complementing our Army; they will be plugging some of the gaps left by cuts to regular personnel. However, when I asked the Government two weeks ago for an assurance that the size of our Regular Army would not be reduced to the intended figure of 82,000 unless the strength of our Army Reserve had been increased to the intended trained strength of 30,000, the Minister said he could not give me such an undertaking.

The Strategic Defence and Security Review in 2010 addressed the issue of the commitments and planning assumptions that our future Armed Forces could be expected to carry out and the maximum level, extent and nature of operations they could be expected to undertake at any one time. Can those planning assumptions, set out in the SDSR in 2010 when there were 102,000 regulars in the Army, still be carried out with a Regular Army of 82,000 and an Army Reserve force of 30,000? Is the reduction in the size of our Regular Army to 82,000 dependent on our having increased the size of our trained Army Reserve to 30,000? If we need a Regular Army of 82,000 and an Army Reserve force of 30,000 to fulfil the maximum level, extent and nature of operations that we would expect our future Armed Forces to undertake at any one time, as set out in the 2010 SDSR, how can the Government allow the size of our Regular Army to fall to 82,000 unless there is, by then, a trained Army Reserve force of 30,000? If the reduction in the size of our Regular Army to 82,000 is not dependent on having first achieved an increase in the size of our trained Army Reserve to 30,000, that must surely mean that we will not have the manpower available that was assumed in the 2010 SDSR. Could the Minister confirm that this would mean less capability as a result and, if so, which capabilities would go or be reduced as a result?

The Statement has confirmed that the Government will be investing an additional £1.8 billion in the reserves over the next 10 years. How will that be divided between buildings, equipment, recruitment—including financial incentives—and pay? Will a trained

3 July 2013 : Column 1220

Army reservist be regarded as having the same level of skills, expertise and experience as a comparable member of the Regular Army?

Some concerns have been expressed about the likelihood of increasing the number in our Reserve Forces to the required level. How is recruitment to our reserves currently going against targets? What was the situation in that regard last year? As for recruitment to the reserves, will new recruits be committed to staying in the reserves for a minimum or any other specific period of time? Will those receiving the taxable bonus of £5,000, to which I think reference was made in the Statement, be required to stay for a minimum period of time? What assumptions have been made about turnover in the reserves in future? How many people has it been assumed will need to be recruited into the reserves each year to sustain the greatly increased numbers in our Reserve Forces, including 30,000 in the Army Reserve?

How easy or otherwise it proves to increase the size of our reserve forces remains to be seen. A recent Federation of Small Businesses survey found that one in three employers believed that nothing would encourage them to employ a reservist, despite the fact that service experience provides people with organisational, team-building and leadership skills. It is of course possible that the financial incentives for SMEs announced in the Statement may change that position.

I reiterate our support for the enhanced role of our Reserve Forces. The move will also provide the opportunity to help to ensure that we can maximise niche civilian skills in a military setting, not least in the fields of cybersecurity and languages. It is also essential that those who want to volunteer to serve their country are protected in the workplace and do not suffer discrimination. That may not always be easy to achieve, since discrimination against someone who is not there the whole time can sometimes be very difficult to prove. I look to the Government to put particular emphasis on that point in the legislation and regulations that will follow.

We hope that the required increase in our Reserve Forces is achieved. The potential consequences for the defence and protection of our nation could be very serious if it is not.

4.06 pm

Lord Astor of Hever: My Lords, I thank the noble Lord for his general support for what we are doing. I share his and the Opposition’s aspiration to strengthen the reserves in a very bipartisan way. The noble Lord asked me about the Commons Statement. The Secretary of State said that he would investigate and write to the right honourable shadow Secretary of State. When I have more information, I will pass it on to the noble Lord. I myself have ensured that all the necessary paperwork was distributed in the Peers’ Lobby and the Prince’s Chamber during the first Question, and I hope that noble Lords have got their hands on everything. If they have not and we have run out of copies, I have some spare copies.

There is one correction that I need to point out: in the information that I have handed out, I have been advised that there is an inconsistency over Kilmarnock.

3 July 2013 : Column 1221

There is no change in the end result for the figure of 46 sites for Scotland, but Kilmarnock should have been scored as a new site rather than as an existing one. That is therefore good news regarding occupation.

The reserves are an essential component of our national security, our future forces and success on operations. In future, their contribution to our defence capability will increase and the reserves will become an integrated part of the whole force.

I turn to the noble Lord’s questions. First, he mentioned plan B. I am confident that we can deliver on that, and I will come to that in a short while when I address another of his questions. His second question concerned whether the reductions in the Regular Forces made them more dependent on the reserves and the commitment that I was not able to give the noble Lord the other day. I still cannot give that commitment. We are aware that there are risks in this, but we are confident. Recruiting is going well and the historical figures are on our side. When I was in the Army—a long time ago, admittedly—the reserves numbered 100,000, with a much smaller population, and we had half the strength of the present reserves in 1990. Other countries, such as the United States, Australia and Canada, have a much higher percentage of reserves. We are investing £1.8 billion over 10 years and, as the Statement said, we are investing £40 million this year. We are confident that the reinvigorated reserves will deliver the quality and number of reservists that we will require in future, both in training and on operations.

Employers play a key role in enabling the reserves to deliver their essential contribution to defending the nation’s security. This future relationship may need some incentives, which could include a cross-government commitment to support employers who encourage volunteering. The public sector will take the lead in setting the example.

The noble Lord asked how the £1.8 billion will be divided. We review our allocation on a continuous basis, to maximise value for money from the available resources to meet the needs of the Reserve Forces. He also asked if a trained reservist would have the same level of skills as a regular. When reservists deploy to operations, they will be equally as skilled in their specialist roles as a regular they serve alongside. The noble Lord asked how recruitment was going. All the indications that I have heard indicate that it is going very well and we believe that the announcement will have a positive effect on Army Reserve recruiting.

Our Reserve Forces have always attracted highly motivated individuals, and the assurance that the reserves will play a more routine and assured role within the whole force concept will act to broaden the appeal and encourage those looking for such an opportunity and their employers. The noble Lord asked about the commitment that a reservist must give and whether there is a minimum time. Every service person enlists for an agreed period of service. As we are a voluntary force, we recognise that individuals can exercise choice to remain or leave. Measures announced in the White Paper should further encourage retention.

As for turnover, I can confirm that retention of reservists, particularly in the Army, is on average much better than that of their regular counterparts. The noble

3 July 2013 : Column 1222

Lord then asked me about employers. The Ministry of Defence is committed to working with employers to understand their views on its use of reservists and the impact of legislation, to understand better what an employer can realistically sustain in future. The Ministry of Defence understands the importance of engaging with employers and potential employers and, in addition of engaging with employer groups such as the CBI and FSB through the chain of command, the National Employer Advisory Board, SaBRE and the Reserve Forces’ and Cadets’ Association.

Finally, the noble Lord asked about the legal situation relating to employment tribunals. An individual cannot generally bring a claim for unfair dismissal at an employment tribunal until he or she has completed two years of continuous service with an employer. Periods of mobilisation do not count towards continuous service; therefore, it can take reservists longer than two years to gain this protection. I think that covers all the noble Lord’s questions, but if I have missed anything I will write to him.

4.13 pm

Lord Palmer of Childs Hill: My Lords, I thank my noble friend for the Statement that he has repeated. From these Benches we associate ourselves with saluting the sacrifice made by our reservists. To meet the challenge of significantly increasing the numbers in our Reserve Forces we need to foster the belief that employers, employees and the nation all benefit from reserve service. Will the Minister say whether medically trained reservists will be able to bring skills to the military and develop additional skills to bring back to their UK employers? Will he also tell the House how employers and employees are to be convinced that there are benefits to the employer and the employee from improved skills and experience while serving, which might outweigh the temporary loss of civilian work time? Finally, will he say whether consultation with employers—which he mentioned previously—have uncovered signs of corporate social responsibility by allowing or even encouraging participation in the reserves?

Lord Astor of Hever: My Lords, in answer to the first part of the noble Lord’s question, medical reservists develop additional valuable specialist skills when they are deployed, which they then bring back to the National Health Service. The Defence Medical Services is uniquely placed to share the development of operationally specific medical science and clinical excellence with the NHS. The National Institute for Health Research centre has brought together military and civilian trauma surgeons and scientists to share innovation in medical research, to advance clinical practice on the battlefield and to benefit all trauma patients in the National Health Service at an early stage of injury.

On the benefits to an employer who recruits an employee who is a reservist, I would say that reserve service will benefit different employers in different ways. For some, the improved skills, experience and training of the individual reservist will be beneficial. For others, where the reservist’s military role is close to their civilian one, there will be more benefit from transferable skills. For some companies and sectors, reserve service suits and supports their business models.

