House of Lords
Tuesday, 6 May 2014.
2.30 pm
Prayers—read by the Lord Bishop of Leicester.
Lord Cromwell took and subscribed the oath, and signed an undertaking to abide by the Code of Conduct, following the by-election under Standing Order 9.
Armed Forces Front-line Combat Roles: Women
Question
2.37 pm
Asked by Lord Selkirk of Douglas
To ask Her Majesty’s Government what steps the Ministry of Defence is taking to evaluate whether women should be allowed to serve in frontline combat roles in the infantry, prior to making a decision in 2018 in accordance with the European Union rules on reviewing that policy.
The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Astor of Hever) (Con): My Lords, first I am sure that the whole House will wish to join me in paying tribute to Captain Thomas Clarke of the Army Air Corps, Flight Lieutenant Rakesh Chauhan of Joint Helicopter Command RAF Odiham, Acting Warrant Officer Class 2 Spencer Faulkner of the Army Air Corps, Corporal James Walters of the Army Air Corps and Lance Corporal Oliver Thomas of the Intelligence Corps, who were killed while on operations in Afghanistan on 26 April. These tragic deaths remind us of the continued commitment and sacrifice of our Armed Forces, and I know that our deepest sympathies are with their families at this very difficult time.
Defence is required by EU law to conduct a review into the exclusion of females from ground close combat roles no later than 2018. This would include posts in the Naval Service, the RAF and the Army. While the nature, scope and timing of the review have not yet been determined, we are considering whether to bring it forward, recognising the need both to improve the diversity of the workforce across defence and to maintain operational effectiveness.
Lord Selkirk of Douglas (Con): My Lords, will the Minister accept that the whole House will wish to be associated with his message of condolence to the families of those who have very sadly lost their lives?
I shall mention a past interest in this subject: 70 years ago my aunt was a pioneering woman who used to fly military aircraft to front-line aerodromes in the Second World War. If women have the inclination, aptitude, ability and strength required, is it not time for the Government to consider following the examples of such countries as Canada, Australia, France, Germany, Norway, Denmark, the Netherlands and, not least,
the United States of America, all of which either have allowed women to take their place in combat roles on the front line or are in the process of doing so?
Lord Astor of Hever: My noble friend is right, which is why we keep this subject very much under review. Women already serve on the front line with great distinction, and we will take into account the factors that my noble friend has mentioned, as well as other aspects, particularly the effect on unit cohesion. My noble friend mentioned other countries. That will be very relevant, although we need to be sure that the answer is right for our Armed Forces and the way they operate.
Lord Rosser (Lab):On this side, we also wish to express our sincere condolences to the families and friends of the five members of our Armed Forces who have recently lost their lives on operations. We are reducing the numerical strength of our Armed Forces in Afghanistan, but the dangers remain, and the enormity of the sacrifices which young service personnel continue to make on our behalf has been brought home to us all once again.
Women currently serve in theatre as engineers, intelligence officers, medics and fighter pilots. The ban on women serving on submarines has been lifted, and increasing numbers of women have been appointed to senior military posts in recent years, but more needs to be done to make sure that our Armed Forces reflect the communities they serve, in line with a key objective of Army 2020. Serious consideration needs to be given to the further roles that women can play, including serving in front-line combat, since we need to maximise the talent and expertise available. The Minister said that the Government are looking at bringing forward the review, which is due by 2018. I wonder whether he can be a bit more specific on that. Is it currently the intention to wait until 2018, or is there an earlier target date for a decision? What are the considerations that will be taken into account by the Government in looking at the issue of women serving in front-line combat roles?
Lord Astor of Hever: My Lords, as I said in my Answer, we are looking very clearly into the possibility of bringing the review to an earlier date than 2018. As soon as I have any information, I will come back and report it to the House.
Baroness Garden of Frognal (LD): My Lords, I associate these Benches with the condolences to those who were killed in the helicopter accident. Given the news, mentioned by the noble Lord, of the first women to serve in submarines and the appointment of the first two-star officer in the Royal Air Force, will my noble friend say what opportunities the Army is giving to extend career opportunities to women, whether in combat roles or elsewhere?
Lord Astor of Hever:My Lords, I am very grateful for my noble friend’s kind words, very much in memory of her late husband, who was a very distinguished helicopter pilot. She asked what front-line roles women already serve in. They already serve in a variety of front-line roles, including as medics, fire support team
commanders, military intelligence operators and dog handlers, with at least two having won the Military Cross. Looking round the House, I know that a number of noble Lords have been to Afghanistan, and I am sure they have met many of the women who play a very distinguished part in supporting our troops out there, particularly the medics, who do an incredible job.
Baroness Dean of Thornton-le-Fylde (Lab): When the Minister is able to inform us when the review will take place, will he also inform us of the factors that will be taken into account? A number of us have heard “force cohesiveness” over the years, but it is a bit like Heinz 57 varieties; it can mean a lot to different people. If we are not clear what factors are to be taken into account, the outcome may in fact be a different decision than many of us would want to see.
Lord Astor of Hever: My Lords, in 2002 there was a review that took approximately two years. There was another review in 2010. The conclusions of both were mixed. As a result, Ministers concluded that a precautionary approach was still necessary and the exclusion of women was retained. It might be helpful to the House if I were to write to the noble Baroness and other noble Lords who are interested, giving a link to the Written Statements made in November 2010 and setting out the full report of the review and the information and research that was carried out.
Lord Lester of Herne Hill (LD): My Lords, great progress has been made in the Armed Forces in dealing, for example, with homosexuality or pregnancy discrimination and other matters of that kind. Will the Government, in considering whether to bring forward the review, bear in mind a case in which I appear, Johnston v Chief Constable of the Royal Ulster Constabulary, in which it became clear that women already are performing vital undercover works of a combative nature, facing real danger, and are at least as important in the work that they are doing as their male colleagues?
Lord Astor of Hever: My Lords, my noble friend makes an important point. As I say, we are reviewing seriously a date earlier than November 2018. I can say to my noble friend that the Ministry of Defence remains fully committed to treating everyone fairly and properly, whatever their gender, ethnicity or other characteristic. We will continue working to eliminate any form of discrimination.
Health: Liver Disease
Question
2.45 pm
Asked by Lord Brooke of Alverthorpe
To ask Her Majesty’s Government whether they will produce a strategy to reduce liver disease.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, improving outcomes for people with liver disease is a priority. Public Health England has a wide-ranging
programme aimed at tackling its three major causes—viral hepatitis, alcohol abuse and obesity—through strengthening local action, promoting healthy choices and giving appropriate information to support healthier lives.
Lord Brooke of Alverthorpe (Lab): My Lords, I gather from that that the Government are not prepared to consider introducing a strategy, which is a great pity given that liver disease is now the fifth biggest killer and we have some of the worst figures in the whole of Europe. How does the Minister see a more general approach, rather than a specific target in a strategy, producing a change in the terrible figures which we now see in the number of deaths, given that the deprived areas of the country where most of them occur, such as Manchester, had a reduction in the funding to commissioners and GPs for this purpose last month?
Earl Howe: My Lords, as the noble Lord is aware, NHS England is responsible for the overall national approach to improving clinical outcomes for people with liver disease. At the moment, it has no plans to produce a strategy specifically for liver disease, but it is adopting a broad strategy to reduce premature mortality, including mortality from liver disease. There is a major emphasis in the work being done by NHS England and Public Health England on prevention. They are supporting clinical commissioning groups and local authorities with a suite of tools to help them maximise the best possible outcomes for their local communities, such as local authority profiles. That can help local authorities and CCGs indentify the significance of liver disease in their area compared to the rest of the country, and the actions they could take to tackle it.
Baroness Gardner of Parkes (Con): Can the Minister identify more clearly for me his definition of liver disease? He cited various things. Do his liver disease figures include the metastases from cancers, which are often a terminal condition? Are they treated separately or classified as part of the existing numbers?
Earl Howe: My Lords, there are over 100 types of liver disease, which together affect at least 2 million people in the UK. The main ones are derived from alcohol misuse, viral infection, being overweight and obesity, and there are conditions that are inherited as well as those which attack the immune system. As regards metastases, I would need to be advised but I would imagine that that falls under the general heading of “liver cancer”, which is certainly included in my remarks to the noble Lord opposite.
Baroness Billingham (Lab): My Lords, given the sad news that we have had in the past 48 hours of the death of Elena Baltacha, one of our best young tennis players—I have no idea about the history of her illness, but I know it has gone on for many years—what is the availability of liver transplants? That is a question that will cross many people’s minds. It would seem to
me that if it was available and she was a suitable candidate, that could have been looked at. Can the Minister give us any assistance on that?
Earl Howe: My Lords, I, too, learnt with great sadness of the death of Elena Baltacha, and was also unaware of the history of her medical condition. It is not appropriate for me to comment at the Dispatch Box on whether she should have received a liver transplant. However, I can say that transplant services are very active in this country. More and more liver transplants take place compared with a few years ago, and there are better techniques to ensure their tolerability in patients. If I can find out some more information, I will be happy to write to the noble Baroness.
Baroness Finlay of Llandaff (CB): Do the Government recognise that a strategy needs to be far wider-reaching than health, given that alcohol abuse results in two-fifths of crimes being alcohol-fuelled and in a cost to society of £55 billion a year? That sum would be recouped in part if the unit price of alcohol was raised by 10%, which would help to decrease the binge drinking which results in young people ending up in liver units with fulminant end-stage liver disease.
Earl Howe: I agree with the noble Baroness that if we are to tackle liver disease we need to look as broadly as we can at the causes of alcohol misuse. We remain concerned about the wide availability of cheap, discounted alcohol and will soon take action to ban sales of alcohol below cost, where the price is equivalent to duty plus VAT. As regards minimum unit pricing, that remains a policy under consideration, but it will not be taken forward at the moment while we gather further empirical evidence. We do not want to launch a policy that may have unintended consequences.
Baroness Manzoor (LD): My Lords, the incidence of liver cancer and liver disease is increasing significantly in young people, and it is the only cancer that continues to increase. Can my noble friend state whether there is a high-profile health education strategy that will help to tackle alcohol abuse and raise awareness among young people, who now talk about getting “preloaded” before they go out to drink alcohol, and which will highlight the issue of obesity? We need a high-profile health education campaign in that area.
Earl Howe: My Lords, as my noble friend knows, there is of course scope to include alcohol awareness in relevant lessons in secondary schools. However, I take my noble friend’s point. I am encouraged by recent figures which show a drop in binge drinking, but that is no cause for complacency. It still takes place, and too many young people end up in specialist care and sometimes lose their lives. That is very much on Public Health England’s radar.
Lord McConnell of Glenscorrodale (Lab): My Lords, Elena Baltacha had a remarkable career—
Baroness Cumberlege (Con): My Lords—
Baroness Wheeler (Lab): My Lords—
Lord McConnell of Glenscorrodale:I was up three times before.
The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford) (Con): My Lords, we are against the clock. It is the Labour Benches.
Baroness Wheeler: My Lords, I, too, pay tribute to Elena Baltacha, who was a truly remarkable and very brave woman. One in five people in the UK is at serious risk of liver damage, but a recent government response shows that the Secretary of State has not met any external organisations to discuss liver disease since May 2010, and current Ministers have not met representatives of people living with liver disease since September 2012. Can the Minister commit urgently to remedying this situation, particularly as it is in such stark contrast to the 130-plus meetings the Government have had with the drinks industry?
Earl Howe: My Lords, liver disease is very much in the sights of my honourable friend the Minister for Public Health, as is evidenced by the document we published last week, Living Well for Longer, in which there is a whole section on alcohol and liver disease, and by what NHS England and Public Health England are doing to tackle them.
Transforming Rehabilitation: Mental Health
Question
2.54 pm
Asked by Baroness Linklater of Butterstone
To ask Her Majesty’s Government what plans they have to include mental health treatment and support in contracts for the probation services as part of the new Transforming Rehabilitation programme.
The Minister of State, Ministry of Justice (Lord Faulks) (Con): My Lords, our reforms will bring in the best of the private and voluntary sectors to work with offenders and reduce reoffending. Community rehabilitation companies will be contracted to work with low and medium-risk offenders in the community, and the National Probation Service will supervise high-risk offenders. Both will be required to deliver services for specific groups such as females and BME offenders, as well as those with mental health issues, to ensure that an offender’s treatment requirements are complied with, including in situations where a court order exists.
