Lord Maginnis of Drumglass: My Lords, has there been a precedent for raising a domestic issue of the European Council in common with a Statement on an international terrorist tragedy, such as in Tunisia? Is that not strange? I can understand why government would want to cloak the impact of what has happened in Tunisia, but as somebody who has lived cheek by jowl with international terrorism for almost three decades,

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I suggest that we would not have mixed up a domestic issue with the Omagh bomb, the Ballygawley bus bomb or the Enniskillen Armistice Day bomb. Why on earth have we chosen now to take this tragedy—and I feel the injustice of that tragedy—in the way we have rather than talk about the positive, concrete steps that we might take to bolster a Government in Tunisia who are not in favour of the sort of terrorism that we see elsewhere in the Middle East?

Baroness Stowell of Beeston: The Prime Minister was due to give a Statement to the House of Commons today about the European Council, as he customarily does following his attendance at a European Council meeting—that being something that he is obliged to do. He decided, quite rightly in my view, that he should also make a Statement about the terrible events in Tunisia. This will not be the final occasion when the Government make a Statement to Parliament about our response to the most recent terrorist attacks. One reason why it was felt appropriate to combine the two is that clearly we are at the initial phase of responding to the events of last Friday. The most important and urgent thing that we are trying to do is to support the families affected by this despicable act. That is what the Prime Minister has sought to do in describing how the Government have responded. As I say, as things unfold, I am quite sure that others from the Government—my other ministerial colleagues—will make Statements as they see appropriate.



5.38 pm

Lord Ashton of Hyde (Con): My Lords, with the leave of the House, I will repeat a Statement made a few minute ago by my right honourable friend the Chancellor of the Exchequer in another place:

“Mr Speaker, let me report to the House on the latest developments in the financial crisis in Greece, how they might affect British citizens and how we protect our economic security at this uncertain time.

The developments over the weekend have been well reported. Greece’s financial assistance programme is due to expire tomorrow. After tense negotiations last week between the Greek Government and their eurozone partners, it looked likely that a deal to extend that programme would be agreed. On Friday, however, the Greek PM suddenly announced that there will be a referendum on 5 July on the terms of that programme extension and that he will be recommending that the Greek people vote no.

On Saturday the eurozone Finance Ministers confirmed that, as a result of this unexpected move, negotiations were at an end and the programme would expire. Yesterday the European Central Bank said that without a programme it could not extend the emergency liquidity assistance that is the life support of the Greek banking system. Last night, clearly under pressure, the Greek Government announced that banks would not open today and capital controls would be introduced.

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There is considerable uncertainty about what happens next. I have spoken over the last 48 hours to fellow Finance Ministers, the chair of the eurogroup and the head of the IMF. This lunchtime, as we just heard, the PM chaired a meeting attended by the Governor of the Bank of England, myself, the Foreign Secretary and others to co-ordinate our response. Britain’s attitude to the developing Greek crisis is clear: we hope for the best but we prepare for the worst.

Let me address some immediate issues that will concern people. First, our view on the overall state of the relationship between Greece and its fellow eurozone members is that, whether or not Greece should ever have joined the euro, it is now part of that single currency and an exit will be traumatic. It was the Greek Government’s decision to hold a referendum that was the immediate trigger for the events over the weekend and the bank closures today.

We should plan on the assumption that this referendum will effectively be a choice for the Greek people about whether their country now leaves the euro. This is a matter for the Greek people to decide, and we respect their democratic right to decide their country’s future. We also respect the right of the eurozone to set conditions of membership. That remorseless logic of integration is one of the reasons we did not join the euro and we do not want to in the future.

Secondly, there is the impact of the current events on the stability of the financial system, in the UK and across Europe. Related to that is the position of the Greek banks here in the UK. This Greek crisis has been with us in one form or another for five years. It has been one of the biggest external economic risks to the British economy, and the situation today shows that these risks remain. I do not think that anyone should underestimate the impact that a Greek exit from the euro would have on the European economy, and the knock-on effects on us. That is why I have consistently agreed that the best way to protect ourselves from these risks is to get our own house in order.

Of course, markets anticipate some of these risks. The private sector exposures to Greek banks and the Greek economy are far lower than they were, say, three years ago, so the financial market reaction today has been relatively contained. Stock prices on European exchanges have fallen by between 2% and 5% and Greek bond yields have increased by around 400 basis points to over 14%, but bond spreads in other eurozone economies have stayed broadly steady.