3 July 2013 : Column 1223

For many, reserve service may support corporate social responsibility objectives and may be part of their social action plans, alongside wider volunteering policies. We encourage employers to publicise their support for the Reserve Forces to customers, suppliers and their local communities. The second part of my answer was in response to my noble friend’s third question.

Lord Craig of Radley: My Lords, the Government say in the White Paper that they will introduce new legislation to enable mobilisation for the full range of tasks that our Armed Forces may be asked to undertake. Current mobilisation arrangements are something of a historical anachronism. Invariably they require ministerial authority. They date from a time when protection for employers was nothing like as good as it will be in future. Will there be arrangements to allow mobilisation of individuals for very small units to be carried out without having to seek ministerial authority?

Lord Astor of Hever: My Lords, I cannot from the Dispatch Box answer the noble and gallant Lord’s question. That point is not in my briefing, but I will write to him.

Lord Freeman: My Lords, as a former president for 10 years of the Reserve Forces Association, I warmly welcome this Statement. I would be grateful if the Minister would confirm two key principles. First, we should maintain the footprint of the Reserve Forces—and the Armed Forces—around the country. I am very pleased that there are no dramatic plans to reduce their number. Secondly, will the Minister confirm that the support of employers, and in particular of small employers, is crucial to maintaining support for the Reserve Forces?

Lord Astor of Hever: My Lords, I can confirm both points. We consider the footprint absolutely vital. Where we have had to close places it is because there has been a very small uptake in recruitment. We have managed to close fewer than we planned. I agree with my noble friend’s point about employers, and in particular small companies. In finishing, I pay tribute to my noble friend for the important work that he did.

Lord Davies of Stamford: The noble Lord was characteristically thorough and conscientious in informing the House and in answering my noble friend’s questions. However, I think that he left out one point. Will the £5,000 joining-up bonus be repayable if the officer does not do a minimum amount of service? I would be interested in the answer to that. I think that it will be quite a challenge to get to 35,000 but an ever greater challenge to get to a point where the reservists are on the same footing as the regulars and do not suffer a higher rate of casualties on active deployment. In that context, it is very important that we should put everything behind them in terms of equipment and training, and the noble Lord gave us some assurances on that point. Equally valuable is the promise by the Government to strengthen the defence of reservists against dismissal. However, would it not be a good idea for the Government to go further and to protect reservists not just against the danger of unfair dismissal but against discrimination in terms of remuneration or promotion? The American national guard has that kind of protection. Surely it is

3 July 2013 : Column 1224

very important that reservists, or those who are planning to join the reserves, are confident that they will not suffer discrimination of that kind in the job market.

Lord Astor of Hever: My Lords, as regards the noble Lord’s first question about the £5,000, I do not change my answer. The reservists who join up are free to leave whenever they want. We are very confident that those regulars who become reservists will stay and will not leave the minute they get their money. We are also very confident that by 2018 we will get up to the figures that we need. I have spent a lot of time being briefed and our recruiting figures are going better than we expected. Noble Lords will see in the White Paper all the inducements that we are giving to the reservists and their families, and the encouragement that we are giving to employers. We realise that we have to work much more closely with employers than has happened in the past and we will endeavour to do that.

Lord Burnett: Will my noble friend confirm to the House that no closures of Royal Naval Reserve and Royal Marines Reserve units are planned? I should remind the House that Corporal Croucher, a Royal Marine reservist, was awarded the George Cross while serving in Afghanistan, and Corporal Seth Stephens, a Special Boat Service reservist who was killed in action in Afghanistan, was posthumously awarded the Conspicuous Gallantry Cross. These two outstanding and brave men had both served for many years as regular Royal Marines. What encouragement are the Government going to give retiring members of the Regular Forces to join the reserves? Regular members of the Armed Forces have so much to offer the reserves. They have a high level of training and expertise and are fully aware of the demands that will be made of them.

Lord Astor of Hever: My Lords, I can confirm my noble friend’s first point. No Royal Naval Reserve or Royal Marines Reserve units are closing as a result of FR20. As part of a wider betterment programme, three units will relocate to new accommodation, often in more populated areas. In some instances, the final decision on where the new locations will be is yet to be made, but the distance that current reserves will be expected to travel to attend their new location is likely to be less than 12 miles.

Regarding my noble friend’s question about regular redundees joining the reserves, the reserves have always benefited from the experience brought by ex-regulars, and some capabilities have relied heavily on their skills owing to the time that it takes to train on advanced equipment. Those who leave the Army through redundancy are being encouraged to consider a part-time military career in the reserves. For the Army, ex-regulars who enlist in the Army Reserve within three years of leaving regular service can enjoy a number of incentives and benefits, such as the reduced Army Reserve commitment and training requirement or, alternatively, a commitment bonus worth £5,000 paid over four years. That partly answers the noble Lord’s question. There is a comprehensive information campaign to ensure that all service leavers, and not just redundees, are aware of the opportunities and benefits of joining the reserves.

3 July 2013 : Column 1225

Lord Kilclooney: My Lords, can the Minister confirm that, pro rata, recruitment to the reserves in Northern Ireland in recent years has been greater than that in England, Scotland or Wales?

Lord Astor of Hever: My Lords, I can confirm that to the noble Lord. That point came up in the Statement in the other place and it is absolutely true.

Lord Clark of Windermere: My Lords, I thank the Minister for his Statement and wish him and his colleagues every success in achieving this plan for the Reserve Forces. As the Minister knows, in the past I have asked him a number of questions about the Defence Medical Services and I see from the White Paper that 38% of the DMS is currently reservists. What percentage of the DMS does he envisage will be reservists in the future and will there be some medical competences within the DMS which will be entirely dependent on reservists?

Lord Astor of Hever: My Lords, I thank the noble Lord for his support. He is absolutely right that the figure is 38%. I have seen the hugely valuable work that they do in Camp Bastion. Both the Armed Forces and the National Health Service benefit from the work that is going on and we will need these medical people in the future. I cannot give a specific percentage figure but I can assure the noble Lord how vital these people will be to us.

Lord Stirrup: My Lords, the Written Ministerial Statement rightly makes reference to the potential implications that the basing changes may have on cadet force units where these are collated with reservist units. I welcome the statement that alternative accommodation will be pursued in such cases but, of course, “pursue” is a slightly slippery word and does not quite imply the same as “achieve”. Will the Minister undertake to keep a very close eye on this to ensure that the changes being made with regard to the Reserve Forces cause no harm to what is widely acknowledged to be the finest youth institution in the land?

Lord Astor of Hever: My Lords, I can give the noble and gallant Lord that assurance. We take the cadets very seriously. In the few cases where a unit closes, mostly the cadets will remain in the building but on a very few occasions they will be moved very nearby. I have been a patron of sea cadets and I have first-hand knowledge of the important work that they do.

Lord Trefgarne: My Lords, can my noble friend say a little more about the integration of the newly enhanced Reserve Forces with the Regular Forces, which will be crucial to the effective transfer to which he referred?

Lord Astor of Hever: My Lords, my noble friend is absolutely right. Army Reserve units will be paired with regular units in peacetime for training and force generation, enabling combined training and helping to build links with the local community, including employers, to aid recruitment and resettlement of service leavers. Reserve units in all three services may be integrated

3 July 2013 : Column 1226

with regular units for mission rehearsals and for operations. We will ensure that our use of reserves is as predictable as possible to help reservists, their families and particularly employers to plan ahead. Specific levels of attendance will become a compulsory part of the proposition and the majority of reservists can expect a maximum of 12-months mobilised service in a five-year period. Whether it is needed will obviously depend on operational requirement.

Lord Glenarthur: My Lords, I very much welcome the Statement. It is certainly extremely comprehensive. From what one can see from a first glance at the White Paper, it fulfils many of the aspirations which those of us who commented on the Green Paper felt were necessary. However, I should like to ask my noble friend about the national relationship management scheme. I suggest that, in any adaptation of the current relationships that exist, the process should be evolutionary rather than revolutionary. Having been involved in it for several years as chairman of the National Employer Advisory Board, the mechanisms that have existed for the past 12 to 15 years have proved to be extraordinarily effective. For example, the branding of SaBRE is such that it is understood throughout the country. I hope that my noble friend will ensure that this can be built on rather than something totally new created which is more likely to confuse than to help.

Lord Astor of Hever: My Lords, I thank my noble friend for his support. I also pay tribute to him for the important work that he has done for the reserves over many years. My noble friend made some very important points. I will take them on board and take them back to my department.

Lord Lee of Trafford: My Lords, in terms of the importance of enthusing and recognising employers, rather on the lines of the Queen’s Awards for Enterprise, and given the military service of Prince William and Prince Harry, would it be possible to consider something like the Princes’ Reserve Forces Award, which would combine employer participation, national interest and royal recognition?

Lord Astor of Hever: My Lords, we are looking at this area very closely. As I said, we take the relationship with the employers very seriously, and this is one of the ideas under consideration.