Baroness Linklater of Butterstone (LD): I thank my noble friend for that reply. I am sure that he will be aware that currently four out of every 10 people who are being supported by the probation service are actively mentally ill: that is, 39%. This underlines the range of skills and knowledge that is required today from experienced members of the probation service in managing and properly meeting the needs of these clients. Therefore,
will the Minister clarify whether the new organisations now bidding for probation service contracts are specifically expected by the Ministry of Justice to include and implement mental health provision across the board—because there are not specialisms to this extent within the probation service, as far as I know—and whether this requirement will be included in the proposals? How will the quality of the proposals of the new probation service contractors and the performance of the new providers be assessed?
Lord Faulks: My noble friend, and the House, may recall that the Government lodged with both Houses of Parliament a detailed draft services agreement, which included provisions that would apply to mentally ill offenders. Clause 3 of the agreement provides that the contractor shall monitor that the treatment provider prepares a full treatment plan with details of the specific mental health needs of each allocated person, with the timescale indicated to the court at the time of the sentence. Therefore, companies will be contractually obliged to do this. They will have an obligation under the Human Rights Act and under the Equality Act. My noble friend is of course right that the skills should be preserved in relation to mental health.
Baroness Howarth of Breckland (CB): Will the Minister clarify the relationship between NHS England’s responsibility for mental health and that of the Ministry of Justice, and how contracts are laid between the two, not only in the private sector but in the voluntary sector, where a number of organisations have lost contracts through this confusion? I declare an interest as a trustee of the Lucy Faithfull Foundation.
Lord Faulks: There is an obligation to treat offenders and non-offenders the same. The circumstances in which they come to be treated may be different. Those who are in prison may suffer from a number of different mental illnesses. Their treatment is the responsibility of NHS England. Of course, there are complications with the delivery of treatment in the community as well, but there is no absolute difference in the treatment that is appropriate to you when you are an offender in prison or out of prison or are an ordinary member of the public. Clearly there are matters of co-ordination that the noble Baroness would say are not sufficiently attended to.
Lord Beecham (Lab): Between 2010 and September 2012, 86% of the prison and probation-related work contracted out to the private sector by NOMS went to G4S, Serco and Sodexo. If the Minister is so confident of the performance of these contractors in this important and sensitive area, why has the Ministry of Justice refused to disclose the figures for the succeeding year, even after an FoI request from the Centre for Crime and Justice Studies? Is he aware that just three third-sector organisations accounted for two-thirds of the third-sector expenditure in the same field?
Lord Faulks: I cannot comment on the details of the noble Lord’s question, but I assure him that neither of those two organisations are part of the CRC delivery, as he may well be aware. The CRC contracts are being
drawn up and will be in operation by 2015. This matter was fully debated before both Houses of Parliament and we believe that any difficulties should be capable of being found in the stress-testing that is currently being undergone.
Lord Ramsbotham (CB): My Lords, to follow on from my noble friend’s question about NHS England, can the Minister comment on a recent freedom of information question and answer that showed that only 5% of clinical commissioning groups were actually funding specific healthcare for probation and that 25% of the CCGs questioned did not even realise that it was their responsibility to fund medical health provision in probation?
Lord Faulks: I cannot comment on the specific freedom of information request to which the noble Lord refers but I can perhaps reassure him that the Government are particularly aware of the danger of individuals escaping the net who are suffering from mental illness—offenders who come to the attention of courts and police services. Much work is done by the liaison and diversion services, which have invested a considerable sum of money to make sure that those who are often reluctant to acknowledge that they have mental illness, when they come into contact with a court or police station, are identified by appropriate health professionals. The information about them is then passed on to the appropriate figure so that, when they go to prison or are in the hands of a CRC, that information is available. A considerable investment has been made and for altogether 22% of the population it is hoped to roll out the arrangement throughout the country so that there is much better liaison in future.
Yarl’s Wood Immigration Removal Centre
Question
3.01 pm
To ask Her Majesty’s Government why the United Nations special rapporteur on violence against women was refused access to Yarl’s Wood immigration detention centre while on an official visit to the United Kingdom.
The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach) (Con): My Lords, a visit to Yarl’s Wood immigration removal centre was never agreed as part of this fact-finding mission. However, as part of her visit, the special rapporteur, Ms Rashida Manjoo, met the Home Secretary, the Minister for Crime Prevention and the Chief Inspector of Prisons.
Lord Ramsbotham (CB): My Lords, I am very grateful to the Minister for that reply. As he will appreciate, it can do our national reputation no good at all if it should ever be felt that the United Kingdom is refusing access to a UN special rapporteur who is here in connection with the signature that we have given to the optional protocol on the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment. Therefore, I hope very much that, in future, that position will be clarified, as the publicity can have
done no good at all. I would be very grateful if the Minister could inform the House of what action will be taken to ensure that future visits can be properly handled.
Lord Taylor of Holbeach: I disagree with the premise of the noble Lord’s question, because Ministers met the special rapporteur and were keen to support a programme for her visit that was more directly relevant to addressing violence against women and girls. That is why we offered the visit to a refuge, facilitated by Women’s Aid, and supported a number of other visits for the special rapporteur, including a visit to a number of government departments, devolved Administrations and front-line agencies relevant to the reasons for her visit.
Baroness Lister of Burtersett (Lab): My Lords, the recent report by Women for Refugee Women found that many of the women in Yarl’s Wood had experienced sexual violence, which surely makes it a relevant visit for the special rapporteur. What is the Government’s response to that report, which showed the traumatic impact on those women of detention?
Lord Taylor of Holbeach: No one can be unaware of the fact that detention is a necessary evil. It is part of the requirements that we have in enforcing an immigration policy. However, the inspection by the Chief Inspector of Prisons found very little evidence of victimisation of women at the centre. It was felt that there was insufficient recognition of particular vulnerabilities of detained women; those points were taken and are being addressed by Yarl’s Wood.
Lord Avebury (LD): My Lords, apart from the chief inspector’s findings on the lack of recognition of the vulnerabilities of women detained in Yarl’s Wood, there was also a finding that the quality of rule 35 reports was poor. Was not the refusal to admit Ms Manjoo not only a kick in the teeth for the UN, violating the terms of its mandate, but an unfortunate indication that those concerns had not been addressed, as the special rapporteur seems to have suspected?
Lord Taylor of Holbeach: No, my Lords, that is not the case. Yarl’s Wood was inspected by Her Majesty’s Chief Inspector of Prisons last year and, overall, the report was positive. I mentioned those aspects of which I felt it was important for the House to be aware. Detention is an essential part of effective immigration control and we take the welfare of those in our care very seriously. Her Majesty’s Chief Inspector of Prisons has responsibility for ensuring that those standards are maintained.
Baroness Scotland of Asthal (Lab): My Lords, does the noble Lord not appreciate that Yarl’s Wood has caused a lot of concern not only in this country but internationally, and that a failure to allow the UN special rapporteur to enter causes even more alarm, although I accept absolutely what he says about detention being necessary in some cases?
Lord Taylor of Holbeach: I have explained to noble Lords and, I hope, to the noble Lord, Lord Ramsbotham, in responding to his Question, the reasons why we felt
that it was more appropriate to give the rapporteur the opportunity to see the effective measures that the Government are taking to address violence against women and girls.
Baroness Symons of Vernham Dean (Lab): My Lords, the noble Lord has been very good in explaining the meetings that the special rapporteur had and sought to say that he thought those meetings were sufficient. However, he has absolutely failed to explain to the House why the special rapporteur was denied access to Yarl’s Wood. It is a very simple question, not about the meetings that she had but why, specifically, she could not go to Yarl’s Wood.
Lord Taylor of Holbeach: Access to Yarl’s Wood is in the gift of the Home Office, which determines whether it is suitable for people to visit it. Her Majesty’s Chief Inspector of Prisons has a statutory role to address that issue. It was not a question of denying this person the opportunity to do her job. She was given every chance to take up our offers to visit refuges, but she did not choose to do so.
Lord Roberts of Llandudno (LD): My Lords, what statement did the Chief Inspector of Prisons make following the refusal to allow the rapporteur to enter Yarl’s Wood?
Lord Taylor of Holbeach: I am afraid that I cannot comment on that as I do not have the details of that question.
House of Lords Reform (No. 2) Bill
Order of Commitment Discharged
3.08 pm
Moved by Lord Steel of Aikwood
That the order of commitment be discharged.
Lord Steel of Aikwood (LD): My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Immigration Bill
Third Reading
3.09 pm
Clause 1: Removal of persons unlawfully in the United Kingdom
The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach) (Con): My Lords, I said on Report that I would table further amendments regarding the power to make regulations about the removal of family members.
In its 24th report the Delegated Powers and Regulatory Reform Committee remained concerned that the scope of the delegated power was still too broad and, as it currently stands, should be subject to the affirmative procedure. In seeking to address this concern, the amendment removes reference to making further provision for the removal of family members under any provision of the immigration Acts and limits the scope of the regulations so that they can not extend beyond the two provisions described, namely the time period for removal and the service of the notice to family members.
I hope that this reassures noble Lords that this limits the regulations strictly to procedural matters that should be subject to the negative resolution procedure. I therefore beg to move.
Clause 15: Right of appeal to First-tier Tribunal
The Advocate-General for Scotland (Lord Wallace of Tankerness) (LD): My Lords, Amendment 2 is to Clause 15(5), which provides that the tribunal may not hear a new matter unless the Secretary of State consents to its doing so. There was a debate on that provision on Report, and I am grateful to those noble Lords and noble and learned Lords who have had an opportunity since then to follow that up and to have a better understanding of the concerns which prompted the tabling of that amendment. Since the Government tabled this amendment a number of points have been raised by my noble friend Lady Hamwee and the noble and learned Lord, Lord Hope of Craighead. I hope that I can address those points in speaking to this amendment.
Our discussions were helpful and not least identified that the definition of a “new matter” is wider than necessary because it includes reasons for wishing to remain in the United Kingdom which, if refused, would not give rise to a right of appeal. This potentially extends the scope of the power to give consent beyond appealable matters. As the significance of “new matter” is restricted to circumstances in which an appeal would arise as a consequence of the decision, the definition should be similarly restricted—hence this amendment.
My noble friend Lady Hamwee has asked why the amendment does not address the substance of the arguments made on Report. The Government remain committed to the important principle that the Secretary of State should be the primary decision-maker. An amendment that provided for the tribunal to have discretion as to whether it should hear a new matter would undermine that principle. It could also create a substantial risk of satellite litigation about the circumstances in which that discretion should be exercised.
We have heard examples, particularly on Report, where it was suggested that it would not be right for the tribunal to be prohibited from hearing a new matter. It is our intention that the Home Office will
publish detailed guidance on when consent should be given. I can assure your Lordships that the examples given—such as when the illness of the appellant makes determination of the appeal urgent, or where inadequate legal representation has meant that the new matter could not have been raised earlier—are the types of circumstance in which that guidance will direct presenting officers to give substantial weight when considering the issue of consent.
In certain circumstances, however, the Secretary of State’s consideration of a new matter is fundamental to that matter being correctly decided, including by the tribunal. For example, where the new matter is an asylum claim it is only the Secretary of State who, having taken fingerprints from the individual, can verify that the claim has not been made previously in the United Kingdom or another EU member state. It is in those cases that consent for the tribunal to hear the new matter may be refused. However, even in such cases, whether to grant consent will also be informed by the individual’s circumstances.
The noble and learned Lord, Lord Hope of Craighead, asked whether guidance would be provided for the situation where the presenting officer is unable to take instructions on whether to grant consent. I assure the noble and learned Lord that the guidance will provide for this situation. I can also elaborate on the details, which I hope will provide further reassurance.
3.15 pm
In this context, it is important to note that at the tribunal the Secretary of State is generally represented by a presenting officer rather than by counsel, it being a First-tier Tribunal. From reviewing the file, a presenting officer can establish whether a new matter has been raised. If, having considered the guidance, the presenting officer takes the view that consent should be granted for the tribunal to hear the new matter, instructions do not need to be taken in order for that decision to be made. It is therefore only where the presenting officer, having considered the guidance, takes the view that consent should not be granted that instructions need to be taken. I believe it is highly unlikely that a presenting officer would be unable to take such instructions. There is an established process by which senior caseworkers in each presenting officer’s unit work on a rota system to provide instructions to presenting officers. If a presenting officer is unable to contact the senior caseworker in his or her unit, he or she can contact a senior caseworker in another unit. This system has, we believe, operated effectively for a number of years.