The eurozone authorities have made clear that they,

“stand ready to do whatever is necessary to ensure financial stability of the euro area”,

and we welcome that commitment to the currency. Equally, the British Government and the Bank of England stand ready to ensure our financial stability in the UK. The four largest Greek banks—Alpha Bank, Euro Bank, National Bank of Greece and Piraeus—all have branches here. Their UK balance sheets are small; between them, their deposits total less than £225 million. The resolution and supervision of these branches is the responsibility of the Greek and EU authorities, while the protection of depositors is solely the responsibility of the Greek authorities. All four branches are open today. There is one Greek

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bank with a subsidiary in the UK, Alpha Bank. This is a separate, standalone entity from its parent bank. It is small, with assets of slightly over £500 million. It is regulated by the Bank of England, and customers can be assured that their deposits are covered by the UK’s Financial Services Compensation Scheme.

Thirdly, there are 40,000 British residents in Greece, including 6,000 receiving payments from the Department for Work and Pensions and around 300 receiving public sector pension payments. The Greek Government have announced a bank holiday in Greece, lasting at least until after the conclusion of the referendum on 5 July, and restrictions on withdrawals from ATMs. Withdrawals will be limited to €60 per day per account for Greek accounts. The Greek bank accounts of those British residents are subject to these restrictions. Their UK bank accounts are not affected.

International payments into Greece are exempt from the restrictions that the Greek authorities have placed on the banking system. That means that UK government payments, including state pension and public service pension payments, should be permitted, and I can confirm that those payments will continue to be made in the usual way. However, the situation remains fast-moving and uncertain; we will keep it under review and I recognise that people may be concerned.

I have asked the Department for Work and Pensions and public service pension administrators to attempt to contact people who draw a British state or public sector pension from a Greek bank account. Those people will be helped to switch these payments to a non-Greek bank account if they wish.

Fourthly, there are on average 150,000 British tourists per week in Greece in the month of July. For the time being, the Greek Government have announced that, as usual, tourists will be able to withdraw up to €600 on cards that have been issued outside Greece. However, the foreign ministry could impose limits in future, and the availability of ATMs that are stocked with cash may get increasingly patchy. I remind people that credit and debit cards are of course accepted only at the discretion of the business that you are paying.

As a result of these limited and potentially unreliable banking services, I confirm that, as I speak, the Foreign Office is updating its travel advice. We recommend that travellers should take sufficient euros in cash to cover the duration of their stay, emergencies, unforeseen circumstances and any unexpected delays. Obviously travellers should be careful and take sensible precautions against theft. The full advice is available from gov.uk, and travellers should check this regularly.

Lastly, we are taking steps to help firms doing business with Greece. There are restrictions on the settlement of payments being transferred out of the Greek banking system. The department for business is today publishing guidance for businesses that may be affected. In addition, I can announce that HMRC’s Time to Pay service will be available to help to give breathing space to businesses that are experiencing cash-flow difficulties as a result of events in Greece.

So let me be clear: British pensioners are being paid as normal, British businesses trading with Greece will be supported and British holidaymakers

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will receive the advice and help that they need. In a rapidly changing situation, I want people to know that Britain is prepared.

To conclude, it is vital now that the Government and people of Greece act to resolve the current uncertainty, and ensure economic and financial stability across Europe. Five years ago we came to office in the first flush of the Greek crisis. At the time, Britain too was dangerously exposed and on the brink. Since then, with the British people, we have worked hard to repair our economy and ensure that we can deal with risks like this from abroad. If ever we needed a reminder of why we need to continue working through our plan to deliver economic security at home, we have it today. I will take further steps to secure our country’s future in the Budget next week”.

5.47 pm

Lord Davies of Oldham (Lab): My Lords, I thank the Minister for repeating the Statement made by the Chancellor in the other place. I think that we can dispense with those last few remarks comparing the British economy with the Greek position and suggesting that it is government action in the past four years that has prevented our position from being the same. We all know the particular and extremely difficult circumstances of Greek society and its economy. These are very serious times for Greece and for the eurozone, of which of course it is a member, and there are risks for Europe and indeed for our country if urgent resolution cannot be found.

The main immediate fact is of course that the Greek banking system is now closed. I shall focus my response, first, on the impact on British citizens and, secondly, on the implications for our economy and financial system. Understandably, exporters, pension funds and the many British visitors to Greece need to know that the UK Government have a thorough contingency plan. I must say that in the Statement today there is a fair amount of wishful thinking rather than clear evidence of a plan.