Lord Mayhew of Twysden: My Lords, will my noble friend come back to the question of retention? If the reserve units are to be fully integrated into the Regular Forces, does it not follow that if their members do not step up to the plate when called on to do so, the Regular Forces concerned will be deficient in their capability? Can he think a little further as to whether what he says he has great confidence in ought not to be toughened up with something more enforceable?

Lord Astor of Hever: My Lords, I repeat that I am confident. As I understand it, retention in the reserves, particularly the Army reserves, is very much higher than in the regulars. I do not have the figures in front

3 July 2013 : Column 1227

of me, but I was told before I came into the Chamber that retention in the reserves is considerably higher than in the regulars. I can write to my noble and learned friend with the figures.

Viscount Slim: My Lords, the noble Lord is aware that the business community has culled and fined its companies in the matter of strength and management to get through this very difficult economic stage. As a number of noble Lords have mentioned, some sort of reward is essential for those companies which are taking part. I will say a little more bluntly that perhaps some tax benefit or some exemption from certain company taxes should be given to companies which fulfil the deal. Giving away one chap today in a company, particularly in a small to medium-sized company, is a considerable sacrifice, and I believe that Her Majesty’s Government have not fully thought through the rewards for the business community.

Lord Astor of Hever: My Lords, I can assure the noble Viscount that nothing is off the table. We are open to any suggestions. As for his proposal for a tax benefit, I will run it by the Treasury. It is certainly a very good suggestion. We seek an open relationship with employers tailored to meet the needs of different sizes and types of employers, based on mutual benefit. That will include working together to credit the skills and the training that reservists gain during service with recognised civilian qualifications, and the area that the noble Viscount mentioned.

Finance Bill

First Reading

4.34 pm

The Bill was brought from the Commons, read a first time and ordered to be published.

Care Bill [HL]

Committee (4th Day)

4.35 pm

Clause 80 : Reviews and performance assessments

Amendment 74

Moved by Baroness Pitkeathley

74: Clause 80, page 67, line 19, at end insert “including their integration with other relevant services”

Baroness Pitkeathley: My Lords, in the unavoidable absence of my noble friend Lord Warner, I shall move Amendment 74 and speak also to Amendment 75.

These two amendments give an opportunity to put into the Bill further emphasis on the importance of integration. Amendment 74 requires reviews by CQC of regulated health providers to cover the integration of those services with other relevant services. Amendment 75 does the same for reviews of local authority adult social care services. They are a clear reminder in the Bill that when CQC carries out such reviews it will have to pay attention to the issue of integration of services for the benefit of patients and service users.

3 July 2013 : Column 1228

I shall not detain the Committee today with yet another speech of a kind that I have made many times before on the importance of integration of health and social care services from the point of view of patients, service users and their carers. We all know how important that is. The Committee is familiar with the arguments and, more importantly, so is the Minister. Indeed, the Chancellor of the Exchequer, no less, acknowledged this in his announcement in the comprehensive spending review in regard to joint budgets. The announcement has been widely welcomed, although caution has been expressed about how these budgets will operate in practice.

The amendments are a modest attempt to give some practical effect to the aspiration for integration which we all share. I hope the Minister will say that it is a good idea, “Let’s do it”, and get us off to a cracking start this afternoon. I beg to move.

Lord Hunt of Kings Heath: My Lords, I declare an interest as a chair of a NHS foundation trust and as a consultant and trainer with Cumberlege Connections. I am happy to support my noble friend Lady Pitkeathley’s Amendments 74 and 75, which rightfully push the CQC into the direction of integration of services. I also sympathise with the amendments of the noble Baroness, Lady Greengross, Amendments 76ZZA and 76ZAA, to which she will speak later.

My Amendments 74A, 76ZA and 76ZB and my opposition to Clause 80 stand part go to the core of the purpose of CQC and its approach to performance assessment in health and social care. Inevitably, recent events at that regulator in relation to Morecambe Bay and before that at Mid Staffordshire will readily come to mind. There can be no doubt that the current leadership of CQC faces a major challenge in changing the culture of the organisation and its approach to inspections. It has much to do to restore both public confidence and confidence within the NHS about the way in which it operates. That is why this clause is so important.

Clause 80 substitutes Section 46 of the 2008 Act and provides that the CQC’s duty to conduct periodic reviews, assess performance and publish reports of such assessments, which are henceforth to be known as “ratings”, is to apply in respect of any regulated activities and any registered service providers as may be prescribed in regulations. In addition, where regulations so provide, the CQC must also review and assess the performance of the provision and commissioning of adult social services by English local authorities. CQC is to be given responsibility for determining the quality indicators against which services and providers will be assessed. This may include measures of financial performance and governance if the CQC deems this appropriate. Different quality indicators, methods and frequency in periods may be used for different types of cases. The CQC may also review the indicators of quality and method statement from time to time as it sees fit.

Let me say at once that I support the broad intention of these clauses to make the CQC responsible for rating providers and local authorities. I say again that one should not underestimate the task. It is important

3 July 2013 : Column 1229

that the CQC is not put under undue pressure to rush to change the way that it operates and to introduce new ratings without proper pilots being done and without having enough time to do it.

I refer the noble Earl to the Nuffield Trust’s work. As he knows, the Nuffield Trust was commissioned to carry out a review for the Secretary of State into the possibility of rating providers of health and social care. It argued that the new ratings must be given adequate time to work together with a range of stakeholders in developing a system which enables both patient choice and professional leadership to drive up standards of quality. That is vital. Yet I am concerned by the document issued by the CQC recently that indicates that it is to start inspecting and regulating NHS acute hospitals, in the ways that it set out in that document, from October 2013. Indeed, from December 2013, it will begin to rate NHS acute trusts and NHS foundation acute trusts, aiming to complete them before the end of 2015.

Have Ministers put pressure on the CQC around the timing of those ratings? Secondly, does the noble Earl not think that there is a risk that the CQC will be forced to rush into a new system without proper consideration? I remind him that the chairman of the CQC has recently made a number of statements. First, he has said that the approach to inspections by the previous leadership was wrong; it was wrong to go for generalist inspections. He also says that the culture of the organisation was wrong. Given that there are about 1,000 people employed by the CQC, although I am not absolutely certain, how on earth is the culture going to change in a short period of three or four months? I just do not think it is going to happen.

I have great admiration for the current leadership of CQC, but the risk is that it is going to be forced into a new system too quickly and it could fall over. As a result, its credibility will be very much damaged. Let us face it; it is almost starting from a negative position. I must confess that I am surprised that such an ambitious timetable has been set.

Who will be assessed? As I have already intimated, the clause provides for the Secretary of State to draw up regulations laying out exactly which services the CQC will rate. They are likely to be hospitals, GP practices, care homes, domiciliary care services across both the public and privates sectors and local authorities. Will the noble Earl confirm that? Will he say why this is not specified in the Bill? Does he not consider it important enough for Parliament to decide which bodies should be assessed, and to do so in primary legislation rather than through regulations?

I asked at Second Reading whether clinical commissioning groups are to be assessed. If not, why not? The Bill allows for local authorities to be assessed for their performance in the commissioning of adult social services, so I cannot really see why NHS commissioners—the CCGs—should not be similarly covered. The same logic then applies to NHS England which, after all, has been given a massive commissioning budget in relation to specialist services. If it is appropriate for local authorities to be assessed for their commissioning responsibility, surely all health commissioners should

3 July 2013 : Column 1230

be similarly assessed. That must apply to NHS England because otherwise I do not see who will hold it to account for the mammoth amount of resources it will spend on commissioning specialist services.

I am particularly interested in local authority assessment, particularly in the way that services are commissioned. Can the noble Earl tell me whether this is intended to be a priority for the CQC? He will know that there is real concern about the practices of many private sector providers in social care in using zero-hour contracts and allocating only 15 minutes with each client. It is vital for the CQC to be able to investigate the way in which local authorities commission those services. We will come to this in Clause 5 but it would be very useful if the noble Earl could confirm that the commissioning responsibilities of local authorities will be a priority for the CQC.

4.45 pm

Turning to the inspection approach and the rating system to be adopted, according to the recent document issued by the CQC:

“Our inspections of hospitals will vary in terms of the things they look at and the time they take, but they will take as long as is needed—typically 15 days, with an average of 6-7 days on site—to make a thorough assessment of the quality and safety of care. In the vast majority of cases, inspections will be longer and more thorough than our current approach of a small team of inspectors being on site for one or two days. Our inspectors will spend more time talking to people who use the service, to staff, senior managers and members”.

That is very welcome. I am sure that that is the right approach. The noble Earl will know that there has been a problem with short-scale inspections, which take just one part of a service and do not really give a measure of the scale of services being provided.