My noble friend Lady Hamwee asked for further detail about the guidance that I have referred to. This will be published guidance to presenting officers who appear for the Secretary of State before the tribunal. We do not propose to consult on the contents of this guidance, which will be to Home Office staff on the exercise of this power. However, it is important to note that if the guidance is not followed and there is no sound basis for departing from it, judicial review of any such decision may well be sought.
The guidance will set out the factors to be considered in each case when the presenting officer who has conduct of the case at the appeals stage decides whether
to grant consent for the tribunal to hear a new matter. It will also set out the process to be followed in each case, including consultation with the original decision-maker where appropriate.
It was useful to have our discussions and I hope that I have clarified the position and have given appropriate reassurance to your Lordships’ House. I beg to move.
Lord Hope of Craighead (CB): My Lords, I express my gratitude to the Minister both for his amendment and for the clarifications that he has given on the guidance that will be given to tribunals. I am sure that the amendment helps to remove an element of doubt about the scope of the words “new matter”. It became clear as we discussed the matter following the debate on Report that some change was needed, and I am extremely grateful to the Minister for his willingness to listen to us and to deal with that point.
As for the guidance, I gave rather short notice of the point that the Minister has dealt with but he has dealt with it to my satisfaction. Again, I am very grateful to him for his willingness to meet us to discuss these rather tricky matters.
Baroness Berridge (Con): My Lords, first, my apologies for missing the first two sentences of the debate on this amendment. I left 1 Millbank over the road as soon as debate on the Bill started but I am not as nimble as I thought and I make my apologies to the House.
I, too, am grateful to the Minister for his reflection on this matter since Report and for the amendment that the Government have laid. I join the noble and learned Lord, Lord Hope, in thanking him for the meeting that was arranged at short notice prior to the Recess. I, too, am grateful that the amendment narrows the definition of what the tribunal should consider to be a new matter and that what is or is not a new matter will be for the tribunal to determine according to the legislation. The narrowing of the definition is most welcome as, once the matter is determined to be a new matter, the tribunal cannot hear it without the consent of the Home Secretary.
I am also grateful for the specific guidance outlining the circumstances in which the Home Secretary will consent to such a new matter being in front of a tribunal. I am grateful for my noble friend’s explanation of what will happen if very junior counsel are in front of a tribunal when a new matter is raised and unfortunately they cannot get instructions or the file containing the necessary information.
Everything in the Government’s amendment is welcome as far as it goes but I do not think that it will come as any surprise to the Minister that I remain disappointed that the Government have not laid an amendment giving the tribunal an exceptional discretion to hear a new matter if the demands of justice require it. Justice is of course the overriding purpose of our courts and tribunals, and ordinarily the Secretary of State should be the primary decision-maker on a new matter but not if justice demands otherwise.
On Report, the constitution arguments were ably outlined by the noble and learned Lords, Lord Hope, Lord Woolf and Lord Brown. This is the first time that a party to any proceedings will have this kind of control over jurisdiction and I shall be interested to
know—as I am sure all noble Lords will be—how it works out in practice. I would be grateful if the Minister could indicate whether, if this new power results in judicial review cases, there will be a way of keeping a record of the judicial review decisions in relation to the guidance and to consent being refused. Will those figures be available some time after the Bill is passed for the purposes of post-legislative scrutiny?
Lord Avebury (LD): My Lords, the Immigration Law Practitioners’ Association has pointed out that this is a meaningless amendment because a tribunal would not be able to consider a matter that was not within its jurisdiction in any case. It is disappointing that the Government have not noticeably reflected, as my noble and learned friend assured me they would, on the alternative suggestions made by my noble friend Lady Berridge, on this clause, and supported by several noble and learned Lords, to give effect to the recommendations of the Joint Committee on Human Rights in its eighth report. Your Lordships were almost unanimous in condemning a proposal to allow one of the parties to an appeal to instruct the tribunal on what matters it can or cannot consider.
My noble and learned friend the Minister did not challenge the assertion that the tribunal had not allowed abuse of its own process in the past or had treated the Secretary of State unfairly, or that the existing process was inefficient. There was no suggestion on Report that the Government had raised any concern in the past over this alleged problem, but if we concede that there might have been cases in which a new matter—which is only to be defined in guidance, as we heard—was raised, that still does not mean that your Lordships should agree to grant this sweeping power to allow the respondent to veto the consideration of the new matter, even when the reason for its last minute appearance was the difficulty in getting hold of the presenting officer, as in one of the cogent examples given by my noble friend in introducing her amendments. In such cases the presenting officer who may have been unable to get instructions from senior counsel overnight can ask for an adjournment. My noble and learned friend did not say that he knew of any instance when such a request had been refused.
My noble friend said that she thought satellite judicial review went against what the Government were seeking to achieve, but that would still be the only way of challenging a decision by the Secretary of State to prohibit the use of a proposed new matter, after the amendment that is now before us. I asked my noble and learned friend whether the Government had made any estimate of the number of judicial review cases likely to be heard as a result of this provision and what would be the estimated reduction in the savings expected from it. I received no answer. I certainly agree with the suggestion made by my noble friend just now that a record should be kept of such cases.
The main reason why the Government insist that the Secretary of State should have this power seems to be, as we have heard, that she is the primary decision-maker of right on these applications rather than the late arrival of new matters, some of which is due to the inaccessibility of the Home Office. Nobody argues with that in principle, although my noble friend
Lady Berridge pointed out that the Secretary of State had, in effect, voluntarily abdicated that role by allowing officials to make such a large number of wrongful decisions at first instance.
Even if that problem is solved, there remains a serious objection to what the Government propose. The fundamental principle of the rule of law is the right to a fair trial. In his wonderful book, The Rule of Law, the late noble and learned Lord Bingham emphasised that the right applies to,
“adjudicative procedures of a hybrid kind … proceedings in which one or more parties may suffer serious consequences if an adverse decision is made”.
He goes on to mention a recent case in the Supreme Court in Canada, where the Chief Justice, delivering the unanimous judgment of the court, said that,
“a fair hearing requires that the affected person be informed of the case against him … and be permitted to respond to that case. This right is well established in immigration law”.
Thus, if the applicant is denied the right to present what may be a crucial piece of evidence, he is denied the right to a fair trial. That right trumps the Secretary of State’s right to be the primary decider. This amendment, leaving Clause 15 effectively untouched, does not cover the mischief dealt with so effectively by my noble friend Lady Berridge.
Baroness Hamwee (LD): My Lords, my noble and learned friend responded extremely speedily to my bank holiday inquiry, and I am grateful to him for that. The points about whether consent should be required for the tribunal to consider a new matter have been covered quite thoroughly, but I would like to mention the question of guidance. I was curious that this is guidance, because it must be guidance by the Home Office, and therefore the Home Secretary, to the Home Secretary. I would have understood had it been called a code of practice. The title does not really matter: it is the content. I wonder whether there is any distinction between the two.
Having seen the letter to the noble Baroness of 29 April, it seems to me that the way the guidance is described comes quite close to the exercise of discretion. I am aware that I have not put a question mark at the end of any of that, but I felt that I wanted to make those points.
Lord Woolf (CB): My Lords, may I be forgiven if, despite my discourtesy in not being here earlier, I say a few words on this matter? It is very important, not only for the principles that noble Lords have clearly expressed already, but purely from a practical point. I urge the Government to think again about this, based on the experience of dealing with immigration cases for the majority of my career in the legal profession. The repeated use of the justice system to obtain delay was always a problem. I understand the motivation of the Government all too well, but that does not justify the departure from principle about which we have heard.
However, this is the point that I am most anxious to make. In reality, if the first tribunal before whom this matter is happening does not have the power to say what the procedure will be, that will create a lacuna
which will be exploited more and more frequently by those who realise that they just need to make a new point and the Government’s representative will have to ask for adjournments so that he or she can take instructions on what action to take. Not only is this wrong in principle, it will create an undesirable position. Although it is not intended, it will undermine the status of those who adjudicate on these matters. More and more immigration matters are now being dealt with outside the High Court, so we should not be undermining that status but supporting it.
I urge the Government to take this away again. I do not think that they have met either the problems of principle that were raised on the last occasion that this was discussed or, more importantly perhaps, the practicalities of sitting on a tribunal and having to deal with applications. As an adjudicator, if you are in doubt about the right course to take, of course you can always adjourn. Most legal systems are plagued by unnecessary adjournments. In my view, what the Government are creating here is unnecessary scope for adjournments. Even if there is just the ability to make applications—you can never stop them—they will result in adjournments, which I would have thought is the last thing the Home Office wants.
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Lord Wallace of Tankerness: My Lords, I thank all noble Lords who have contributed to this debate. I do not think I tried to oversell what the amendment will do because it is in many respects technical and addresses a problem that was identified as the result of an amendment moved on Report by my noble friend Lady Berridge. Even those noble Lords who have raised questions acknowledge the principle that the Home Secretary is the primary decision-maker; it is something that Parliament has agreed. What this subsection seeks to do is to accept that there will be circumstances where the consent of the Secretary of State is given for the tribunal to hear a new matter, albeit that the Secretary of State is the primary decision-maker. I am also sure that the guidance will reflect what the noble and learned Lord, Lord Woolf, has said. It will be based on the great experience garnered over the years on how these tribunals work, and the intention is to facilitate rather than to frustrate.
I would say to my noble friend Lord Avebury that, as I indicated in responding to the point raised by the noble and learned Lord, Lord Hope, if a presenting officer, having considered the guidance, takes the view that consent should be granted for the tribunal to hear the new matter, he or she does not need to take instructions in order for that decision to be made. It is only where the presenting officer, having considered the guidance, takes the view that the consent should not be granted that instructions would need to be taken. I discussed the position with officials before coming to your Lordships’ Chamber today, not least because the noble and learned Lord, Lord Hope, had raised it, and I have been assured that it is very unlikely indeed that a presenting officer would be unable to take instructions. I shy away from using the word “impossible” because you can bet your life that, if I say that, something will happen in the first week.
However, I am told that it is highly unlikely because an established process is in place by which the senior caseworkers in each presenting officer’s unit work on a rota system to provide these kinds of instructions to presenting officers. It is anticipated that there would be a very brief adjournment to allow the instruction to be taken.
My noble friend Lady Berridge asked about judicial review, a point that was echoed by my noble friend Lord Avebury. The Home Office keeps a record of the judicial reviews that are brought, and certainly it will continue to monitor closely the effectiveness of this new power. It is important to note that judicial review can be brought for a number of reasons, not just the ones that have been identified in this debate. The question I was asked was whether a record is kept, and the answer is yes. A record is kept which will help to inform a review of the effectiveness of this provision.
My noble friend Lady Hamwee is right inasmuch as this guidance is technically for the Home Secretary, but it is intended for the presenting officers who act on behalf of the Home Secretary. However, as I say, it will be published and so people will know what it contains. I also indicated to my noble friend when moving the amendment that, if the guidance is not followed and there is no sound basis for departing from it, I rather think that a judicial review may follow hot on the heels of any such decision. How the judicial review is determined is of course a matter for the courts, but the fact that it will be published should, I hope, provide some degree of certainty and consistency in how the Home Secretary exercises the consent provision set out in this subsection. I therefore commend the amendment to your Lordships.
3: Before Clause 66, insert the following new Clause—
“Persons unable to acquire citizenship: natural father not married to mother
After section 4D of the British Nationality Act 1981 insert—
For the purposes of sections 4F to 4I, a person (“P”) meets the general conditions if—
(a) P was born before 1 July 2006;
(b) at the time of P’s birth, P’s mother—
(i) was not married, or
(ii) was married to a person other than P’s natural father;
(c) no person is treated as the father of P under section 28 of the Human Fertilisation and Embryology Act 1990; and
(d) P has never been a British citizen.
4F Person unable to be registered under other provisions of this Act
(1) A person (“P”) is entitled to be registered as a British citizen on an application made under this section if—
(a) P meets the general conditions; and
(b) P would be entitled to be registered as a British citizen under—had P’s mother been married to P’s natural father at the time of P’s birth.
(i) section 1(3),
(ii) section 3(2),
(iii) section 3(5),
(iv) paragraph 4 of Schedule 2, or
(v) paragraph 5 of Schedule 2,
had P’s mother been married to P’s natural father at the time of P’s birth.
(2) In the following provisions of this section “relevant registration provision” means the provision under which P would be entitled to be registered as a British citizen (as mentioned in subsection (1)(b)).
(3) If the relevant registration provision is section 3(2), a person who is registered as a British citizen under this section is a British citizen by descent.
(4) If the relevant registration provision is section 3(5), the Secretary of State may, in the special circumstances of the particular case, waive the need for any or all of the parental consents to be given.