I turn first to the impact on British citizens. As the Minister has indicated, some 150,000 British citizens would have been expected to go to Greece in July, although of course that number may now reduce. However, it will still be a very large number because people have made their plans. How will people travelling to Greece this summer be able to obtain full information and updates about the best way to plan and proceed with their arrangements? An obvious piece of advice the Government can give is this: “Go there absolutely loaded with euros and make sure that you look after them carefully”. That is wise advice, I am sure, but it is not much solace to the British traveller. What we want to know is what discussions have British officials had with the Greek authorities and banks to ensure that UK citizens are able to withdraw sufficient funds. What is the Minister’s assessment of the number of British citizens with resources deposited in Greek banks who will be anxious about what this means in terms of their ability to access their funds? For many, the British embassy in Athens and the consular staff will be the first port of call. Can the Minister give us an assurance that the

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embassy is sufficiently staffed and has the resources to cope with what inevitably will be a flood of anxious calls and representations?

I turn now to the impact on our economy and financial system. What discussions have the Treasury and the Bank of England had with financial institutions both here and across the European Union about the implications for our financial system, and what structures are in place to monitor closely any emerging risks? It is clear that if there are wider ramifications for the eurozone economies in the months ahead, there will be greater risks for UK business, trade and, of course, our economy. What assessment have the Government made of the number of British firms and the volume of exports that are potentially at risk? Billions have been invested from eurozone economies in bailouts and considerable hardship has been felt by the Greek people, who are facing economic distress. Does the Minister agree that it is important that the institutions should continue to seek opportunities for a negotiated settlement with the Greek authorities during the week ahead? Time is of the essence. Does he also agree that it is important for the Greek Government to accept their part in charting a course towards a long-term resolution?

This is surely a time for all parties to pursue a responsible approach for Greece and for the wider European economy, for much is at stake.

Baroness Kramer (LD): My Lords, watching the events in Greece is like watching a car crash in slow motion, and we on these Benches hope very much that steps will be taken over the coming days and weeks to avert what is undoubtedly a lose-lose outcome for essentially everyone involved. I have a few questions for the Minister.

Everyone in the House will be concerned for British citizens who are travelling in Greece. For tourists, the advice is to carry cash. I understand that that seems to be the most obvious solution, but I do not think that anyone would recommend it for themselves or their family because it exposes one to extraordinary risk. What conversations are taking place with our consular officials in Greece to see if they can provide some better advice, and if this continues beyond a few days, on looking to work with financial organisations? American Express and Thomas Cook are organisations that come to mind in terms of going back to some of the older methods of payment like travellers’ cheques, which were used before the days of credit cards.

Can the Minister give an assurance that the UK banks have passed stress tests which look not just at the immediate fall-out of the impact on the Greek banks, but on banks in other parts of the eurozone which might be the victims of knock-on effects by predatory financial traders, and indeed of the normal actions of the market looking for other weak spots? Can he also assure me that conversations have been held with the bank regulators? At times of volatility, and this crisis could lead to one, there is an obvious opportunity for misbehaviour in the financial system. We have another burgeoning crisis in the US swap market and one would hate to see those bad behaviours use the opportunity to take advantage of the volatility that may result from this crisis.

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Does the Minister agree with the Financial Times that this,

“is a soluble problem merely cloaked in an aura of impossibility”?

Although the British Government have pointed out that they are not directly involved because they are not members of the eurozone, surely this is the time for the Government to make strenuous efforts and urge all parties back to the table. Does he not also agree that this crisis in Greece offers up some broader lessons, one of which is that EU Ministers and Governments will not put up with endless game playing? As a consequence, as he looks at the EU’s own negotiations on reform, will he ask the Government to make sure that they do not focus on synthetic issues—quite frankly, like whether there are phrases about ever-closer union—but on real issues such as the standing of non-eurozone countries and whether they are on a par with others? Perhaps he will speak to members of his own Cabinet who think that playing with a no vote in a referendum is a way to strengthen Britain’s negotiating hand. That is the kind of childish behaviour that we have just seen get Greece into extraordinary difficulties. This is a time when everyone needs to act like a grown-up.

Lord Ashton of Hyde: My Lords, I thank the noble Lord and the noble Baroness for their comments. I shall start with the initial remarks of the noble Lord, Lord Davies. I shall just refer back to what the Chancellor said, because I do not see any part of the Statement where he compared this country to Greece. He said:

“If ever we needed a reminder of why we need to continue working through our plan to deliver economic security at home”.

Economic security at home is extremely important to deal not only with the obvious problems in Greece, which are not the same as we have here, but the other, unexpected problems that occur in the worldwide economy.

The noble Lord and the noble Baroness asked about British citizens. Of course, that is one of the most important issues as far as we are concerned. Greece is a big tourist destination, with 150,000 tourists normally going there in July. The Foreign Office updated its information both last night and again, I think, within the last hour. All British citizens should look at the information from the Foreign Office on the GOV.UK website because the situation is developing fast and that is the best way to get up-to-date information. The Foreign Office has been dealing with the Greek authorities and I can answer the noble Lord opposite directly: it has undertaken contingency plans to make sure that if the situation gets worse, adequate support will be provided for UK citizens in Greece and it will ensure that adequate resources are available.