We then come on to the rating of services, which I have raised with the noble Earl. As far as I can see, the intention is to follow the Ofsted approach of rating from 1 to 4, with 1 being outstanding, 4 being a measure of inadequacy, 2 being good and 3 being satisfactory but needing to improve. That is an approach. But the noble Earl will be aware that the Nuffield Trust has argued that,

“the Government and CQC must be alert to the possibility of aggregated ratings which reflect high general standards of care but conceal individual failures within organisations”.

It goes on to say:

“For hospital trusts in particular, which operate across multiple sites and provide a range of complex services in different wards and units, it is important that service-level assessments are easy to find and understand”.

This is very important because the CQC is going to follow the Ofsted example. Outstanding hospitals will be inspected only every three to five years and good hospitals every two to three years. So a hospital could be rated as outstanding and then not inspected for five years. The problem with that is that we all know that services can go up and down and that changes in leadership can have an impact on the quality of an organisation. We know there are examples in education where schools or colleges have been rated 1, have not been inspected for five or six years, and some of them have gone down to 3 or 4.

I am more concerned about the public’s confidence in such a system. Where a hospital has been rated 1, within 1 there will probably be some inadequate services;

3 July 2013 : Column 1231

if something goes drastically wrong, the whole rating system will come into serious question. What I am asking for is a much more sophisticated, balanced approach to rating these institutions. That is why it would be right that before any substantive programme comes into being there should be pilots, which should be fully assessed. I hope that Parliament would have an opportunity to debate them as well.

Finally, I come to my Amendment 76ZA. My understanding is that part of the criteria which will form the ratings judgment by CQC will be whether staff would recommend their organisation to patients. I am sure that that would be a very valuable component of the ratings. I have been contacted by the Chartered Society of Physiotherapists, which says that, perhaps, we should go even further and actually consider staff health and well-being. That seems to make a great deal of sense. Sickness absence in the NHS is a major problem. The sickness absence rate for the winter among healthcare assistants has been very problematic. I do not expect the noble Earl to agree to my amendment, but I hope he will give some comfort that CQC, in looking at the way staff feel about their organisation, might be able to develop some kind of indicator of the way staff are dealt with. Health and well-being might be a very good way to do this.

Overall, we wish CQC well. I am concerned about the pressure being put on it to come up with a new system before it has time duly to consider it. I hope the noble Earl will agree to an amendment around pilots.

Baroness Greengross: My Lords, I shall speak to Amendments 76ZZA and 76ZAA in my name. I thank the noble Lord, Lord Hunt, for the support he expressed earlier. On Amendment 76ZZA, we know that one of the major problems identified in the Francis report was the inadequate handling of complaints and concerns. This issue has not been addressed in the Care Bill. My amendment would enable the Care Quality Commission to introduce more rigorous complaint systems across all care settings. I hope the Minister will consider this because it is very important to get this right now. This is about the way in which a registered service provider or a local authority will handle complaints and concerns, and it is very important.

Amendment 76ZAA is about continence care. I declare an interest as chair of the all-party parliamentary group on this subject. It is hardly spoken about, but it is terribly important; people just do not recognise how many people have some problem with continence. The NHS services should have continence care as an essential indicator of service quality. It therefore needs to be established as an essential indicator of high-quality services across the NHS and care settings within the periodic assessments of care standards undertaken by the CQC.

A number of recent assessments have demonstrated that continence care is still a low priority across NHS settings, with poor treatment resulting in escalated and more costly care needs and poorer patient outcomes. This is in spite of the fact that good bladder and bowel control are fundamental to people’s dignity and independence and that NICE has published a wealth of best practice recommendations to effectively assess and treat the condition. The Francis report included

3 July 2013 : Column 1232

an entire chapter outlining the scale of failures in continence care. Given the expected rise in prevalence of incontinence and the impact that poor care can have on patients and the NHS, continence care must be seen as a key indicator of high-quality provision across care settings. An explicit requirement within the Care Bill for the CQC to assess providers for the quality of their continence care would directly respond to the failings in this field which the Francis report identified—the stated purpose behind Part 2 of the Bill. That would encourage providers actively to address how they manage incontinence by assessing their local protocols and policies about the condition, taking steps to improve awareness among staff about incontinence and undertaking internal audits in order continuously to improve care standards.

Lord Sutherland of Houndwood: My Lords, I wish to register my support for the proposals in some of these amendments. The integration of services should always be highlighted. We have a long way to go and, since we are not providing an integrated budget, every encouragement short of that should be given, so I support the amendments that propose this.

The amendments and stand-part question in the name of the noble Lord, Lord Hunt, have to do with the standing of the CQC. CQC has been through a very rough patch, and to some extent, responsibility lies as much here as elsewhere. I remember the debates a number of years ago, when we changed the structure of the regulation that should be provided in this area three or four times within four or five years and always handed the ball on to a new organisation that we thought would solve all the problems. We failed consistently to answer the question: what are the signs that the new organisation will succeed in all the tasks being given to it? We now see that there have been difficulties. Moving with a degree of caution has a great deal to commend it, and I look forward to the Minister’s response to the questions raised by the noble Lord, Lord Hunt.

The rhetoric around the comments of politicians, those in health regulation and the press continually refers to Ofsted and Ofsted-style inspections. I declare an interest, in that I had something to do with founding Ofsted and the type of inspections that in due course developed. Ofsted is a rather a different beast, and these comparisons do not help. For example, the chief inspector is independent of the control of the department, which seems not to be the case in the plans for the future. That means that the relationships with the Minister and Secretary of State will have to be very carefully managed. I am not sure that sufficient thought has been given to that. That is part of the case for asking whether Clause 80 should stand part of the Bill.

The other pressures being put on CQC have to do with financial assessment. These are additional responsibilities for which CQC is hardly prepared. There is a need for specialist staff and specialist abilities to decide whether companies providing care at all levels have the ability to continue sustainably to do that—but that does not, as we have seen in other forms of financial regulation, come easily to regulatory bodies. This has to be looked at very carefully, along

3 July 2013 : Column 1233

with the pace at which change is introduced into the practices of CQC, which is under, we hope and expect, good new management.

5 pm

Lord Campbell-Savours: My Lords, the need for the specialist staff referred to by the noble Lord clearly lies behind the tabling of Amendment 76ZB. It is precisely why we need to pilot the proposed system.

My noble friend on the Front Bench referred to the system being created as a new system. We were told that we were going to get a new system in 2009. I sat on the third Bench behind my noble friend—the noble Earl was on the Front Bench on this side—and pointed consistently to the deficiencies in the system while it operated under CSCI and the inevitability of further problems arising under the new structure that was being created. Indeed that is precisely what has happened.

It seems to me that it can only get worse. The report of the Select Committee on Public Service and Demographic Change sets out the scale of the problem that confronts us in future. It prays in aid the Office for National Statistics updating its projections up to 2021 based on a recent release of data from the 2011 census on the ageing population. It says that, by 2021:

“There will be 24% more people aged 65 and over”,


“39% more people aged 85 and over”.

It goes on to say that by 2030 there will be,

“will be 51% more people aged 65 and over”,

and that the population over 85 will have doubled. This means, to put it bluntly, that a lot more people will go into a lot more nursing homes throughout the country. Therefore, we have an absolute responsibility to make sure that the structure that we establish on this occasion is fit for purpose.

At the moment, I understand that there are 2,400 nursing homes catering for approximately 220,000 residents. That is going to increase, and I am still not convinced that the structure that this new so-called CQC is to set in place will be fit for purpose for taking on that task. Nor has the structure been defined in the legislation, as my noble friend has referred to. When I say fit for purpose I am reminded of the comments made by the noble Earl when we met on the last occasion to discuss this Bill, when he talked of a new broom at the CQC. As I understand it, it is not a new broom but an old broom with a new handle, because the person who is now running the operation is in fact the same person, I am told—and the information is available on the internet for anyone to read—who was responsible for the structure, which we are now debating, which has failed miserably over the past four years and is the subject of the complaint.

Mr David Behan, who runs the new operation, prior to his current appointment at the Care Quality Commission, was director-general of Social Care, Local Government and Care Partnerships at the Department of Health. As the director-general—and I read these words very carefully, because I do not want in any way to misrepresent the position—he had lead responsibility for the social care aspects of the Health and Social

3 July 2013 : Column 1234

Care Act 2008, which created the CQC, the very organisation that we are having to review today because of its total failure and the scandals that have been drawn to our attention in the national media over recent years. I understand that he should have been aware of the Act’s requirements for the CQC to perform its functions for the general purpose of encouraging the improvement of health in social care services. This failure is implied in the Department of Health capability review, which in effect admits that the Department of Health was not sufficiently challenging and strategic in the way it supported the CQC.