(5) For that purpose, the “parental consents” are—
(a) the consent of P’s natural father, and
(b) the consent of P’s mother,
insofar as they would be required by section 3(5)(c) (as read with section 3(6)(b)), had P’s mother been married to P’s natural father at the time of P’s birth.
4G Person unable to become citizen automatically after commencement
(1) A person (“P”) is entitled to be registered as a British citizen on an application made under this section if—
(a) P meets the general conditions; and
(b) at any time in the period after commencement, P would have automatically become a British citizen at birth by the operation of any provision of this Act or the British Nationality (Falkland Islands) Act 1983, had P’s mother been married to P’s natural father at the time of P’s birth.
(2) A person who is registered as a British citizen under this section is a British citizen by descent if the British citizenship which the person would have acquired at birth (as mentioned in subsection (1)(b)) would (by virtue of section 14) have been British citizenship by descent.
(3) If P is under the age of 18, no application may be made unless the consent of P’s natural father and mother to the registration has been signified in the prescribed manner.
(4) But if P’s natural father or mother has died on or before the date of the application, the reference in subsection (3) to P’s natural father and mother is to be read as a reference to either of them.
(5) The Secretary of State may, in the special circumstances of a particular case, waive the need for any or all of the consents required by subsection (3) (as read with subsection (4)) to be given.
(6) The reference in this section to the period after commencement does not include the time of commencement (and, accordingly, this section does not apply to any case in which a person was unable to become a British citizen at commencement).
4H Citizen of UK and colonies unable to become citizen at commencement
(1) A person (“P”) is entitled to be registered as a British citizen on an application made under this section if—
(a) P meets the general conditions;
(b) P was a citizen of the United Kingdom and Colonies immediately before commencement; and
(c) P would have automatically become a British citizen at commencement, by the operation of any provision of this Act, had P’s mother been married to P’s natural father at the time of P’s birth.
(2) A person who is registered as a British citizen under this section is a British citizen by descent if the British citizenship which the person would have acquired at commencement (as mentioned in subsection (1)(c)) would (by virtue of section 14) have been British citizenship by descent.
4I Other person unable to become citizen at commencement
(1) A person (“P”) is entitled to be registered as a British citizen on an application made under this section if—
(a) P meets the general conditions;
(b) P is either—
(i) an eligible former British national, or
(ii) an eligible non-British national; and
(c) had P’s mother been married to P’s natural father at the time of P’s birth, P—
(i) would have been a citizen of the United Kingdom and Colonies immediately before commencement, and
(ii) would have automatically become a British citizen at commencement by the operation of any provision of this Act.
(2) P is an “eligible former British national” if P was not a citizen of the United Kingdom and Colonies immediately before commencement and either—
(a) P ceased to be a British subject or a citizen of the United Kingdom and Colonies by virtue of the commencement of any independence legislation, but would not have done so had P’s mother been married to P’s natural father at the time of P’s birth, or
(b) P was a British subject who did not automatically become a citizen of the United Kingdom and Colonies at commencement of the British Nationality Act 1948 by the operation of any provision of it, but would have done so had P’s mother been married to P’s natural father at the time of P’s birth.
(3) P is an “eligible non-British national” if—
(a) P was never a British subject or citizen of the United Kingdom and Colonies; and
(b) had P’s mother been married to P’s natural father at the time of P’s birth, P would have automatically become a British subject or citizen of the United Kingdom and Colonies—
(i) at birth, or
(ii) by virtue of paragraph 3 of Schedule 3 to the British Nationality Act 1948 (child of male British subject to become citizen of the United Kingdom and Colonies if the father becomes such a citizen).
(4) A person who is registered as a British citizen under this section is a British citizen by descent if the British citizenship which the person would have acquired at commencement (as mentioned in subsection (1)(c)(ii)) would (by virtue of section 14) have been British citizenship by descent.
(5) In determining for the purposes of subsection 1(c)(i) whether P would have been a citizen of the United Kingdom and Colonies immediately before commencement, it must be assumed that P would not have—
(a) renounced or been deprived of any notional British nationality, or
(b) lost any notional British nationality by virtue of P acquiring the nationality of a country or territory outside the United Kingdom.
(6) A “notional British nationality” is—
(a) in a case where P is an eligible former British national, any status as a British subject or a citizen of the United Kingdom and Colonies which P would have held at any time after P’s nationality loss (had that loss not occurred and had P’s mother been married to P’s natural father at the time of P’s birth);
(b) in a case where P is an eligible non-British national—
(i) P’s status as a British subject or citizen of the United Kingdom and Colonies mentioned in subsection (3)(b), and
(ii) any other status as a British subject or citizen of the United Kingdom and Colonies which P would have held at any time afterwards (had P’s mother been married to P’s natural father at the time of P’s birth).
“British subject” has any meaning which it had for the purposes of the British Nationality and Status of Aliens Act 1914;
“independence legislation” means an Act of Parliament or any subordinate legislation (within the meaning of the Interpretation Act 1978) forming part of the law in the United Kingdom (whenever passed or made, and whether or not still in force)—
(a) providing for a country or territory to become independent from the United Kingdom, or
(b) dealing with nationality, or any other ancillary matters, in connection with a country or territory becoming independent from the United Kingdom;
“P’s nationality loss” means P’s—
(a) ceasing to be a British subject or citizen of the United Kingdom and Colonies (as mentioned in subsection (2)(a)), or
(b) not becoming a citizen of the United Kingdom and Colonies (as mentioned in subsection (2)(b)).
4J Sections 4E to 4I: supplementary provision
(1) In sections 4E to 4I and this section, a person’s “natural father” is a person who satisfies the requirements as to proof of paternity that are prescribed in regulations under section 50(9B).
(2) The power under section 50(9B) to make different provision for different circumstances includes power to make provision for the purposes of any provision of sections 4E to 4I which is different from other provision made under section 50(9B).
(3) The following provisions apply for the purposes of sections 4E to 4I.
(4) A reference to a person automatically becoming a British citizen, or a citizen of the United Kingdom and Colonies, is a reference to the person becoming such a citizen without the need for—
(a) the person to be registered as such a citizen by the Secretary of State or any other minister of the Crown;
(b) the birth of the person to be registered by a diplomatic or consular representative of the United Kingdom; or
(c) the person to be naturalised as such a citizen.
(5) If the mother of a person could not actually have been married to the person’s natural father at the time of the person’s birth (for whatever reason), that fact does not prevent an assumption being made that the couple were married at the time of the birth.””
Lord Avebury: My Lords, the rationale behind this amendment, to put it as simply as possible, is to enable a child born before 1 July 2006 to a mother who is not married to the natural father to become a British citizen automatically, or to have an entitlement to be registered as a British citizen in circumstances where the child would have had either of those rights if the parents had been married.
I am grateful to the Minister for accepting in principle the amendment that I moved for this purpose in Committee and for deploying the formidable resources of the Bill team to turning the inadequate wording of my original attempt into the text now before your Lordships in Amendments 3 and 5, as well as for the useful exchanges that I had with the Minister and the Bill team during that process.
The reason for the cut-off date is that, after that, a child born to parents who were not married is already covered by the definition of “father” in Section 50(9A)
of the British Nationality Act 1981—the BNA. These amendments will now cover the child born before 1 July 2006 whose mother never married the father or who was married to someone else at the time of the child’s birth. This reflects the way the Home Secretary has previously exercised discretion under the Act and will continue to do so for children born post-2006 where the mother’s husband is not the child’s natural father.
Proposed new Section 4F deals with persons who would currently have had an entitlement to register as British citizens under the specified sections of the BNA if their parents had been married. Currently, these persons can be registered at the discretion of the Home Secretary under Section 3(1) of the BNA, but Section 4F gives them an entitlement. If a person would be entitled to registration under Section 3(2) only, had their parents been married, registration under Section 4F gives them citizenship “by descent”—the status they would have acquired if their parents had been married. Section 14 of the BNA needs to be amended to secure this outcome, and this is accomplished by Amendment 5.
If a person would be entitled to registration under Section 3(5), had their parents been married, there is an additional discretion to waive parental consent. For the other specified subsections of the BNA in Section 4F, consent is required from both the mother and the “natural father”—the person who satisfies the proof of paternity regulations made under Section 50(9B) of the BNA.
Proposed new Section 4G covers those born after 1 January 1983 and before 1 July 2006 who would have become British citizens automatically if their parents had been married. The main beneficiaries of this section will be persons born in the UK to a British or settled parent who would have become British citizens under Section 1(1) or 1(1A) if their parents had been married and persons born abroad to a British parent who would have become British citizens under Section 2(1) if their parents had been married.
Proposed new Section 4H covers persons who were citizens of the UK and colonies immediately before 2 January 1983 but did not become British citizens because their parents were not married. This will benefit those who acquired citizenship through birth in a British colony and still had that status on 31 December 1982—for example, a person with a UK-born natural father who was born in a current overseas territory or was born in a former colony and did not acquire citizenship of that country when it became independent. Here again it is necessary to place these persons in the category “by descent” or “otherwise than by descent” to correspond with the status they would have had if their parents had been married. The distinction between these two categories occupies 26 pages of Fransman’s magisterial tome on British nationality law, so I hope your Lordships will be content with that reference.
Proposed new Section 4I benefits people who would have acquired British citizenship in three situations: first, if they were British subjects or citizens of the UK and colonies by birth in a former colony and would not have lost that status when that country became independent if their parents had been married; secondly,
if they were British subjects before 1 January 1949 and would have become a CUKC on that date if their parents had been married; and thirdly, if they did not acquire the status of British subject or citizen of the UK and colonies but would have done so if their parents had been married. This will also benefit those who would have acquired citizenship under Section 5(1)(a), (c) or (d) of the British Nationality Act 1948. I am sorry to say that that will not apply to those whose parents had the right to register their births at a British consulate under Section 5(1)(d) while they were minors but omitted to do so. That reflects existing law for persons whose parents were married, and the rights of both groups will have to wait for a future opportunity.
Proposed new Section 4J defines a person’s “natural father”. It is interesting to recall that when the BNA was originally going through another place in 1981, the Minister—now the noble Lord, Lord Luce—said that citizenship could not be extended to illegitimate children because,
“the problem of identifying the father in such cases remains insurmountable”.—[
Official Report
, Commons, Standing Committee F, 17/3/81; col. 623.]
Watson and Crick had received the Nobel Prize for determining the structure of DNA 19 years earlier but the practical applications of their discovery were still a long way in the future. The power in proposed new Section 4J(2) is a broad one but this reflects the power to make different provisions for different circumstances that already exists in Section 50(9B) of the BNA. The provision is intended to benefit potential applicants and ensures that regulations for establishing the proof of paternity can be adapted if circumstances change; for example, following scientific advances.
It has not been possible to deal with the British Overseas Territories in these amendments because of course they would have to be consulted about any proposed amendments to the Act dealing with the forms of citizenship connected with those territories, as we have acknowledged. I would be grateful if my noble friend the Minister could assure me that the Government will launch such a consultation, preferably in the next Session of Parliament, so that, having done so, next time we have an immigration Bill we can deal with the limited number of stateless persons left with only BOTC status. At the same time this will enable us to annul some of the reservations we have put to our accession to the convention on the elimination of discrimination against women.
At Third Reading of the then Nationality, Immigration and Asylum Bill, the then Minister, the noble Lord, Lord Filkin, said:
“One can only go so far back in seeking to right the wrongs of history and of previous generations”.—[Official Report, 31/10/02; col. 298.]
My noble friend the Minister echoed this on the last day of Report. In the thickets and undergrowth of immigration law, there are still plenty of wrongs of history waiting to be rectified, but at least if your Lordships agree to these amendments they will remove most of the discrimination against people whose parents were not married that has infected our immigration law in the past. I beg to move.
Baroness Smith of Basildon: My Lords, I am grateful to the noble Lord, Lord Avebury, for his explanation of his amendment. Immigration law is far more complicated than most people realise and he did a great service to the House in explaining his amendment, which of course we welcome and support.
Turning to Amendment 6 concerning the Long Title of the Bill, which the Government have amended, I share with your Lordships my confusion and hope that the Minister can give some clarification. I am grateful to the Minister for meeting me last week to discuss this and other issues. He gave me a letter explaining the amendments before us today, which was very helpful. But he also said about what was then Amendment 4 and is now Amendment 6 that,
“an amendment to the Long Title is necessary to ensure that it covers nationality matters”.