I was asked what structures are in place in this country to monitor the situation. The Bank of England has primary responsibility for stability and is looking at this on a daily basis. The number of firms that deal with Greece is relatively minimal. The financial sector has reduced dramatically over recent months, with the latest figures for March showing that exposure levels were approaching a quarter of what they were in December last year. By way of comparison, they comprise less than 2% of the UK’s financial exposure to France. Direct trade and investment links are also minimal, with only 0.6% of total UK goods and

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services exports going to Greece—worth around £2.8 billion in 2013—while only $1.1 billion of Greek foreign direct investment stock comes from the UK. In fact, of all the periphery euro area economies, Greece receives the smallest amount of UK outward foreign direct investment.

I agree with the noble Lord opposite that a negotiated settlement is preferable. I also agree that the Government here will do whatever they can to help in that. They have been in touch with European institutions, but, obviously, as we are not part of the eurozone, we have less influence in this matter. But I agree with him that a negotiated settlement would be best. I have to bear in mind what the president of the IMF said: it is time to have some adults in the room when they get to negotiations.

The noble Baroness, Lady Kramer, asked about cash, which obviously is a risk. I think that it is sensible to take more cash than you would normally take. One could also take more than one card, if one has them. Of course, the problem is that those cards are no good if the banking system is not working and the ATMs have run out of cash—and I think that they will run out of cash fairly soon. She mentioned travellers’ cheques. Again, they are only any good if the banking system is open and working. Hotels, I think, fairly rapidly run out of cash.

The noble Baroness asked about the stress tests and the banks in this country. I cannot answer directly whether they involved a specific reference to a situation like Greece, but all our banks have passed their stress tests. These take into account instability in the economy, which is one of the tests—and the banks passed. There is much less contagion risk in the periphery than there was a few years ago. Countries such as Spain and Italy have reduced their exposure to Greece as well—it is not just this country. As for the discussions with the bank regulator, the Bank of England—the regulator in this country—has talked to other European institutions.

The noble Baroness said that this was a soluble problem. I think it is soluble with good will on both sides, but it will be very difficult. The performance of some of the players has made that more difficult, to be frank. On reform generally and the effect that this will have on our negotiations with the EU, I do not agree that ever closer union is a synthetic issue. When you have a eurozone, ever closer union is an absolutely important part of that. That is a real issue we have to address, and the Prime Minister is determined to do so.

6.02 pm

Lord Lawson of Blaby (Con): My Lords, is it not clear that the Greek disaster is simply the most acute evidence of the fact that the European monetary union was, from the start, a fundamentally flawed enterprise, as a number of us predicted and explained very clearly at the time? Is not the best thing that we can do now to persuade our friends in the eurozone to enable Greece to exit from the eurozone in the most orderly way possible? Inevitably, it cannot be totally orderly; it will be difficult. But to facilitate the most orderly exit of Greece from the monetary union is the best service we could provide.

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Lord Ashton of Hyde: My Lords, I am not sure that it is fundamentally flawed. The key is that the participants in the eurozone have the right economic fundamentals that allow them to go into it and play their part. As for exit, that is up to the Greeks. It is they who are having a referendum. It is not for us to tell them which way to vote. I absolutely agree with my noble friend that if they decide to exit by dint of the referendum, which is their democratic right, we should do all that we can to make it orderly.

Lord McFall of Alcluith (Lab): My Lords, it is clear that a Greek exit would provide an existential threat to the whole European monetary and economic framework, with knock-on effects geopolitically and also for the United Kingdom. As Angela Merkel said, if we lose the ability to compromise, we will lose Europe. Even at this late stage, is it not incumbent on the UK Government to ensure that their voice is heard and that a compromise is agreed with a degree of debt write-down and concomitant structural changes in Greece itself? That is still a possibility and every effort has to be made to ensure that before the weekend.

Lord Ashton of Hyde: I agree that we should do what we can, but it is fundamentally a eurozone problem. There is a limited amount we can do. In terms of the bailout, we would not be on the hook for that. I agree that we should do what we can. Of course, the former Leader of this House is hard at work in Europe, even as we speak.

Lord Higgins (Con): My Lords, in the present confused situation, only one thing is clear. It is inconceivable that Greece will become competitive and achieve economic recovery at the present exchange rate. Therefore it will be condemned to endless austerity, abortive negotiations and financial crisis until such time as it leaves the euro. My noble friend’s Statement refers to an exit by Greece as being traumatic. The important, thing, therefore, is that we should do everything we possibly can to make it happen in an orderly way, rather than in a traumatic way, where other European countries are not taking action because they believe that it is fundamental that Greece remains in. It is not going to remain in; sooner or later, it is coming out. Therefore it is very important that we should work together with other European countries to achieve a sensible exit.