David Behan is not new to social care regulation. Before taking up his appointment at the Department of Health, he was chief inspector of social services at the Commission for Social Care Inspection—CSCI—the organisation that we criticised in 2009 when the Act was going through on the basis of its failure in this particular area. I remember Ministers going to the Dispatch Box—Labour Ministers, yes—reading briefs produced by civil servants, in which they repeatedly assured us, as they did in personal correspondence to us, that the new structure that was going to be set up would work. It has not worked. It has been a complete and utter disaster area, which is why we are now faced with problems in this particular area that are reflected almost daily in the national press.

There is a very reputable organisation called the Relatives & Residents Association. Before anyone seeks to discredit its operations, it is worth pointing out that it is quoted in the most recent report by the House of Commons Health Select Committee. Its comments are prayed in aid in the committee’s criticism of the CQC. On 18 May 2009, in a letter to me following my criticism in the House, it affirmed its view. Four years ago, it said:

“we are concerned that … inspectors judge homes as delivering an adequate standard of care even when they are failing to meet national minimum standards for care homes”.

We were assured that that was going to be stopped. It has not been stopped under the structure that was established. The letter continued:

“the overall number of inspections of care homes has reduced. Homes that are failing to meet minimum standards are now inspected less often than used to be the case”.

We know that over the past 10 years, there has been a steady decline in the inspection of care homes nationally. We were told when the Act was passed in 2009 that it was going to be a risk-based system with a minimum of one inspection every three years. We know what a disaster that has been. We need an absolute minimum of unannounced inspections of care homes of at least twice per year, irrespective of the grading and irrespective of the ratings that have been applied to a particular home, because we all know that the management of a home can change over months, weeks or even overnight, and the home may drop in ratings dramatically as standards of care fall, depending on the financial considerations of the management of those homes.

The 2009 letter to me, four years before we stand here now, continued:

“requirements made by inspectors for action to improve care homes are often not met, there is little evidence of systematic follow-up by inspectors and requirements left unmet from one inspection to the next are common”.

3 July 2013 : Column 1235

That has happened over and over again over the past four years, and I am convinced that it will carry on happening until we set clear targets and a requirement of two unannounced inspections annually with a proper rating system, which is precisely why I support the amendment tabled by the noble Baroness, Lady Greengross, on the need for a pilot system for inspections.

I would now like to place on record the latest views expressed by the Relatives & Residents Association about what it believes the new structure should be. I do so because I understand that under the provisions of the Bill, the CQC will itself, following consultation with Ministers and others where necessary, be taking decisions on those very important areas. What does the Relatives & Residents Association say? I think that what it says should be implemented. It calls for the,

“reinstatement of regular twice-yearly inspections of all care homes to ensure compliance with regulations and standards. This case and others show that CQC needs to listen, record and act quickly on complaints which show older people are not receiving”,

the quality of care they should receive.

I add at that point that we are talking about complaints. I could never understand why we established the CQC without a proper complaints remit. According to the Relatives & Residents Association, people ring up to complain about the fact that the CQC is not dealing with complaints. The CQC says, “We do not deal with them, you have to go to the local authority”. The structure is wrong. The CQC should be the body that deals with those matters and should be given that responsibility. The association calls for investment and more and better training of all care home staff, with vastly improved training in leadership skills of care home managers and operators and up-to-date inspection reports which are easy to understand, with any action required by the provider clearly highlighted. It also wants to see:

“Care homes focusing on individual care rather than putting pressure on staff to complete daily tasks such as dressing and feeding.

Statutory registration of all care workers”—

a matter that we were dealing with on the last occasion we met as a Committee—

“by a professional body which can set standards for competence and hold individual care workers to account for their own practice.

The reinstatement of specific standards for care homes for older people”.

That might seem a particularly substantial agenda. However, if the Select Committee’s views on the ageing population are true and there is going to be a vast expansion of the care business in the future, more and more homes will have to open to deal with that increased population. We should be setting in place in this Bill a structure that is capable of dealing with that expansion in care. If we do not, we will be back here again in five years’ time arguing about a deficiency in the system. If I am still alive, I will be on my feet again complaining about the fact that the Bill we introduced in 2013 miserably failed. That is the route that the Government have set out to go down. Unless they make the resources available to address this, the CQC will inevitably fail again.

Baroness Howarth of Breckland: My Lords, I had not intended to speak in this debate and will do so briefly. We need to allow the CQC time to settle down

3 July 2013 : Column 1236

under its new management. We should also remind ourselves of the rest of the history, because it is important to put it in context.

I was the deputy chair of the National Care Standards Commission, the first organisation that brought together the inspectorates for homes under the previous Government. It was also the previous Government who, after two years, made the decision concerning the organisation—which had been quite successful. It had established a baseline of inspection. It had integrated the inspectorates, which several other organisations which had tried to integrate the different teams had failed to do. Like other noble Lords, I would also cite CAFCASS in that regard. The commission did all of that. We should remind ourselves that it was only a year later that the previous Government announced through a newspaper, not directly to the staff, that the organisation would be merged with CSCI.

The merger took place and I think that it was extremely successful. David Behan was involved in ensuring that it went well. CSCI then took on the starring system which was put into place and was having some success. By that time, we had closed 400 poor establishments. The work was continuing in terms of co-operation when it was again decided that there should be a restructuring, this time to bring the inspectorate into health.

I think that we have two lessons to learn. The first is not to restructure yet again on a political basis. If there is good leadership and the lessons have been learnt, let the organisation settle down. The second lesson is clear. If you are going to inspect anything, you need to have the expertise within the teams to carry out the inspections. Again under the previous Government, it was a sort of theory that if you had somebody other than a nurse looking at nursing, a social worker looking at a social work establishment or a teacher looking at teaching—indeed, you usually did have teachers looking at teaching; that always seemed to be an exclusion—then you could get a better answer than if you had a professional do it.

I think that the present leadership at the CQC has learnt that lesson and understands that you need the professional expertise to know what you are looking for, although that should certainly be cross-checked by independents. I hope deeply that we will be able to keep that steadiness, because I understand absolutely what happens to organisations when they are in constant flux and change.

Perhaps I may make one other point while I am on my feet. I support anything that we can do about integration. We have singularly failed to reach some complex conclusions about how health and social care can truly be put together for the benefit of those who are the recipients of that care. We should ensure that we put into the Bill whatever we can about integration. I would support all of that.

5.15 pm

Baroness Eaton: I endorse what the noble Baroness, Lady Howarth, has just said because I am firmly of the belief that it will take time to find all the appropriate people for the move which the CQC has clearly said it would make, from generic to specialist inspectors. I am sure that this will make a huge difference to the

3 July 2013 : Column 1237

outcomes of inspections. I, too, think that we should give this organisation time. From what I have seen, it has the drive and the initiative to make sure that things improve enormously.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, this has been a very useful debate and in addressing this group of amendments, it might be helpful if I began by setting out why we believe this clause is necessary.

At the moment, there is no straightforward way for members of the public to get a clear view of performance in hospitals and care homes, nor is there a measure to help drive up performance, so we believe that a new system is needed to give patients and the public a fair, balanced and easy to understand assessment of the quality of care provided. Clear ratings on performance will help to incentivise providers to improve their services, as they will be able to see how well they are doing. One of the central principles behind this clause is that it will enable the CQC to develop the new performance assessment system—informed by the views of stakeholders, of course, but nevertheless independent of government. In its report into ratings, the Nuffield Trust said:

“While there is a legitimate role for … government … to influence priorities, the process should largely be sector-led including the public and users”.

I am rather pleased that we did not debate this group of amendments on the previous Committee day because the CQC has, in the mean time, published a consultation on changes to the way in which it regulates, inspects and monitors care. I draw that to the attention in particular of the noble Lord, Lord Campbell-Savours, whose points I will address in a moment. This consultation, A New Start, sets out the commission’s initial thinking on the timetable for implementing ratings. The consultation document also sets out some detailed thoughts on how the CQC will rate NHS acute hospitals. I take the point made by the noble Lord, Lord Sutherland: this rating process will have to have some fundamental differences from that followed by Ofsted. However, the ratings will be based primarily on inspection judgments. They will be informed by a series of indicators, using data already available and the findings of other bodies such as those from accreditation schemes, clinical peer review and the judgments of other regulators. The CQC will be consulting on this model more fully later this year.

Noble Lords have raised concerns about the ability of a rating system to reflect the complexity of NHS acute hospitals. I assure the Committee that both the CQC and the Government are fully alive to this risk. The CQC is committed to producing ratings at a level which recognises the complexity of NHS services and is useful to people who use them, as well as those who commission NHS care. It is therefore proposing to provide ratings for certain individual services, such as emergency and maternity services, as well as for each hospital.

A rating will also be provided against each of the CQC’s key questions. They are: is the service safe? Is it effective? Is it caring? Is it responsive to people’s needs, and is it well led? This will mean that where the

3 July 2013 : Column 1238

evidence is available, a trust would have five ratings at three different levels—for the individual service level, for the hospital site and for the whole trust. I am sure that noble Lords will agree that this is an ambitious aim, and one that seeks to reflect the complexity of the organisations that provide care.