He then referred to the amendment moved by the noble Lord, Lord Avebury,
“with a view to appropriate amendments on the issue at Third Reading to create a new registration provision for persons born before 1 July 2006”.
However, he did not say that that was not the only amendment being made to the Long Title, because the amendment as printed—although not referred to in his letter—says that it also makes,
“provision about the removal of citizenship from persons whose conduct is seriously prejudicial to the United Kingdom’s vital interests”.
Yet when we debated that issue here in your Lordships’ House at both Committee and Report stages—they were very good and lengthy debates, unlike those which took place in the other place, which were rather cursory—it was decided, despite the length of the debate and the complexity of the issue, that an amendment to the Bill would be made removing the Government’s clause and inserting a new clause saying in effect that this was a complex matter which should go to a committee of both Houses. That amendment, in the name of the noble Lord, Lord Pannick, was passed by a majority of 62. Although that issue is not in the Bill, it is now in the Long Title.
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The other amendment to be passed on Report was that in the name of the noble and learned Baroness, Lady Butler-Sloss, on child trafficking and guardians for those children who are trafficked. Your Lordships’ House voted by a majority of 98 in favour of an amendment which would provide guardians for such trafficked children, yet that is not proposed to be in the Long Title. We therefore have the slightly curious position where something that was taken out of the Bill is now being inserted by the Government in the Long Title—although it is no longer in the Bill other than in the form of referral to a committee for further and proper examination—yet something that was inserted in the Bill is not referred to in the Long Title. Although I am sure that it is not the case, it would be outstandingly arrogant of the Government if they were to say, “Well, we know what is going to happen in the other place; we know what is going to happen later, so we will prepare for then”, whereas my understanding is that the Long Title should reflect the Bill as it leaves your Lordships’ House.
I wonder whether, in that, the Minister is trying to give us a clue as to what the Government’s intentions are when the Bill leaves this House today and goes to the other place for consideration of the amendments that we have proposed. If he is able to comment on why something that is not now in the Bill is in the Long Title, while something that is in the Bill is not in the Long Title, that would be very helpful, because the issue of deprivation of citizenship was removed from the Bill yet that of guardians for trafficked children was inserted. Can the Minister shine any light on that and say whether further amendments are expected and how the Government intend to consider further the amendments already passed in your Lordships’ House? If so, it would be a helpful contribution to this debate.
Lord Taylor of Holbeach: My Lords, perhaps I may begin by taking this opportunity to thank my noble friend for tabling these amendments, which he will know we welcome. The House will recognise that nationality law is a complex and difficult area. Anomalies do arise, and have indeed done so, particularly as the way in which people view the family has changed since the British Nationality Act was introduced in 1981.
In 2006, amendments to that Act enabled illegitimate children to inherit nationality from a British father in the same way as a legitimate child. However, those amendments were not made retrospective. To have done so could have caused problems for individuals who were now adults and had made a life for themselves in a different nationality.
The amendments proposed by my noble friend today will enable illegitimate children born to British fathers before 2006 to register as British if they choose to do so. The measures apply to those who would have become British citizens automatically if they had been born legitimately. I realise that my noble friend is concerned also about the situation of those who could have become British if their unmarried parents had been able to register them as British, or in some circumstances if they had been able to register the birth with the consular service. However, the Government’s position—indeed, my noble friend restated it in his introduction—remains that we can go only so far to right the wrongs of history. There can be many reasons why parents may not choose to exercise these options and we cannot, therefore, now make assumptions about whether unmarried parents would have chosen to exercise them if they had had the opportunity to do so.
I know that my noble friend is also concerned about British Overseas Territories citizens. Changes to those provisions require consultation with the territories concerned and this has not been possible in the time available. However, I assure my noble friend that the Government will look for suitable opportunities to discuss this issue with the overseas territories once the provisions are implemented.
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Perhaps I might now turn to the change to the Long Title of the Bill, under Amendment 6. Looking at the Bill, we still have deprivation as an issue under Clause 66. It is covered by that clause and it is quite proper that it
should therefore be part and parcel of the Bill, but I will not suggest for one moment, while speaking at the Dispatch Box here today, what may be considered by the House of Commons when it takes on the amendments that we have made to the Bill. We have made a number of amendments and, as the noble Baroness will know, it is quite in order for the House of Commons to consider them and let us know what it thinks of the amendments that we have made.
Baroness Smith of Basildon: I am sure that, as a former Member of the other place, I was not suggesting for one second that it does not have the right to look at our amendments and come to its own decisions. This is about the contrast between the two issues. While I am happy to accept the explanation that deprivation will be considered further by a Joint Committee of both Houses once the Bill leaves your Lordships’ House, that contrasts with the issues of the trafficking of children and guardians for trafficked children. That provision was passed by your Lordships’ House and does not now appear in the Long Title, even though it has been amended to deal with something that is not in the Bill in the same way. It is just that contradiction between the two and I would hope that the Minister can reassure me that, since this House has committed to the guardians for trafficked children, the Government will also remain so and are not taking for granted the support from the other place on the issue of deprivation of citizenship and making people stateless.
Lord Taylor of Holbeach: It would not be in my nature to take anything for granted where Parliament is involved. However, I think I made the position of the Government quite clear on guardians for trafficking when the amendment was considered, and the noble Baroness herself has been well aware of that. I hope she will accept what I am saying. It will be a matter of our listening to the House of Commons, as we must now call the other place, and giving it an opportunity to present to us what it considers of our amendments. That is a reasonable position to take. Meanwhile, this change to the Long Title facilitates the adoption of my noble friend’s amendments, which I hope the House will support because they will be welcomed by many and assist individuals hitherto precluded from British citizenship by historical anomaly. They will therefore be able to register as British citizens if they wish to do so. I am extremely happy to be able to offer my support to my noble friend in this matter.
Lord Avebury: I am extraordinarily grateful to the Minister for his kind remarks and for his undertaking to take an opportunity, I hope in the near future, to raise the question of overseas territories and how their position can be brought into line with what we are now about to agree, as far as our own citizenship is concerned.
We have whittled away at the wrongs of history in 2002 and 2006, and now again in 2014. It is not beyond the bounds of possibility that on a future occasion we will be able to rectify some of the remaining difficulties that affect our nationality law, particularly the wrong that I think we did to people whose parents did not register them when they were minors. It would have been right, not just in the case of the illegitimate
but also for those who were born to married parents, to allow those individuals when they became adults to exercise the rights that their parents had not exercised on their behalf.
However, that is only a very minor niggle compared with my pleasure at being able to move an amendment that grants citizenship to people who are illegitimate in circumstances where, if their parents have been married, they would have had it long ago.
Clause 74: Orders and regulations
4: Clause 74, page 59, line 27, leave out “or an order under section 43;” and insert—
“( ) an order under section 43, or under a section amended by such an order;”
Lord Taylor of Holbeach: My Lords, Amendment 4 is a technical amendment concerned with bank account measures. It is intended to ensure that, should any of Clauses 40, 41 or 42 be amended by the Treasury using the power provided in Clause 43 in such a way that further matters may be specified by order under any of those provisions, then any orders so made will be subject to the affirmative resolution procedure.
Clause 43 currently gives the Treasury the power to amend any of Clauses 40, 41 and 42 to allow it to ensure that the restriction on opening accounts remains effectively targeted. This power allows the Treasury to amend those provisions in such a way that a particular matter could be specified in a further order, should that be considered appropriate. To give an example, Clause 42 could be amended so that the reference to “bank” means a reference to an institution of a type to be specified in a further order made by the Treasury.
In that example, though, any subsequent order that specified the types of institution would then properly be made under the amended Clause 42, rather than by Clause 43. Any order made under Clause 43 that amends any of Clauses 40, 41 or 42 is already subject to the affirmative resolution procedure. However, orders subsequently made under Clauses 40, 41 or 42 are not referred to in Clause 74(2) of the Bill, which means that without this amendment they would be subject to the negative rather than the affirmative procedure. Given the importance of the matters involved, the Government’s intention is that any such order should be subject to the affirmative resolution procedure, and the amendment confirms that the affirmative procedure should therefore apply. I beg to move.
Schedule 9: Transitional and consequential provision
British Nationality Act 1981
1 (1) The British Nationality Act 1981 is amended as follows.
(2) In section 14 (meaning of “British citizen “by descent””), in subsection (1), after paragraph (d) insert—
“(da) the person is a British citizen by descent by virtue of section 4F(3), 4G(2), 4H(2) or 4I(4); or”.
(3) In section 41A (registration: requirement to be of good character), in subsection (1), after “5,” insert “4F, 4G, 4H, 4I”.
British Nationality (General) Regulations 2003
2 (1) In regulation 14 of the British Nationality (General) Regulations 2003—
(a) after “4D(3)” insert “or 4G(3)”;
(b) after “section 4D” insert “or 4G”.
(2) The provision inserted into regulation 14 by this paragraph may be amended or revoked by the exercise of the powers conferred by section 41 of the British Nationality Act 1981 as if that provision had been inserted by those powers.”
4 pm
6:In the Title, line 4, after “nationals;” insert “to make provision about the acquisition of citizenship by persons unable to acquire it because their fathers and mothers were not married to each other and provision about the removal of citizenship from persons whose conduct is seriously prejudicial to the United Kingdom’s vital interests;”
Lord Taylor of Holbeach: My Lords, I will be moving this amendment formally at the conclusion of what I believe is now the practice of the House to thank the House and Members of the Bill team at this stage of the proceedings. I should like to do so because this has been an extremely interesting Bill. I have enjoyed myself in taking it through and have enjoyed the House’s engagement with the issues that have been presented. Even this afternoon, although we have been dealing with clearing-up matters, we have had the opportunity to listen to the power of argument of noble and learned Lords, my noble friends and the noble Baroness, Lady Smith of Basildon.
A lot of people have been involved. I thank in particular my noble and learned friend Lord Wallace of Tankerness and my Whips, my noble friends Lord Attlee and Lord Ahmad. They have been great stalwarts during the period in which we have been taking this Bill through. I thank the noble Baroness, Lady Smith of Basildon, and the noble Lord, Lord Rosser, who have been extremely courteous to me throughout the proceedings. We have had the opportunity of a number of meetings that have helped the passage of the Bill through the House and have improved it. I particularly thank my noble friend Lady Hamwee, as a coalition partner, the noble Lord, Lord Avebury, and a number of other noble Lords from the Lib Dem Benches who have provided penetrating observations on the Bill, from which we have all been able to benefit.
A lot of other government departments have been involved in the Bill. I hope noble Lords will realise that it is not just the Home Office but the Government who have brought forward the Bill. I am sure that noble Lords will recognise the way in which my noble friend
Lord Howe has worked to establish the health provisions in the Bill in the context of health reforms generally. It was a great advantage to us all to have the opportunity of a joint meeting with him.
Although they are not in their places, I thank the noble Lords, Lord Hannay and Lord Best, for making it possible to find ways of dealing with the issues concerning students and landlords, which were causing a great deal of anxiety when the Bill appeared before the House at Second Reading.
There are too many noble Lords to mention by name. I shall just say to all those who have been involved in this Bill that I hope they will look back on it with pleasure and know that they have been party to a Bill dealing with an important matter in a proper way.
We are all grateful to our friends in the Box and the many elsewhere who have been briefing us. We have been very demanding. The House has been extraordinarily demanding of their time. That is quite proper, and they would not wish it to be any other way. They have responded as we have asked. It reflects great credit on the skills and abilities of those who lie behind Ministers at the Dispatch Box that they have been able to satisfy the House in the way that they have. With those words, I beg to move.
Baroness Smith of Basildon: I concur with the comments made by the Minister and respect those about this being a much improved Bill. That is accurate. We are pleased that the Bill has seen significant improvements, with amendments and concessions from the Government addressing issues raised by noble Lords. I was also pleased that he thanked the noble Earl, Lord Attlee, for his help and advice during the passage of the Bill.
I also thank the Minister. Where he has been unable to address issues from the Dispatch Box, he has been prepared to meet and discuss them, and to clarify those issues in writing. All noble Lords who have taken part in these debates have contributed to the improvement of the Bill, and we hope that some of those improvements will remain as debates continue. There are others that we would have liked to have seen and have not been able to achieve, but we still agree with the noble Lord that this is an improved Bill from that which presented itself to your Lordships’ House.
I add my thanks to colleagues, not only on the Labour Benches but across all Benches, who have put a lot of work into and contributed much to the Bill. I also thank the Bill team for its efforts and for being prepared to meet, and the Labour research team that helps us on our side of the House. It is no surprise that Sophie Davis, who has been advising the Labour Front Bench on this, was the Labour researcher of the year, which we all thought was very well deserved. We look forward to another Bill and another debate in the next Session.