In particular it needs to be made clear that, if there is an exit of Greece from the eurozone, it does not mean that Greece exits from the European Union. From a political point of view, it is very important indeed that it should not do so. At the moment, however, I fear that we are underestimating our interest in this matter. We are of course already contributing in part to the bailout through our contribution to the IMF, and it is obviously extremely important as far as our export markets to Europe and so on are concerned. So we need to work with the other members in the European Union to seek to achieve a resolution to this crisis that is long term. That can only be if Greece exits the euro.

Lord Ashton of Hyde: My noble friend is obviously right. I would not swap economics with him. I accept that there are difficulties if your exchange rate is

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constrained by the euro and your interest rate policy is determined by the euro authorities. Ultimately, that is why it would be traumatic, as my right honourable friend said, if they leave—and it will be traumatic for individual Greeks, for whom we should feel a great deal of sympathy.

As far as the IMF is concerned, it is true that if Greece does not pay back its loan, it will go into arrears. There are contingency funds within the IMF which may cope with that. Ultimately, however, if that was the case, we would have about a 15% share of that. I agree with my noble friend that if we get to the stage of Greece leaving the euro, we should do all we can to help. I note that on Twitter today, President Juncker has said that, in his view, if Greece leaves the eurozone it will mean that it will be leaving the European Union.

Lord Pearson of Rannoch (UKIP): My Lords, does the noble Lord agree that it is strange that the Greek people, and indeed the Portuguese and the Spanish, blame their problems on austerity, without seeming to realise that that is caused entirely by the ill-fated project of European integration and its euro, which they think they want to keep? Do the Government agree that, as other noble Lords have suggested, the Greek people’s best way out of the cruel euro trap is to leave it, devalue and gradually rebuild their economy? Would it not be nice if the Greeks were to succeed in this task and were eventually followed by the Portuguese, the Spanish and perhaps even the French? That might start to break up the whole euro project and, indeed, the project of European integration itself, which is doing so much damage to Europe.

Lord Ashton of Hyde: The noble Lord may be surprised to know that the Government do not agree with that analysis. I know that he has certain views. Austerity per se is not the cause only of the Greeks’ predicament. It has been a long time coming, and other European countries have dealt with it in a possibly more effective way. Austerity alone is not the answer, but nor is leaving the euro. We need to help the Greeks negotiate a position where they can face the future with a bit more optimism, and I am sure that the noble Lord will join me in that.

Baroness Falkner of Margravine (LD): The noble Lord has accepted that the United Kingdom is exposed through the IMF to a Greek default or Greece being in arrears. He has not given us a figure, but the Times this morning said that Greek indebtedness to the IMF was to the tune of about €21 billion. Will he tell the House what specifically the United Kingdom exposure would be in that regard?

Lord Ashton of Hyde: I do not have the exact total number, but I am told that it is about 15% to the IMF.

Lord Davies of Stamford (Lab): Would it not be a good idea for the Government, when they refer to ever closer union, to quote the phrase correctly? It is the ever closer union of peoples. It has never been a legal or an institutional matter. On Greece, I am sure that the Government have given some thought to what

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follows, or what might follow, from the referendum on Sunday. Presumably, if the vote is no, Greece will continue down the tube of bankruptcy, and no doubt leave the euro, have high inflation and so forth. If the vote is yes, will the package, which was so petulantly rejected by Mr Tsipras the other day, be revived and be on offer to a new Greek Government? Will our Government use their influence with our eurozone partners and the IMF to urge them to adopt that cause?

Lord Ashton of Hyde: My Lords, I do not think that the package is a matter for this Government. We would certainly take into account what would happen after the referendum, which of course is a Greek choice, but it is for the eurozone to decide what package is given to its members.

As for the ever closer union of peoples, the point is that when you have one currency, you need to have closer political union to make that one currency work. If you do not have that, you end up having some of the problems that we are seeing.

Lord Forsyth of Drumlean (Con): My Lords, given that the German Finance Minister only a month ago suggested that a referendum on the package might be appropriate, is it really acceptable that the package should be withdrawn the moment the Greek Government announce that they are going to have a referendum on whether the people should accept it? What exactly are the Greek people voting on if the package has been snatched away? When the Minister refers to the loan to the IMF being in arrears, will he explain the difference between being in arrears and being in default?