The Government will draw up regulations that will enable the CQC to develop the programme of performance assessment in the manner outlined in A New Start. The consultation is the first small, but important, step in the process of developing a robust system of performance assessment of providers of health and adult social care. The first ratings of acute hospitals will appear at the end of this year: I will come on to the timetable in a moment. This will be another significant step in developing a ratings system, but it will not be the end of the journey. The Government are clear that the development of ratings will be a process of continuous evolution.

Amendments, 74, 75, 76ZA, 76ZZA and 76ZAA set out areas that the CQC must or could consider as part of its performance assessment of providers. These amendments would mean that the CQC would be required to include or consider the specific issues raised as part of its methodology. The Government share the view of noble Lords on the importance of the issues they have raised through these amendments. I am sure we can all agree that they are useful ideas. However, I hope that they will equally accept the importance of the central principle that we believe should be adhered to: that the CQC should be given freedom to develop its own methodology for the new performance assessments. The clause is deliberately designed to be flexible in that sense. I therefore hope that noble Lords will be content to withdraw their amendments, in the knowledge that the CQC is ready and willing to listen to all good ideas as it puts its final plans together.

The noble Lord, Lord Hunt, has also tabled Amendment 76ZB, which would require the CQC to undertake a pilot of its new performance assessment system and require the evaluation report to be approved by Parliament. The Government agree that the CQC’s new performance assessment methodology should be subject to evaluation. This is why, in our response to the Francis inquiry, Patients First and Foremost, the Government made the commitment that:

“The Department of Health will commission an independent evaluation of the operation of the new ratings system, and this will inform future adaptations”.

The amendment would give Parliament a power of veto over the methodology which the CQC develops for performance assessment. This is not desirable as it would constrain the freedom of the CQC to act on the findings of its consultation with stakeholders. I therefore hope that noble Lords will be content not to move that amendment.

Amendment 74A would require the CQC to undertake performance assessments of commissioners of healthcare services, specifically clinical commissioning groups and NHS England. The wording of Clause 80 could enable the CQC to undertake reviews of local authority commissioning of adult social care services. The absence of a similar requirement for healthcare commissioning therefore requires an explanation. The requirement for

3 July 2013 : Column 1239

the CQC to review healthcare commissioning was removed by the Health and Social Care Act 2012 on 1 April 2013 when primary care trusts were abolished. This is because the function of supporting the development of the commissioning system for healthcare in England has become the responsibility of NHS England. NHS England’s role is to determine how the performance of healthcare commissioners, including clinical commissioning groups, is assessed and managed. There is therefore no need for the CQC to carry out a virtually identical role. I trust that the noble Baroness will be content to withdraw her amendment, but I would like to address the particular points raised.

Lord Hunt of Kings Heath: I do not quite see the logic of that, because in a sense NHS England has a vested interest in ensuring that all is well with the CCGs. It is not an independent body in the way that the CQC would be.

The other question is about NHS England itself. It is a massive commissioner of specialist services. If a local authority is to be assessed, I still do not see why NHS England ought not to be subject to some kind of independent assessment. It could have a huge impact on where specialist services are going to be provided in future. We know that Ministers are no longer prepared to answer questions about lots of things that NHS England does, so there seems now to be a gap in the architecture.

Earl Howe: Ministers most certainly are willing and able to answer questions about what NHS England is doing, and will continue to do so. Parliament, of course, will be entitled to keep NHS England’s performance in the spotlight; that architecture was built into the 2012 Act very deliberately. I do not accept the noble Lord’s point about clinical commissioning groups, because it is for NHS England to assure itself that the commissioning system for healthcare in England is working properly. There will be a high degree of transparency in that regard. The performance management role of NHS England will be right there, and I think that the proof of that will emerge over the coming months.

Perhaps I could cover the individual points raised by noble Lords. The first point was raised by the noble Lord, Lord Hunt, and echoed by the noble Lord, Lord Campbell-Savours, about how we expect the CQC culture to change in a relatively short time. I say to both noble Lords that I firmly believe that the CQC is already very much a changed organisation. It has a new leadership team in which I have full confidence. It has a new board—which, incidentally, the noble Lord, Lord Hunt, may be interested to know will include Kay Sheldon—and I think it has a new attitude to openness and transparency, as its handling of the Grant Thornton report demonstrates.

On 16 July, the CQC’s chief inspector of hospitals, Professor Sir Mike Richards, will start in post, so that is very soon. By September the CQC will be publishing a list of hospitals that it has the greatest concerns about, and it will be using its new surveillance system to develop this list. The CQC is committed to learning from the past and pressing ahead rapidly to improve for the future. I agree with the noble Baroness, Lady Howarth, that the CQC needs stability.

3 July 2013 : Column 1240

Lord Campbell-Savours: On the question of the surveillance system that the Minister just referred to, what about the proposal that keeps coming up all the time of two unannounced visits per year for every care home within the United Kingdom? Why can that at least not be set down by the Government as a requirement, irrespective of all the other recommendations and decisions that the CQC comes to over its new so-called surveillance system?

Earl Howe: My Lords, it really is for the CQC to determine the frequency of its own inspections.

Lord Campbell-Savours: It will not work.

Earl Howe: It is not for Ministers to do that. I say that with great respect to the noble Lord. In saying that, however, I also highlight the ability of the CQC to flex its inspection frequency in accordance with information received. The noble Lord will know that organisations such as local Healthwatch, and indeed local authorities themselves, are able to alert the necessary authorities through Healthwatch England, which, as noble Lords know, is an integral part of the CQC, to any problems that may be flagged up. The CQC will be consulting in future on its proposals for care home inspections, and I do not doubt that a difference of view will emerge about the frequency of those inspections. I am the first to say how important it is that the inspections take place, and I totally take the point that those assessments should not be allowed to drift in any way. However, for better or worse we have an independent body known as the CQC, which should be allowed to act accordingly. The noble Lord, Lord Campbell-Savours, took us back to the 2008 Act. I would say to him that, in agreeing with the noble Baroness, Lady Howarth, Robert Francis was clear in his report that the system should not be significantly reorganised.

5.30 pm

I fully agree with the point raised by several noble Lords that the CQC under new leadership should be given the time that it needs, both to improve the performance of its current functions, such as registration, and to embed the new functions, such as ratings. The noble Lord, Lord Hunt, asked whether Ministers had put pressure on the CQC. No, absolutely not. We are clear—I am looking at the noble Lord, Lord Sutherland —that the chief inspector should be an independent post in itself. The chief inspectors are appointed by the CQC, not by the Government or the Department of Health, and we think that this is appropriate.

The noble Lord, Lord Campbell-Savours, asked why the CQC does not have a complaints remit. Again, going back to earlier debates under the previous Government, all organisations in healthcare were aware that the Healthcare Commission—as it then was—provided independent review of individual complaints cases. This seemed to act as a perverse incentive not to investigate thoroughly at a local level. In other words, it is arguable that providing an independent stage through a separate organisation had actually worked against effective local resolution of complaints, because NHS organisations were aware that the Healthcare Commission would ultimately undertake the work.

3 July 2013 : Column 1241

So there was less willingness to take ownership of the problem at the source of that problem. A lot of duplication also emerged from that, with the Healthcare Commission tending to carry out investigations even where the work had been done at local level. That was not a good use of public money. I remember that the Parliamentary and Health Service Ombudsman and the Local Government Ombudsman fully supported the decision to remove handling individual complaints from the regulatory body.

As for the evolution of these ratings, the Government do not expect the CQC to have fully developed ratings for hospitals by the end of this year. That would be unrealistic. The initial ratings will not be a final product. They will instead represent the first stage in an ongoing development process. The Government expect that CQC will improve its methodology over time, and one of the most robust ways to do that is to continually test the methodology in the field. The new Chief Inspector of Hospitals will spearhead the new approach to assessing hospitals, using his clinical expertise to develop an effective approach for rating. I direct noble Lords to the CQC’s consultation document A New Start, which sets out all these plans in some detail.

CQC plans to commence rating providers of acute care from December, with the aim that all these providers receive a rating before the end of 2015. It will begin to develop ratings for mental health trusts during 2014, and for other NHS trusts, such as community healthcare and ambulance trusts, during 2015-16. Why do we not specify in the Bill who will be assessed? The answer in the first instance is that this Bill consolidates the existing regulation power in Section 49 of the Health and Social Care Act 2008, to allow the CQC to have the flexibility to focus on providers of most interest to the public. That is important in defining the scope of the new performance-assessment system through regulations. We are giving the CQC increased flexibility to focus its assessment on those providers and services that are of most interest and concern. We must avoid overloading it with the task of assessing the entire system. We wanted to focus, first, on services where an assessment and subsequent rating are likely to provide the most benefit to everybody.