Baroness Hamwee: My Lords, with the leave of the House—I know that it is unusual to speak at this stage—I promised my noble friends that I would say something at the appropriate point. It will have been an open secret to your Lordships that a number of us on the Liberal Democrat Benches have found these issues particularly difficult. The negotiations within our little group were sometimes quite difficult, because these are difficult issues.
I am sure that in the next Session we will tax my noble friend the Minister with matters that are mostly outside the scope of the Bill but which some of my noble friends showed considerable ingenuity in raising. I thank the Minister personally for his generosity, including extraordinary generosity with his time and his patience.
Bill passed and returned to the Commons with amendments.
Pfizer and AstraZeneca
Statement
4.06 pm
Lord Popat (Con): My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer given by my right honourable friend the Secretary of State for Business, Innovation and Skills to an Urgent Question in another place on the Pfizer bid for AstraZeneca. The Statement is as follows.
“The life sciences industry is of paramount importance to the UK as part of the Government’s industrial strategy, which is securing a long-term plan for key sectors where we are global leaders. We are committed to ensuring that we continue to be at the forefront of life sciences research and development, with high-quality jobs, manufacturing and decision-making in the UK.
There has been a lot of comment and debate in the press recently on this important issue, although I should stress that there has not been a formal bid from Pfizer to take over AstraZeneca. The Government must and are approaching it from the position of even-handed neutrality and recognise that this is ultimately a matter for the shareholders of both companies. But I can assure the House that my colleagues across the Government and I engaged early with both companies to ensure the outcome is positive for the long-term future of this sector in the UK, precisely to avoid previous Governments’ failure in this type of situation.
The Opposition call for changes to the law, but we are operating within the framework that they introduced in 2002. They removed Ministers from making decisions about mergers apart from in a few specified public interest areas. I notice that they chose not to reform the regime in response to the Cadbury/Kraft merger.
One of our options as the Government would be to consider using our public interest test powers. This would be a serious step and not one that should be taken lightly. We are open-minded about it, but we should stress that we are operating within serious European legal constraints. I can, however, assure the House that we are very alive to the national interest considerations here. We see the future of the UK as a knowledge economy, not as a tax haven. Our focus is
on what is best for the UK: securing great British science, research and manufacturing jobs and decision-making in the life sciences sector”.
4.09 pm
Lord Stevenson of Balmacara (Lab): My Lords, I thank the Minister for repeating the Statement made by his right honourable friend the Secretary of State in the other place.
The bid from Pfizer for AstraZeneca, like others before it in recent years, raises questions. We are a party of business. We believe in free trade and open markets. We also celebrate the extraordinary success of the UK over decades in attracting FDI and R&D. There is no doubt that the largest global companies see the UK both as a centre of excellence and as a gateway to European markets. However, we have to work hard to retain that position.
We have heard a lot from the Government over the past few years about the need to rebalance the economy. The recently published BIS industrial strategy suggests that pharmaceuticals, and life sciences more generally, is one of the sectors that could make the greatest contribution,
“to future growth and employment in the UK”.
Given that, and the need to ensure that we have sustainable clusters of industrial activity across the whole UK, we need to consider the proposed takeover very carefully. This company contributes more than 3% of our exports and provides more than 7,000 jobs directly around the country. Any takeover could have a big impact on employment in Cheshire, Macclesfield, Luton and Bristol, as well as in London. Many more small and medium-sized firms are part of their supply chain, and they, too, are at risk.
The issue is whether this transaction will be good for jobs and growth in the UK, whether it will protect Britain’s knowledge, research and skills base, and whether it represents a long-term investment in the UK. However, it is also a question of whether such key decisions can be left to shareholders and boards. With that in mind, perhaps I may ask the Minister the following questions. First, Pfizer has said it is committed to making a long-term investment in the UK through this purchase, but this is the same company that shut down its R&D facility at Sandwich in 2011. Why do the Government believe that the same fate will not befall AstraZeneca? Have they not learnt the lessons of the Kraft takeover of Cadbury Schweppes? What assurances will they obtain from Pfizer? Secondly, do the Government support the case for an immediate independent assessment of this deal and the impact it may have on our science base, as called for by the Leader of the Opposition? If not, why not?
4.11 pm
Lord Popat: My Lords, the good news is that this country is very attractive for inward investment from across the world. Long-term economic plans play a key role in making Britain the best place in the world for global companies to invest and create jobs. Therefore this approach by Pfizer, which will be one of the biggest investments in Britain in our history, is a vote
of confidence in our economy. However, as it is a vital part of the scientific research base and supports thousands of high-quality jobs, we will scrutinise any proposal extremely closely to ensure that it is in the UK’s best interest.
On the history of Pfizer in Kent, this is like any other large corporate company. We live in the age of the global economy, when large companies quite often take over our companies, and our companies do the same abroad. They tend to consolidate and try to remove duplication. What happened in Kent was regrettable. We lost 2,500 jobs. I am glad that the site has been regenerated. However, we are keeping a very close eye on the situation. A large number of Cabinet Ministers are involved in this proposal. There has not as yet been a formal approach for a takeover—it is just being discussed—but Cabinet members are involved, as are some civil servants, and the department is keeping a very close eye on this bid by Pfizer.
4.13 pm
Lord Fowler (Con): My Lords, it would be unwise for the Opposition to make a party issue of this. I will put a point to the Minister which I have not heard made before. It is said that the only people who have an interest in the outcome are the shareholders, but surely there is a wider public interest here. Does not the taxpayer, through the National Health Service, spend more than £12 billion a year on branded drugs? Is it, therefore, in the interests of the British taxpayer that there should be fewer but ever more powerful companies in this market?
Lord Popat: My Lords, AstraZeneca is a global company with activities around the world. It has a strong Anglo-Swedish heritage. It is not 100% British-owned, having a large number of shareholders right across the world. It is a business that brings expertise from both the UK and the US. It has a French CEO and a Swedish chairman. Yes, it supplies drugs to the NHS and makes a very good contribution in that respect, but I am sure that if the deal goes through we will watch very closely to make sure that we protect ourselves. It will go through the Competition Commission. The deal will also go through the European Commission to make sure that this takeover is in the best interests of this country, taxpayers and the public.
Lord Patel (CB): My Lords, the history of acquisitions in the pharma industry is that R&D facilities are shut down. AstraZeneca has developed a very strong collaborative culture with scientists, working particularly in the life sciences, in drug development. What effect will the merger have on our science base and the excellent facilities that AstraZeneca has for drug development?
Lord Popat: I agree with the noble Lord that AstraZeneca does some of the best research in this country. This is why it is in our interests to make sure that if the merger does take place, we will scrutinise everything that is being put forward by Pfizer to our
Government. As I said earlier, the NHS makes very good use of this company when it comes to research and development.
Lord Mitchell (Lab): My Lords, we cannot get away from the fact that Pfizer has form. It closed its successful R&D facility in Kent, as was mentioned; it bought and gutted three American competitor companies; and now it plans to set up a tax-inversion wheeze to buy a British gem. Does the Minister agree that this deal is not in the British interest, that it is not even in the American interest and that it is certainly not in the interests of one of our great science-based companies?
Lord Popat: My Lords, as a Government we have a role to play—but a very limited one—when it comes to takeovers and mergers. All takeovers and mergers depend on boards of directors and shareholders. Like all global pharmaceutical companies, Pfizer has faced challenges from many of its drugs going off-patent and having to replace them with new, innovative medicines. Both Pfizer and AstraZeneca have had to restructure major research projects around the world. That is a reality for some of these research and development companies.
Lord Stoneham of Droxford (LD): My Lords, it seems that without a formal bid it is important that the Government maintain their neutrality on the merits of any bid but that they still have a major interest in jobs and research. Have the Government researched whether the advantages of the so-called tax-inversion scheme could be obtained without Pfizer establishing their international corporate headquarters in the UK?
Lord Popat: I agree with the noble Lord; the Government are very neutral on this thing and there is no formal bid at this stage. If the merger or acquisition process continues, we will keep a close eye on the subject to make sure that Pfizer cannot come and invest in this country simply as a tax haven.
Lord Haskel (Lab): My Lords, the World Health Organisation advises that priority number 1 in public health is to develop new antibiotics, because germs are becoming resistant to old ones. The Government’s major responsibility is public health. In what way will this merger help public health in this country?
Lord Popat: My Lords, as I said earlier, as yet there is no formal bid for this merger. The relevant government department is looking into a number of things, including public health and the supply of medicines to the NHS by AstraZeneca. We will have to wait and see what developments take place over the next few weeks on this merger.
Baroness Neville-Rolfe (Con): My Lords, I was glad to hear the Minister say that the Government would do whatever was best in the UK public interest in this case. I was disappointed that the Cadbury merger was not fully scrutinised or blocked, and concerned about a succession of takeovers by utility companies, which ensured that they are now owned from Germany or France and that the UK interest is not always preserved. What powers do the Government or the EU have to
ensure adequate scrutiny of this important merger, and how will they ensure the observance of any promises on jobs or R&D?
Lord Popat: The noble Baroness makes a very important point. The law already backs boards that feel that a takeover would be against the long-term interests of their company. Directors must have regard to the likely long-term consequences of their decisions. With regard to foreign takeovers, the code was amended to make it explicit that directors are not required to consider the offer price as a determining factor when deciding whether to recommend a bid. They can take full account of the bidders’ plan which, since 2011, has also had to be set out in more detail.
Quite often takeovers or mergers are looked at on a case-by-case basis. Cadbury Schweppes was a classic example of a large takeover. Although there is a limitation on what the Government can do under present legislation, the party opposite, when it was in government, had the opportunity to make the necessary changes. It did not happen, and the Cadbury Schweppes takeover went very smoothly. We are very concerned to make sure that the interests of British research and development and British exports are taken into account if any such merger or takeover takes place.
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2014
Motion of Regret
4.21 pm
Moved by Lord Hunt of Kings Heath
That this House regrets that the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2014 create arrangements for the management of services for very rare conditions that are much more fragmented than those in place prior to the Health and Social Care Act 2012; and further regrets that the process by which services for rare and very rare conditions are considered by the Prescribed Specialised Services Advisory Groups and NHS England for commissioning nationally are unclear and lacking in openness and transparency. (SI 2014/452)
Lord Hunt of Kings Heath (Lab): My Lords, I am grateful to have the opportunity to debate services for very rare conditions. The House has long had an interest in those rare conditions and, indeed, in specialised services more generally. During our debates on the Health and Social Care Bill in 2012, we had extensive discussions about how to protect specialised services. Of course, the funding of those services is at the moment the subject of much debate because of the overspending under the auspices of NHS England. That clearly emphasises some of the problems arising because of the changes brought about by the Health and Social Care Act 2012.
Rare diseases are more of a feature of healthcare in the United Kingdom than many people think. Indeed, I understand that there are reckoned to be about 6,000 such diseases, and it is calculated that 6% of the population have such a rare disease, but each separate disease can affect fewer than 500 people. Those diseases can often involve some of the most vulnerable patients; given the small patient numbers and clinical complexity involved, it can be difficult to plan and manage. I understand that work has shown that four in 10 patients with a rare disease report difficulty in getting a correct diagnosis and then face similar challenges with obtaining suitable treatment.
Prior to the 2012 Act, these services were commissioned by a single national specialised commissioning team, subject to approval by Ministers on advice from the Advisory Group for National Specialised Services. That single commissioning team could draw on advice from the advisory group’s broad multidisciplinary membership to ensure high-quality service developing. The advisory group itself benefited from the bespoke ethical decision-making framework appropriate to considerations of products and services for such small patient populations.
Under the new system, responsibility for highly specialised services has been fragmented in a number of ways. Services are planned by an advisory group within NHS England called the rare diseases advisory group, while new highly specialist technologies are due to be developed and evaluated by NICE under a new methodology currently under development. Separately, the prescribed specialised services advisory group advises Ministers which services to instruct NHS England to commission, including new highly specialised services, such as in the statutory instrument that we debate this afternoon.
Apart from the complexity of these new arrangements, a number of problems have been identified by the Specialised Healthcare Alliance. First, the separation of these complex and interrelated functions between different national agencies risks the loss of efficiency and expertise in planning highly specialised services. As an example, links between NICE and NHS England would need to be extraordinarily close given that many highly specialised services are heavily dependent on high-cost, low-volume drugs.