Lord Ashton of Hyde: As regards the arrears, I was merely repeating the official nomenclature of the IMF. I would not comment on the precise meaning of the IMF vocabulary, but it is true that it refers to being in arrears. If that was the case, Greece would join Zimabwe, Somalia and the Sudan. On the referendum, the negotiations are coming to an end because, despite what the German Finance Minister said, if you are to have a sensible negotiation, you need to have willingness on both sides to compromise. Walking out instead of taking the decisions that are needed, and turning around without any warning and instituting a referendum, is not the way to get proper negotiations and to achieve success.

Lord Lea of Crondall (Lab): My Lords, is not one of the difficulties of the analysis that people assume that something follows on from having a referendum, which of course must be nonsense? It is not a logically connected piece of analysis. There can be all sorts of scenarios from where we are now, but Angela Merkel has said that the referendum question is simply, “Do you want the euro? If so, vote yes. If you want the drachma, vote no”. Can it be as simple as that? Are there not a number of scenarios that could follow, and should we not be thinking through a number of them, otherwise the schizophrenia in this debate about whether a referendum is a bright idea has not been followed up by thinking through the policy scenarios?

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Montenegro is just up the road from Greece. It is a member of the United Nations and a singing and dancing country. It uses the euro without permission from Frankfurt. It is not obvious to me exactly what the connection is between the way the referendum is posed and the scenarios that follow.

Lord Ashton of Hyde: I can see the noble Lord’s problem, but I do not think that it is a problem for the UK Government. The referendum was instituted by Greece and it is up to them what the question should be, what they are trying to address and why they are trying to have one. I completely agree with the noble Lord that there are many scenarios resulting from that. The Treasury, the Government, the Bank of England and the Foreign Office are looking at this and working out contingency plans on a daily basis.

Lord Tugendhat (Con): My Lords, the Minister said that the British Government would be preparing for the worst. I think it is quite widely thought that the worst that might come quite quickly is a humanitarian crisis within Greece. Once no cash is circulating, particularly in an economy that has such a substantial cash sector as in Greece, the difficulties for people in getting food and basic services will become very immediate. Are the British Government going to play a role, should that be required, in any EU humanitarian effort to mitigate suffering in Greece?

Lord Ashton of Hyde: My Lords, I agree with my noble friend that in preparing for the worst—I alluded earlier to the sufferings of the Greek people—a humanitarian crisis would be very serious and possible. I am afraid that I am not in a position to commit today on how we would help in that situation. I would like to, but I just do not have the knowledge to do so, I am afraid.

Lord Berkeley (Lab): My Lords, the Minister said that the Foreign Office was updating its advice to travellers to Greece hourly, daily or something, which clearly is welcome. For humanitarian reasons and for the sake of people’s holidays, clearly we do not want to discourage people from going to Greece, but surely the only safe advice at a time when the banks are shutting and credit cards may not work is for people to take cash, probably in euros but any hard currency would do. Is that not the best advice to give people, rather than saying, “Well, you might be able to go to a bank or you might not?”, or anything else?

Lord Ashton of Hyde: My Lords, I have not checked the latest advice. I have been informed that it was updated last night and will be re-updated today. I think that is exactly what the advice said.

Lord Stoddart of Swindon (Ind Lab): My Lords, are we not just kidding ourselves about the real situation? Does the noble Lord not agree that the eurozone is fundamentally flawed and has been so right from the beginning? The grown-ups among us recognised that when we opposed going into what was to be a flawed system. Is it not true that without the fiscal and social power, together with the monetary policy, the eurozone

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simply cannot work? The idea that it could work, particularly with the membership of Greece, was always absurd.

Lord Ashton of Hyde: My Lords, the Government do not believe that the eurozone is fundamentally flawed as long as its members have the right economic position when they go in and go in at the right exchange rate. The euro institutions’ power is adequate as long as the members go in at the right time and with the right criteria. I accept that there are different views on this, but the countries in the eurozone are varied. Greece may well leave—I do not know; it is up to the Greek people—but just because one country on the periphery leaves does not necessarily mean that the eurozone is fundamentally flawed.

Lord Empey (UUP): Does the Minister agree that politics brought the Greek people into the eurozone and that politics will be deployed to keep them in it as the week goes on? Will that not mean that the misery that they suffer continues? As the noble Lord, Lord Davies of Stamford, said, what happens if the Greek people vote yes when their Government recommended no? What policy can we expect to be implemented following such a decision?

Lord Ashton of Hyde: I completely agree that politics is very important in all these things, along with the economic arguments. Politics demands that all people in positions of power take decisions that are not just in the short-term interests of their political persuasion but in the long-term interests of the Greek people.