The noble Lord, Lord Hunt, asked about the commissioning responsibilities of local authorities, and whether they would be a priority for the CQC when it conducts its ratings. The CQC has a duty under the Health and Social Care Act 2008 to carry out reviews of local authority commissioning, but the policy position agreed with the Department of Health is that, for the time being, local authority commissioning performance and assessment will be led by councils as part of wider moves to devolve responsibility for improvement in the sector, underpinned by strengthened transparency and accountability to local people. The policy position is still under consideration. Therefore, the clause gives the Secretary of State the power to define in regulations the scope of the performance-assessment system. Until it is agreed to what extent there will be a need for reviews of local authority commissioning, the policy will be kept out of scope in the regulations.

3 July 2013 : Column 1242

I hope that I have answered most if not all the questions. Naturally, I shall reply in writing to any noble Lords whose question I omitted.

Lord Sutherland of Houndwood: Perhaps I may ask for clarification on one further point relating to complaints. Amendment 76ZZA does not propose that the CQC should handle complaints, which was the gist of the Minister’s response. Rather, it proposes that there should be a clear and transparent method of handling complaints within each trust and relevant area. The role of the CQC is to open up that window, very much in line with the Francis report, so that we can know that complaints will be handled at the appropriate level and in the appropriate way.

Earl Howe: I completely understand the noble Lord’s point. He will remember that in the registration requirements for providers of health or social care, the existence of a complaints system is one factor on which the CQC will need to satisfy itself. On the quality of the complaints-handling system within that provider, my answer is that it is a powerful point and an important area, but in the end it is one on which we should let the CQC decide as it develops its methodology. I do not in any way dismiss the noble Lord’s suggestion, but it is one for the CQC to take forward.

Baroness Pitkeathley: My Lords, this has been a wide-ranging and well informed debate. It has focused on anxieties about the role and competence of the CQC. The anxieties seem to focus on questions about whether the job of the CQC is doable at all, doable in the very short timescale, or doable with current resources. Suggestions about how to address the anxieties and concerns have included piloting new structures, but there has been much support for the CQC being given time to improve its strategy and performance—although with strong reservations from my noble friend Lord Campbell-Savours. I am grateful for the support for my amendments on integration, and sorry that the Minister was unable to accept them. Given the concern and strength of feeling about the CQC, I am sure that we shall return to this matter on Report. For the present, I beg leave to withdraw the amendment.

Amendment 74 withdrawn.

Amendments 74A to 76ZB not moved.

Clause 80 agreed.

Amendment 76A had been withdrawn from the Marshalled List.

Amendment 76B not moved.

Clause 81 : Offence

Amendments 77 and 77A not moved.

Clause 81 agreed.

Clause 82 agreed.

3 July 2013 : Column 1243

Amendment 77B

Moved by Lord Best

77B: Before Clause 1, insert the following new Clause—


The provisions enshrining the new duties and responsibilities for local authorities in Part 1 shall not come into force unless and until a comprehensive and sustainable solution has been provided by the Secretary of State to address the funding of existing care and support commitments for local authorities and those arising from this legislation.”

Lord Best: My Lords, we now come to the beginning of the Bill and the very important Part 1, sensibly postponed until after the Chancellor’s Statement last week on the spending review.

I declare my interest as president of the Local Government Association. The LGA has drafted this amendment and, as with many other Bills, has provided invaluable analysis and briefing for parliamentarians, alongside its direct negotiations with central government on behalf of local councils. Indeed, I commend the LGA’s new publication, Rewiring Public Services, which was launched yesterday and sets out a radical agenda for local services, including social care services.

The provisions in Part 1 have been widely welcomed. They will update and reform the adult social care system. They will support greater integration of health and social care and, on the issue of paying for care, the Bill’s provisions will redefine the relationship between the state and the citizen. Some of these changes will lead to future savings in the cost to the public purse of providing adult social care.

However, achieving later savings means spending more today, and some elements of the Bill mean a shift in the cost of care from the individual to the state. Therefore, before your Lordships’ Committee embarks upon its consideration of the important changes contained in Part 1, it seems important to consider the financial position from which we are starting out.

There is compelling evidence that rising costs of care are leading inexorably towards a crisis in funding for the local authorities which are trying to meet the needs of an ageing population. Before we can assess the practicalities of extra activity and extra spending for social care, it is necessary to be clear how existing care commitments can be paid for, as well as how extra costs arising from the Bill will be funded. Decisions on funding need to be taken before, or at least at the same time as, the policy decisions. Therefore, Amendment 77B—and I am very grateful to the noble Lord, Lord Tope, who has added his name to it—seeks to postpone implementation of Part 1 until the Secretary of State has addressed the crucial issue of how the costs of social care and support will be met in the years ahead.

What we now know from the Chancellor’s Statement last week is that the spending review includes genuinely helpful steps to fund key measures contained in the Bill. Following productive dialogue between central government and the LGA, the plans set out in the spending review make it clear that significant extra funds will be available from the NHS to assist with the costs of local care services. As well as needing reassurance that all extra costs for local authorities resulting from

3 July 2013 : Column 1244

the Bill really will be covered, there remains the greater underlying concern that the financial foundation on which the new position is to be built is not secure. Over the past three years, adult social care budgets have reduced by 20%. In a number of areas, to cope with the funding cuts it has already been necessary for councils to raise the bar before regarding older people as eligible for help from the council. Accordingly, despite growing numbers of older people, fewer people are now being helped because their needs are assessed as moderate, not substantial, even though earlier support can prevent the need for higher costs later.

The Association of Directors of Adult Social Services notes that the bulk of this reduction has been made up by efficiency gains. Many adult services directors believe that they can go a bit further; for example, through better procurement, shifting activity to cheaper settings, subcontracting provision to the private sector, and so on. But the scope for further efficiencies clearly now is much reduced. Demographic pressures, with a 3% growth every year in numbers of older people, mean that savings are predicted to be immediately cancelled out by the cost of meeting increasing demand. The cost of just standing still is estimated at another £400 million a year. Efficiency savings alone cannot keep pace with these budget pressures.

5.45 pm

Local government funding from central government has taken a huge hit with a 33% reduction over the period 2011 to 2015, prior to the additional 2% cut made in the Autumn Statement for 2014-15 and now the further 10% reduction in funding for 2015-16 announced in the spending review. Many of your Lordships will be aware of the frightening prediction that, unless the funding arrangements can be sorted out, local authorities face the so-called Barnet graph of doom. This shows how social care costs could absorb almost all local authority resources by 2019-20, leading to massive reductions in a whole range of existing local authority services. Already increasing costs, alongside a growing ageing population, are stretching adult social services to the limit. The funding issue really needs to be addressed before we consider a reform system for social care. Analysis by London Councils suggests that the combined effect of inflation and demographics means that there will be a potential £421 million additional cost pressure on adult social care in London by 2015-16. That is before any reforms are implemented.

The new spending review includes some really helpful measures for adult social care and health. The £3.8 billion pooled budget for health and social care services, with a continuation of the existing transfer from the NHS to social care that emerged from the 2010 spending review, is enormously important. Some of that transfer includes additional funds for the measures in this Bill. The new costs to be covered include resources to accelerate the transformation of services, provision of support for carers, capital funding for projects to improve integration locally and help for councils to organise themselves to implement this legislation. Costs are also coming down the line to support the scheme of local authority assistance for equity release by home owners who defer repayments. The extra funding in the spending review is greatly welcomed. I believe that

3 July 2013 : Column 1245

the Government have listened to the concerns expressed by the LGA and others, and recognise the importance of providing sustainable funding for adult social care.

However, it is not clear that the sums add up. London Councils has helpfully spelt out that very significant costs arise from the legislation covering paying the care costs for people who have spent up to the cap of £72,000 and/or have become eligible for support because the means-tested threshold is being raised to £118,000; assessing the increasing number of self-funders coming forward as a result of the reforms; monitoring each individual’s care accounts and progress towards spending up to the cap; assessing carers’ needs for support and making extra carers grants; setting up new safeguarding boards for adult services like those for children safeguarding boards; and promoting integration with health services, fulfilling a new duty to provide information and advice on care.

In its new analysis released this week, London Councils has found potential total additional cost pressure of £1.3 billion for London local authorities by 2019 as a result of introducing the new measures. Approximately £877 million of this will be as a direct result of implementing the capped cost model for care and raising the eligibility threshold over the first four years. If these figures are right, the Government’s estimates of providing £1 billion per year to fund the cost of the reforms for the whole country will clearly be inadequate. London Councils’ analysis has found that the reforms nationally over the four years will be in the region of £6 billion, on average £1.5 billion per year, with cost pressures heavily weighted in the first and fourth years of implementation. It seems very likely, therefore, that the additional burdens on local government will not be matched fully by extra central government support.