Further, changes to the commissioning of these services present additional causes of concern. Rather than retaining a single national commissioning team to manage relationships with providers of highly specialised care across the country, delivery is now delegated, I understand, through NHS England’s four regional offices, with contracts held by the 10 area teams with responsibility for specialised commissioning which have providers on their patch. The alliance has expressed concern that cohesive oversight of these services is likely to be undermined in the process and may even introduce a greater degree of clinical risk. The efficiency of the arrangements, moving from one national to 15 different teams with a greater or lesser involvement, also seems highly debateable. As an example, where access to a service across the country is dependent on only three or four providers, problems at one will have an immediate consequence on the others as well as on patient referrals.
The prescribed specialised services advisory group advises Ministers on changes to the scope of specialised services to be prescribed in regulations for direct commissioning by NHS England. Under the terms of the 2012 Act, Ministers prescribe services for NHS England to commission directly, including specialised services, while all the other non-prescribed activity falls to clinical commissioning groups to commission for their local populations. In prescribing a service as specialised, four factors in the Health and Social Care Act 2012 are taken into account: the number of individuals who require provision of the service; the cost of providing the service or facility; the number of persons able to provide the service or facility; and the financial implications for clinical commissioning groups if they were required to commission the services or facility themselves. Ministers receive advice from the advisory group hosted within the Department of Health to inform such changes. However, this has not been at all transparent. Indeed, in its first year of operation, the advisory group was hidden from public view. It was not until 2 May 2014 that the first details of its membership, decision-making processes and recommendations were published. A few members of the alliance have campaigned to secure inclusion of their services as specialised services but were taken by surprise by the publication of this statutory instrument as they did not know that the advisory group had issued a recommendation to Ministers.
The noble Earl may have good news for us about the publication of a report on this matter either today or in the past few days. As it reached me by e-mail this morning, I have not had time to read it, and it is certainly not available in the Printed Paper Office. That is a pretty poor do if we were meant to have it in time for this debate. It is very important that this work is transparent. I hope the noble Earl can give us more assurance on that this afternoon.
Will the noble Earl respond to the evidence given by the NHS England chief executive to the Commons Select Committee on 29 April, in which Mr Simon Stevens suggested that the scope for specialised services had been overextended and needed to be reviewed? The noble Earl will know that the overspend by NHS England is causing great concern in the health service not only because it suggests that NHS England has lost control over the commissioning of specialised services but because the resources have had to be taken from other parts of the health service. Clearly, this position is not sustainable. I would be grateful if the noble Earl would respond to that question.
4.30 pm
I should also like to ask the noble Earl about access to medicines, a matter which is very relevant when it comes to the issue of rare diseases. Like the noble Earl, I am sure, I listened carefully to the previous debate on the proposed takeover of AstraZeneca. As he will know, one of the concerns about the relationship between UK pharma and the NHS is the slowness of the NHS in the widespread uptake of innovative new medicines. I know that the noble Earl, with his responsibilities in the department, has been anxious to see some change in the NHS regarding that issue.
Perhaps I may ask the noble Earl about the potential impact of the new PPRS agreement on the way that the Government negotiate with the pharma industry. The Department of Health and the ABPI have agreed a limit on growth in the overall cost of branded medicines. If expenditure goes over the overall cost and exceeds the permitted level, retrospective payments will be made quarterly to the Department of Health. In return, the pharma industry has been able to maintain flexibility in the pricing mechanism, which has always been one of the advantages that the industry has sought in the United Kingdom. We may not be very good at buying the industry’s new products, but pricing in the UK often sets a marker for the rest of the European market and has been one of the reasons why it has been prepared to invest so heavily in the United Kingdom.
The question that I want to put to the noble Earl is this. I do not know whether he knows the returns from the first quarter of the new scheme yet, but let us assume that the industry is to make regular payments back to the department. Has the department given any consideration to how that resource will be spent? Although I can appreciate that the department—or, indeed, the Treasury—might make first call on such payments, I also wonder whether the Government have considered using that resource to fund innovative medicines for rare diseases. That would create a fund with which the UK could invest in new medicines, particularly in the area of rare diseases, where funding has proven to be such a problem.
The way in which medicines for rare diseases are commissioned and provided in this country is important. Although it is fairly early days, there are some discouraging signs, and I am grateful for the opportunity to raise my concerns with the Minister this afternoon. I should have declared my interests as the chair of a foundation trust, a consultant and trainer with Cumberlege Connections, and president of GS1. I beg to move.
Baroness Brinton (LD): My Lords, the regulations, which address an important Cinderella service in the NHS that not many know about, are extremely important. I thank the Specialised Healthcare Alliance for its briefings, which have provided an extremely helpful background. I know that the noble Lord, Lord Hunt, has provided a couple of figures, but it might be worth pointing out that there is a clear distinction between “rare” and “very rare” diseases. It sounds silly to say, but those with very rare diseases would welcome having, for the one in 17 or fewer of the population who will be affected by a “rare” disease—that is the ratio—a reasonable coverage throughout the country, although it may be in specialised areas. However, “very rare” diseases may affect fewer than 500 patients in the UK and, in the case of one or two diseases, may affect perhaps only one or two patients.
With the implementation of the new clinical commissioning groups it has obviously been important to reassess how treatments for rare diseases are commissioned. I do not have to declare an interest because I do not have a rare disease but, as someone who has to access rare biological medicines, I know that my local CCG and many others are struggling with the whole issue of prescribing expensive drugs.
However, they cost pocket money when compared with the cost of medicines and treatments that we are looking for as regards rare and very rare diseases. The key is that one-size commissioning will absolutely not fit all, even within the definition of one rare disease, because it would be very unusual to find one clear clinical route. These days, the personalisation of drugs based on genes identification—80% of rare diseases have a genetic component—and the range of co-morbidities with most of these diseases mean that we absolutely must have clear and individualised treatment routes, with a much higher level of understanding of the diseases.
That is why I welcome the prescribed specialised services advisory group, which, for brevity, I shall refer to from now on as the PSSAG—I do not know what the Department of Health is calling it but we may as well add something else into the alphabet soup. It is important that the Secretary of State consults the PSSAG. The regret Motion was laid prior to the publication last week of the recommendation from that special advisory group. Inevitably, the timing is unfortunate, but life is like that. However, I believe that the publication of this report significantly reduces the concerns in the regret Motion about fragmentation and transparency. For example, the sections on membership and process on pages 7 and 8 of the report, some of which the noble Lord, Lord Hunt, referred to, make it very clear that both lay members and representatives from the royal colleges, as well as members with financial and technical expertise who can offer assistance, will come together to look at things. The noble Lord referred to what has to be reviewed but the other elements are equally important. The PSSAG must also consider how activity can be identified to enable separate contracting, monitoring and payment, which I think addresses the noble Lord’s point about what happens when things are devolved to a regional level. It also has to address the running costs associated with separate and direct commissioning, as well as consider defining elements of service to be commissioned. Therefore, I think that I am more reassured than the noble Lord, Lord Hunt.
It will be very important to monitor implementation, partly because, certainly in the early days, it will be difficult to budget for it, in part because of what I said about the personalisation of treatment routes and medication but also because, as we and the commissioners become much more familiar with the changes taking place in the treatments, particularly the gene therapy treatments, we may find that the costs of associated treatments are significantly reduced quite early on if the biologics and other superdrugs, as well as stem cell drugs, begin to work. Therefore, I would be grateful if the Minister could reassure the House about monitoring the situation once the PSSAG gets fully into its stride and commissioning starts to take place.
I have one area of concern, which is perhaps where more than one of the specialist groups that are going to be looking at treatment routes are involved in commissioning a patient’s treatment. Often two, three or possibly even four specialist groups are likely to be involved. In cystic fibrosis there would obviously be a principal neurological one but blood and kidney specialist groups might be involved as well. My fear is
that we may end up, as we have done in the NHS in the past, with the position where a patient in a hospital sees lots of different consultants but does not know who has overall responsibility for holding the ring. Is there an equivalent in this sector to make sure that one group has a specific responsibility, partly so that clinicians and therefore their patients are not passed from pillar to post among these different specialist advisory groups?
Lord Walton of Detchant (CB): My Lords, I am grateful to the noble Lord, Lord Hunt, for raising this crucial matter. This issue of rare diseases is of increasing importance with the developments in knowledge and in new forms of treatment that are beginning to emerge. For many years in the NHS, doctors and scientists recognised that there were a good many rare diseases, but those received comparatively little attention save for supportive treatment because no effective drugs were available that were curative or that would at least alleviate significantly the effects of such diseases.
Of course, one has to recognise that many rare diseases still exist in medicine but every single disease, even if it is incurable, can have its effects modified to some extent by pharmacological, psychological and physical means. However, that was not particularly brought to public attention until the past few years, when developments in molecular biology—not least in genetics—highlighted by the rare diseases consortium and by the Genetic Alliance UK meant that in a very large number of rare diseases the causal gene was identified, isolated and localised in the genome. In addition, drugs have begun to emerge which will alleviate or overcome the effects of the genetic defect. For those patients who have a rare disease, affecting up to several thousand individuals, these are known as orphan drugs; for those affecting a few hundred or a few dozen patients, these are known as ultra-orphan drugs, which are very expensive. The number of patients likely to benefit is relatively small so the commercial viability of these remedies is at least a matter of grave concern.
While there are important things to take on board here—we were talking about R&D and AstraZeneca a little while ago—we must recognise the fact that Britain has an outstanding record in medical research and development. As I have often said, today’s discovery in basic medical science and in applied science brings tomorrow’s practical development in patient care. People with rare diseases can be helped by these remedies that are now coming on stream much more rapidly than has been the case in the past. The important thing is this: as the noble Lord, Lord Hunt, said, before the Health and Social Care Act was passed, we had the Advisory Group for National Specialised Services which commissioned services for some people with rare diseases. When the Act was passed, we—those who debated it extensively in this House—were reassured by the knowledge that there was an agreement that highly specialised services would be commissioned by NHS England. In recent debates with the noble Earl, he has been able to reassure us that that organisation has a rare disease advisory group, advising it on the management of these conditions. He was also able to reassure us
about the early availability in this field, and in others, of unlicensed drugs in specific circumstances that may be effective in the management of many conditions in medicine—not just for cancer but for rare diseases, too. That is crucial.
However, as the noble Lord, Lord Hunt, said, we are concerned that the services are somewhat fractured in the sense that I have been unable to find out with any great clarity the terms of reference of the prescribed specialised services advisory group. It is not at all transparent at the moment. As the noble Lord said, nothing has been clearly published about its membership, its modus operandi and how it will function, or to what extent it has a relationship, if any, with NICE on the new procedures that NICE is introducing for the examination of orphan and ultra-orphan drugs. We need reassurance and more information on how this group works and, in the interests of public scrutiny, how it makes an effective contribution to health service decision-making. These are matters of great importance because rare diseases, though rare, are a major blight on people in the community. However, we cannot assess human suffering in purely numerical terms. The suffering resulting from many of these rare diseases is in many ways serious and exceptional and deserves very special attention.
For that reason I was very concerned, and I hope that I have misinterpreted the remarks of the director of NHS England, Mr Simon Stevens, in his report to the Commons Health Select Committee. He said that he thought there was a need for the scope of specialised services to be reviewed because he thought that they had been overextended. This is a phase in medicine in the UK when that would cause great concern to patients and their families and to many doctors who are concerned about the treatment of these diseases.
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Baroness Thomas of Winchester (LD): My Lords, I am grateful to the noble Lord, Lord Hunt, for initiating this debate and giving us the opportunity to talk about the new health service arrangements as they affect rare and very rare conditions. As other noble Lords have done, I shall range wider than the regulations—only briefly—because it is not often that this subject comes up for debate. The opportunity should not be missed to say something about those of us with a rare disease, in my case muscular dystrophy, and how it is faring as the new NHS arrangements are being put in place. I declare that interest.
All muscular dystrophies are rare diseases and some are very rare and there has been a great deal of uncertainty about how existing services for patients would fit into the way that services are commissioned, planned and delivered in the new NHS landscape. However, the situation was far from perfect before the changes. Some patients might not see a consultant for several years and many found it very difficult to access the right respiratory and heart checks, physiotherapy—especially hydrotherapy—and emotional and practical support. It was very much a postcode lottery. I had to discover for myself, 20 years ago, how helpful an exercise regime was, and this is now advised by healthcare professionals.