Lord Marlesford (Con): My Lords, it looks inevitable and is probably desirable for the euro’s sake that Greece leaves the euro area. Does the Minister agree that it is very important that Greece stays in the EU, which is a more important organisation of longer standing than the euro and should be much more durable? Does he agree that Greece should not invent some Mickey Mouse currency such as a new drachma, which would not fulfil the functions of money—store of value, unit of account and medium of exchange—but should instead continue to use the euro? As the noble Lord, Lord Lea, said, a country does not necessarily have to be in the euro area to use the currency. It has been done with the dollar in South America. Tourists, who are so important to Greece, could use travellers’ cheques. Hotels and so on do not have to cash them; they can accept them and keep them. As long as they have been issued by a reputable outside bank, they are as good as cash for them.

Lord Ashton of Hyde: My Lords, I am not an economist, but I accept that it is theoretically possible to use other countries’ currencies. The problem is that a country does not have control over its currency if it does that. It is not up to me or to the UK Government to decide which currency Greece should use in the event that it leaves the euro. That will be up to the Greek Government.

Lord Lamont of Lerwick (Con): My Lords, has the Government’s policy on the euro changed dramatically—

Baroness Evans of Bowes Park (Con): My Lords, I am afraid that the time is up for this Statement.

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Cities and Local Government Devolution Bill [HL]

Cities and Local Government Devolution Bill [HL] 1st Report from the Delegated Powers Committee1st Report from the Delegated Powers Committee2nd Report of the Constitution Committee

Committee (3rd Day)(Continued)

6.24 pm

Amendment 44DA

Moved by Lord Berkeley

44DA: After Clause 9, insert the following new Clause—

“Sustainable development

After section 117 of the Local Democracy, Economic Development and Construction Act 2009 (orders) insert—

“117A Sustainable development

(1) In determining whether or how to exercise the power conferred by section 113D, a combined authority shall have regard to the effect which the proposed exercise of the power would have on—

(a) the health of persons in its area; and

(b) the achievement of sustainable development in the United Kingdom.

(2) Where the authority exercises the power conferred by subsection (1), it shall do so in the way which it considers best calculated—

(a) to promote improvements in the health of persons in its area, and

(b) to contribute towards the achievement of sustainable development in the United Kingdom,

except to the extent that the authority considers that any action that would need to be taken by virtue of paragraphs (a) or (b) above is not reasonably practicable in all the circumstances of the case.

(3) In subsection (2)(a), the reference to promoting improvements in health includes a reference to mitigating any detriment to health which would otherwise be occasioned by the exercise of the power.

(4) In deciding whether or how to exercise that power, the authority shall have regard to any guidance issued under section 118.””

Lord Berkeley (Lab): Amendments 44DA, 44DB and 44DC are probing. They mirror similar texts in the Greater London Authority Act 1999. Why do the Government not propose to include these important safeguards for devolution outside London that the 1999 Act provides for within London? That is particularly important in relation to the concentration of power that is proposed for mayors. It is also relevant to the exercise by combined authorities of the general powers of competence.

Amendment 44DA requires the combined authority to have regard to the effect on the health of persons in its area and to the achievement of sustainable development. I would have thought that the Government were keen to see those things promoted and would be in favour of the provision in proposed new subsection (3), which states that,

“the reference to promoting improvements in health includes a reference to mitigating any detriment to health which would otherwise be occasioned by the exercise of the power”.

Amendment 44DB relates to consultation. All Governments say that they do not like lists of people who have to be consulted, but the list in my amendment seems reasonable. Amendment 44DC refers to transport strategies. The London mayor has produced many

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strategies—most of them are good, some less good—and people in the London area have been consulted on them. I was in Liverpool last week hearing people’s views on the northern way, or northern powerhouse or any of the other names for the new area for development across the Pennines—from the Humber to the Tyne and Tees to Liverpool and most places in between. It is good, and surprising, that the authorities have got together and appear to be coming up with a joint strategy for the whole region. Only a few years ago, as the Minister will know from her experience there, such a strategy was a bit of a pipe dream, but it is happening now. It will need funding and it will need more detail, but it is happening.

The key is to achieve consensus without any one mayor thinking that he or she is in charge. A couple of years ago I was told that the people of Liverpool had to run everything because they were better. Perhaps Manchester is supposed to be better now, but in fact everyone is working together.

Amendment 44DA is a probing amendment to find out why the Government have not felt it necessary to replicate the text from the Greater London Authority Act in this Bill. Is it seen as an unnecessary constraint on the mayor’s powers? We need some constraints, especially on health and sustainable development. The measure has not been entirely successful in London because, before the Olympics two years ago, the mayor managed to hide the statistics for air pollution by covering up the monitors. It was an easy way of doing it and he seemed to have got away with it. We were certainly said to have better air quality than Beijing, which would not have been the case if the monitors had not been covered up.

I shall be interested to hear what the Minister has to say. She may say that the amendment is not necessary, but if it is good for London, why is it not good for the rest of the UK in the circumstances that the Bill covers?