I think we all appreciate the hazards of going boldly forward without real clarity on whether councils can afford to meet both their existing and their new commitments for social care. This amendment provides the opportunity for greater clarity as we set out to consider the details of Part 1. I conclude by asking the Minister the following questions. Have the Government fully assessed the likely costs of the nation’s adult social care for the years ahead? If so, do they accept that there is an alarming growing gap between resources and demands? Do the Government consider that their new funding plans are adequate both to cover the extra costs of implementing the Care Bill’s measures and to fill the funding gap already looming so dangerously, and, indeed, that funding allocations will reflect different costs and population pressures in different parts of the country? In relation to the existing funding gap and to any inadequacies discovered in the financing of the extra spending in this Bill, what contingency plans are in place if actual costs prove more than expected to prevent the already hazardous position becoming quite untenable? Until these questions are answered satisfactorily, it seems wise to hold back on implementation of Part 1 of the Bill. Accordingly, I beg to move Amendment 77B.

Lord Bichard: My Lords, I rise briefly to support this amendment as a mere vice-president of the Local Government Association. Very few Members of this

3 July 2013 : Column 1246

House were here a week or so ago when the noble Lord, Lord Bates, sponsored a debate on the increasing complexity of legislation and, indeed, the increasing volume of legislation. It is a shame that more noble Lords were not there. In that debate, the noble Lord referred to a recent report from the Office of the Parliamentary Counsel, which pointed out that when the Queen came to the Throne in 1952, after 740 years of legislation we had 26 volumes of

Halsbury’s Statutes


we now have 74 volumes. In 1952, the average Bill was 22 pages long; it is now 122 pages long. In 1952, there were 29 statutory instruments; last year there were 3,328. This is an astonishing increase even on 2008, when there were just 1,325. On that last statistic, I can bear witness as a member of the Secondary Legislation Scrutiny Committee. Indeed, my postman particularly asked me if I could do something about the volume of secondary legislation.

We have reached a point where we need to think seriously about the volume of legislation and its complexity, and whether we can carry on imposing new burdens and responsibilities, not least on local authorities. It would be fine if all this additional legislation was actually removing some of the red tape and bureaucracy that previous legislation had provided, but we know that it is not doing so and that it does not do so. We need to do one of two things. Either we genuinely reduce the volume of legislation and the additional responsibilities that it places on all sorts of bodies, or, as the noble Lord, Lord Best, suggests, we have realistic costing of what these new responsibilities entail and ensure that resources are available. If we do not, we remain in a cycle of despair and decline where we expect others to deliver new responsibilities, which they are just not able to do. We also raise the expectations of clients and users, who believe that things will change, when in all honesty they probably will not. That, I think, is a cycle of despair and decline, and it is the reason why I support this amendment.

Baroness Howarth of Breckland: My Lords, I rise briefly, as yet another mere vice-president of the Local Government Association, to bring a slightly different dimension to this debate. The noble Lord, Lord Best, pointed out that local authorities are finding a variety of different ways of delivering services. I have been looking at some of those and listening to messages about them. One issue is that they are delivering cheaper services, which often means commissioning them from providers which will then deliver them at a different level of quality. I declare an interest as a provider in the charity Livability, which delivers services to the disabled, the elderly and some children from residential care.

We need to know whether we are prepared to open the debate. Have the Government as a whole given thought to discussing with the community at large what we really can and cannot afford for the future? The noble Lord, Lord Campbell-Savours, raised the issue of the numbers of inspections. When I was involved in inspections, one issue was that you could deliver as many inspections as you had funding for. Now you can use that funding in a variety of different ways to get better options but, at the end of the day, resources count and, unless we know how far the resources will go, it is pointless to try to descend into the abyss, as the noble Lord, Lord Bichard, said.

3 July 2013 : Column 1247

If we are going to take this forward, we have to know what level of quality people are prepared to accept. Then, when there are failures in organisations, people are not blamed, because the failure is not necessarily one of individuals or even of groups but of the corporate whole simply not having enough resources to work across the whole piece. Until we start that debate, we will not be able to intervene in discussions about criticisms of local authorities giving only 15-minute slots to people when they have only enough resources for 15-minute slots. In residential care, we are taking away some of the extra services because there is no more money them. We are reducing staffing in various institutions because there are simply not enough resources.

I am not denying that because of the deficit we have to look at funding; I think we do. However, we have to open up the debate. Otherwise, we raise expectations in the country of what we are entitled to. I sat in this Chamber until 11 o’clock last night discussing the Children and Families Bill, and we were having exactly the same discussion. We all want these wonderful things. I want things in this Bill, but somehow we have to decide on some priorities between them all. Whatever we say, we cannot go on expecting to get the same out of the same.

Lord Rix: My Lords, I support this amendment in particular. I declare an interest as the president of Mencap. There is no doubt that the services that we are able to provide are being severely cut back because local authorities simply do not have the money to support those services. Where we used to get, say, £15 an hour, we now get £12 an hour. The implication is that we can lower the standard of our services, but we are not prepared to do that. Therefore, we will end up reducing our services and, as a result, people with learning disabilities, their families and their carers will suffer. This is exactly the situation at the moment. Local authorities will try to provide the services, but they are making it much more difficult for voluntary organisations such as Mencap.

6 pm

Lord Campbell-Savours: My Lords, I shall refer to the report of the Public Service and Demographic Change Committee. Members of the House who have not read the report should do so because it is a fascinating document. It is probably one of the best documents to come out of the House of Lords for many years. On the question of Dilnot, to which I am opposed but I shall explain that later on in the Bill, paragraph 193 states:

“The major gainers will be the relatively better-off, who will be protected from depleting their housing assets”.

In other words, potentially we will be spending in the longer term money that could have been raised in taxation. We are losing that revenue at a time when the same report refers to the deteriorating ability of the state to help people who are in need of medical services. It refers to the fact that the number of people aged over 75 is expected grow from 5.4 million in 2015 to 8.8 million in 2035. It refers to the fact that the demand for hospital and community service spending by those aged 75 and over is, in general, more than three times the demand from those aged between 30 and 40.

3 July 2013 : Column 1248

We have higher demands from the elderly, more people falling into the groups that are liable to want the services historically provided by local authorities and the state, and yet, at the same time, with these Dilnot proposals, over a period of time we will be handing back money to the taxpayer to which, in my view, the taxpayer has no right.

The report says that the number of people in England with three or more long-term conditions is predicted to grow from 1.9 million in 2008 to 2.9 million by 2018. It is forecast that the number of people in England and Wales aged 65 and over with dementia—we all know the care requirements of people with dementia—or moderate or severe cognitive impairment will increase by over 80% between 2010 and 2032 to 1.96 million. The report goes on to say that it is estimated that by 2022 the number of people in England aged 65 and over with some disability will increase by 40% to 3.3 million.

As I understand the amendment of the noble Lord, Lord Best, he is simply saying, “Hang on a minute, before we start spending money, we should take stock of what is available in the longer term. Can the state afford to pay all the bills that are to come? Has that work been done?”. I hope that the noble Earl will seek to give the Committee those assurances because if the work has not been done and the predictions of some have not been taken into account, it may well be that the amendment of the noble Lord, Lord Best, is relevant. Let us defer much of this expenditure until we have sorted out the budgeting.

Baroness Campbell of Surbiton: My Lords, I had thought that I would not respond to the amendment of the noble Lord, Lord Best. However, I feel I must because there seems to be a missing voice in this debate—the voice of the thousands of people who use social care, over 70,000 of whom receive some form of direct payment. Ten years ago, when direct payments were successfully introduced and allowed disabled people to live independently in this country, we were proud to be employers. We were able to employ RPAs at a good rate, with holiday pay, and we were able to advertise. We were equal to those who employed individuals in their own companies. Ten years on, many cannot even give holiday pay and cannot advertise. They fall back on costly social care services or enter hospital as a result of not being able to employ assistants.

We, too, want to know the costings before new services come into effect. Disabled people may have to accept these services and find that they lose choice and control over their lives. So please do not forget the voice of those who say, “We, too, wish to know that the money is settled. We, too, need a voice to remind people that, in order for us to employ or control our services, we must feel that we can do this with equality and dignity and do it absolutely properly”. Otherwise independent living will become just a memory.

Lord Sutherland of Houndwood: My Lords, the noble Lord, Lord Best, is right in his analysis. He is pointing towards a financial problem that we all know is there and will continue to be there, not least in the current situation, for a number of years to come. The noble Lord, Lord Rix, is right about the consequences

3 July 2013 : Column 1249

of this within the community. I declare an interest as president of Alzheimer’s Scotland and I know that the same applies to its sister body in the rest of the UK. There is a shortage of cash, which means that services are being provided more cheaply or, of greater relevance, are not being provided and are being squeezed. That is the analysis.