The new NHS set-up has provided not just a challenge but an opportunity to get things right from the beginning. The Muscular Dystrophy Campaign has worked closely with NHS commissioners on both a national and regional level and has achieved significant and encouraging progress in developing a dedicated neuromuscular standard through a specific annexe in the specialised neurosciences service specification. This has ensured that there are now more than 40 neuromuscular care advisers and specialist nurses funded by and embedded in the NHS, who provide invaluable support and advice to those with muscle-wasting conditions and their families. More are still needed, particularly to help guide patients and families through the transition from childhood to adulthood.
Another valuable initiative is Bridging the Gap, a Department of Health-funded project run by the MDC which began last July to help shape the future of neuromuscular services in England. This project brings together NHS commissioners, clinicians and health professionals through regional patient-led neuromuscular forums. Already it is bearing fruit, such as the development of GP online modules and emergency care plans, which it is hoped will improve the quality of care and support of people with neuromuscular conditions.
Clinical reference groups have been a positive step overall towards the effective commissioning of specialised services, although there are still problems. First, there is a disparity of CRG arrangements for rare diseases. Cystic fibrosis, for example, has its own CRG for children and adults and works well, but neuromuscular diseases are spread across three CRGs. I am taken with my noble friend Lady Brinton’s suggestion of there being a designated clinical lead so that everyone knows who to turn to. I believe that a one-off meeting has been arranged by NHS England to bring together these CRGs, but a long-term plan is also needed to work out how they will work together in the future.
Secondly, the main neuromuscular service specification prepared over the past three years, which covers children, transition and adults, mainly sits in the adult neurosciences CRG, which has adult-only expertise. It is a very welcome and recent step in the right direction that the paediatric neurosciences CRG has agreed to adopt the neuromuscular annexe of the service specification, but further work is needed here. I look forward to my noble friend’s reply.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, I am well aware that the noble Lord, Lord Hunt of Kings Heath, retains a keen interest in this topic, and I thank him for bringing it to the Floor of the House. I was naturally disappointed to hear that he feels that the new commissioning arrangements for specialised services which were put in place through the Health and Social Care Act 2012 are fragmented, and that the process for determining which services are considered to be specialised is unclear and lacking in openness and transparency.
Let me begin by emphasising that the Government continue to uphold the principle that no one is left behind, no matter how rare their condition, and that people with rare conditions should receive the same access to high-quality care as people with more common conditions. The Health and Social Care Act 2012
established the NHS Commissioning Board, now known as NHS England, and gave it responsibility for commissioning, among other things, specialised services. These services are prescribed in the regulations that the noble Lord has referred to. The arrangements for managing the commissioning of these services replace a system whereby 10 specialised commissioning groups and one national commissioner were responsible for commissioning both specialised and highly specialised services. Under that previous system, it became clear that there was variation in the range of services which some specialised commissioning groups were commissioning and the policies that were being applied to these services. This led to an inequity in access to services. Furthermore, the lack of standard contracts across the 10 specialised commissioning groups meant that the quality of services across the country was inconsistent.
All that has been replaced with a new system whereby one national commissioner is responsible for commissioning all specialised services for people with rare and very rare conditions. NHS England has developed standard service specifications and policies for commissioning these services, and these are underpinned by detailed identification rules that allow the commissioner of the activity, either NHS England or CCGs, to be determined. NHS England has implemented a robust process for developing and consulting on commissioning specifications and policies that includes public consultation. NHS England works with the 10 area teams responsible for the delivery of this work to ensure that highly specialised services continue to be commissioned in an effective way at the national level. I understand that all those involved in commissioning these services meet on a monthly basis to discuss any issues arising and how they might be resolved.
The noble Lord, Lord Hunt, raised the issue of the separation of functions carried out previously by AGNSS. I note his concerns that the system will be worse off without AGNSS. As a consequence of the 2012 Act, AGNSS ceased to have a role and its key functions have been picked up by other groups. From April last year, Ministers retained the power to decide which services should be commissioned, but NHS England became responsible for determining the number of centres and levels of funding in commissioning all specialised services. The prescribed specialised services advisory group has been established to provide Ministers with advice on whether services are specialised and should be directly commissioned by NHS England. NHS England worked with the former chair of AGNSS to consider how best it might receive high-quality clinical advice on highly specialised services. The Rare Diseases Advisory Group was set up by NHS England to provide it with this advice. The assessment of very high-cost drugs for patients with rare conditions was the final strand of AGNSS’s work which needed to be properly secured for the future. Ministers decided that NICE was best placed to offer this advice. I hope that that gives clarity to the arrangements that are now in place and the reasons why we considered this to be a compelling set of arrangements.
As I am sure noble Lords will acknowledge, the changes that were made through the Health and Social Care Act were extensive. With change being made on
such a broad scale as this, one might expect that the processes for setting up the reformed commissioning arrangements will take a little time to settle in.
There are a variety of reasons for the trend in spending on specialised commissioning, which the noble Lord, Lord Hunt, mentioned, including increased demand for specialised services and increasing demand for high-cost drugs. NHS England is taking steps to address budget management and reviewing the opportunities to reduce costs while maintaining the quality of services, which I know it attaches great importance to doing.
I remain confident that these new arrangements will lead to high standards for all patients needing to access specialised services, wherever they live and no matter how rare their condition is. I listened with care to my noble friend Lady Brinton. The intention and ultimate effect will be to ensure that patients in need of specialised services receive consistent access to high-quality care, wherever they live, and that services are organised and delivered as efficiently as possible.
Our agenda is very much one of continuing improvement. Although I am aware of the concerns expressed by the Specialised Healthcare Alliance, neither I nor NHS England accepts the premise that the changes we have made are leading to greater fragmentation. However, I am grateful to noble Lords for drawing these issues to my attention. I assure noble Lords, not least my noble friend, that I share their wish to see joined-up, consistent services across the country. I can give an assurance, too, that I will monitor the provision of specialised services over the coming months.
The noble Lord, Lord Hunt, said that the process by which services for rare and very rare conditions are considered by PSSAG for commissioning nationally are unclear and lack openness and transparency. That concern was echoed by the noble Lord, Lord Walton. It may be helpful if I talk a little about the group and its role. The National Health Service Act 2006, as amended by the 2012 Act, requires that before making regulations setting out which specialised services are to be prescribed, and thus made the commissioning responsibility of NHS England, the Secretary of State must obtain advice appropriate for that purpose and consult NHS England.
PSSAG was established in 2013 as a Department of Health expert committee to provide this advice. Its role is to provide advice to Ministers on whether services are specialised and should be directly commissioned by NHS England rather than by clinical commissioning groups. The appointment of this group helps to ensure that the Secretary of State has appropriate advice when exercising functions under Section 3B of the NHS Act 2006. The group met for the first time in September 2013.
The noble Lord, Lord Walton, asked about the group’s terms of reference. It has working terms of reference, which are currently being further developed and will be signed off at a future meeting. As part of the exercise in advising Ministers, the group will also consider proposals for NHS England on the formulation of its service descriptions, which are used to explain what NHS England is providing under the different
headings for the specialised services provided for in the regulations. The group will provide advice to Ministers on whether the service descriptions and any proposed changes are appropriate in respect of the prescribed service.
Evidence, supporting information and activity in respect of those services currently prescribed in legislation for direct commissioning by NHS England, along with any new services identified as potentially specialised and warranting commissioning by NHS England, are all made available to PSSAG from a range of sources. These sources may include clinical reference groups—CRGs—patient groups, clinicians, commissioners and members of the public. The proposals that the group considers are in large part generated by NHS England through its CRGs, which cover different areas of clinical practice. As PSSAG is still relatively new, the processes for enabling services to be referred to the group for consideration, and the annual cycle for considering whether services are specialised or not, are still being refined.
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I agree with the noble Lord, Lord Hunt, that we need to bring greater transparency to the processes that are in place. We have recently created a webpage for PSSAG, located on the gov.uk website, which sets out information about the group, including its membership and contact details for those wishing to suggest a service for consideration by PSSAG. We also published a report on 2 May 2014 which details the recommendations that PSSAG has made to Ministers on the specialised services it considered in 2013, and our response. A copy is available at gov.uk. I give the House my assurance that timely publication of PSSAG’s report will form an integral part of the annual PSSAG process going forward.
I will cover some of the questions that I have not already dealt with. It may help the noble Lord, Lord Walton, if I explain that NHS England and NICE have a partnership agreement and have been working together across the range of specialised services. In addition, NHS England’s Rare Diseases Advisory Group has been established specifically to maintain a focus on highly specialised services, as I have already mentioned. It has a role in developing the strategy underpinning highly specialised services and is working with NICE on the highly specialised technologies programme.
The noble Lords, Lord Hunt and Lord Walton, both referred to the comments of the new chief executive of NHS England, Simon Stevens, in his evidence to the Health Select Committee. I agree that the list of prescribed specialised services should be kept under careful review to ensure that we get the balance right, and I am sure that view will be shared by the noble Lord, Lord Walton. Of course, NHS England will be able to advance views on this matter; again, it is entirely right for it to do so. Ultimately, however, the scope of these services is a matter for Ministers, with independent advice from PSSAG and with reference to whether services meet the requirements for national commissioning by NHS England on the basis of the four factors set out in the National Health Service Act 2006, as amended by the 2012 Act.
Finally, the noble Lord, Lord Hunt, asked me about the impact of the 2014 PPRS agreement, and in particular whether payments from pharmaceutical companies could be channelled or earmarked for particular purposes. The broad position here is that the anticipated payments under the PPRS have been taken into account as part of future planning by NHS England. It is not the case that these funds have been hypothecated or earmarked for a particular purpose. Indeed, that has been made clear to the pharmaceutical companies.
I hope that I have been able to reassure the noble Lord, Lord Hunt, in particular about his concerns, not least around transparency, which, as I have indicated, we are determined to address. I thank all noble Lords who have spoken about these important issues. I hope that they are reassured by what I have been able to say today.
Lord Hunt of Kings Heath: My Lords, first, I thank the noble Earl for his response, and the noble Baronesses, Lady Brinton and Lady Thomas, and the noble Lord, Lord Walton, for taking part in the debate. I say to the noble Baroness, Lady Brinton, that of course the Motion was drafted well before the publication of the report. In fact, I received notification of the report only this morning. She seems to have got hold of it before me. Obviously it is helpful to have the report, which I have no doubt we will study, but I hope that this will be the start of an engagement between the advisory group and Parliament, and I hope that the advisory group will offer an open meeting for parliamentarians in the near future where we could discuss these matters with it.
The noble Lord, Lord Walton, was absolutely right to remind us of the increasing importance of ensuring that we have appropriate mechanisms for providing services and funding for these very rare diseases, particularly as technology advances and given the likelihood of orphan drugs being required more in the future.
I had hoped that I might identify a way to fund some of these services, but the Minister has told me that the money has perhaps been discounted and is already in the system. I say to him, however, that the low uptake by the NHS of innovative new medicines is a major problem. Alongside the issue of AstraZeneca, we have to persuade and cajole the NHS that it has to change its approach to new medicines. My own experience is that increases in staffing, in units and in medical equipment are all regarded as a good thing but that an increase in the drugs budget is seen per se as a bad thing. This, frankly, is nonsensical given what many drugs can bring to the public. The fact is that we have a hugely innovative R&D and pharmaceutical industry in this country which we should be very proud of, but the NHS has a lamentable record in investing in the output of that R&D industry. This is a very serious issue from the point of view both of patients and of our continued success—one hopes—as a country in attracting that R&D investment in the future. My understanding is that, in research and clinical trials in the future, unless we are able to compare innovative new drugs with what would in many countries be the normal drug usage, we will find it even more difficult to have clinical drugs started in this country. This is a very serious issue and we have collectively to tackle it.
I note what was said by the noble Baroness, Lady Thomas, who made some very powerful points. The noble Earl, Lord Howe, believes that the current system is not fragmented in the way that I described. Obviously, we will have to see whether this proves to be the case in the future, but there is a risk, with four regional and 10 area teams, of pretty widespread inconsistency within those teams and areas. We need to keep that under very close review.
I am very grateful to the alliance for its briefing and the work that it does. I wonder whether Ministers would be prepared to meet the alliance to discuss our debate and the advisory group’s report. I have already asked whether the advisory group would be prepared to meet parliamentarians. I am grateful to the Minister for expanding on the comments made by Simon Stevens to the Health Select Committee about the overspend on specialised commissioning. NHS England is not very visible in the Palace of Westminster and it should become more so. Before it makes pretty fundamental decisions on specialised commissioning, it would be very good if it was again to agree to meet parliamentarians to discuss it. This has been an excellent debate. I beg leave to withdraw my Motion.