6.30 pm

Lord Teverson (LD): I support the amendment. A question has come from a number of Benches and the Minister about the problem of trying to recreate London devolution in the north and elsewhere in the country. I understand that and I concede that there might be differences in the way it is implemented which are more relevant to those areas. However, I suspect it is dangerous to talk about the north because those cities to the left of the Pennines might not see it in the same way as those on the eastern side. The fundamental thing is not necessarily to make it the same—as the noble Lord, Lord Berkeley, said, this is a probing amendment—but why should metropolitan areas outside London have a second-division method of governance in comparison to what has been trialled and used in London, to a degree successfully, although not completely?

The areas of particular importance in this are sustainable development—which ties up completely with the outline planning rules introduced by the previous Government—and transport. When we discussed the Infrastructure Act last year we asked for a transport strategy—particularly around cycling and pedestrians—

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which I hope the Government and the Secretary of State are developing. It is important that this becomes part of the work of combined authorities.

This may not be the perfect amendment but it is necessary to include this kind of framework in the Bill for northern cities and combined authorities. Even though a direct comparison with and a copying of London legislation and regulations may not be completely appropriate, it is important to find something that fits the situation of combined authorities in the north and elsewhere that enables them to be successful. In that sense, I hope the Government will come forward with a different formula that meets those objectives.

Lord Deben (Con): My Lords, I know that opposition to motherhood and apple pie is always disliked in this House, but the impression put forward by these amendments is very worrying. Do we have any indication that the governance of London has been affected by this, because any sensible mayor of any denomination would do the useful things that are listed here? However, some of them mean very little. For example, what can we take from subsection (2) of proposed new Section 117B, which states that any body or person a combined authority considers consulting must include any council within its area and,

“bodies of each of the descriptions specified in subsection (3)”?

Those bodies in subsection (3) include:

“(a) voluntary bodies some or all of whose activities benefit the whole or part of its area;(b) bodies which represent the interests of different racial, ethnic or religious groups in its area;(c) bodies which represent the interests of persons carrying on business in its area”.

Are there any bodies of any kind whatever not covered by that? It makes no sense. It is a list of things. Will a decision by the mayor be illegal which did not follow a discussion with a particular body providing for the interests of a small number of people in a particular ethnic group for whom it was not appropriate? This is a list of things which are good, valuable and helpful but totally not useful in the activities which we envisage the mayor carrying through.

It would be perfectly reasonable to say that the mayor should have serious concern about sustainable development; that he should have appropriate consultation; that it would be a good idea to ensure that transport strategies were,

“consistent with national policies and with such international obligations as the Secretary of State may notify to the mayor for the purposes of this section”.

However, I have my doubts about whether it would make any difference. If there are things to be said, they should be said when they are necessary. There should not be merely a list of things about which we can all feel warm because we have voted in favour of reminding people that it is a good idea to consult.

Lord McKenzie of Luton (Lab): My Lords, the amendments of my noble friend Lord Berkeley reasonably probe the Government and focus on issues which should underpin a combined authority’s operations and strategies. There are issues around the health of people in the area and around sustainable development, about which my noble friend always speaks with passion.

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I know the Minister’s answer will be, “You can ask for all these things; you may well get these things in a deal; but you do not have to have them in the Bill”

The consultation requirements in these amendments are a little more specific than one would like, even if one were in support of putting them in the Bill. The issue here is to encourage all the deals that take place under these devolution proposals to have, as their underpinning, issues around sustainable development and the health of people in the area. I am sure the Minister will tell us there is no reason why those issues should not feature in any deal that might be entered into. If that is not the case, there is a stronger case for putting something more specific in the Bill.

As to the strategic view on transport, if there is an argument for putting measures in the Bill it might be to hold the Government to account so that we do not proceed on an assumption of a northern powerhouse, with a big debate around connectivity, and hear a few days later that the funding is not there to deliver on it. That does not help trust between government and local authorities in creating an environment where devolution can work and where issues around sustainable development and the health of people in an area are at the forefront of the strategic operations of a combined authority.

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Williams of Trafford) (Con): My Lords, these amendments seek to introduce into the Bill new clauses that would place on combined authorities prescriptions and requirements about how they exercise certain powers which may be conferred upon them.

Amendments 44DA and 44DB place requirements on how a combined authority which has been given the full general power of competence through the provisions of Clause 9 of the Bill is to exercise these powers. These requirements are about having regard to certain matters and having to undertake consultation with various specified authorities and other bodies. The intention of new Section 113D, which Clause 9 inserts into the Local Democracy, Economic Development and Construction Act 2009, is to allow the same power of general competence that is available to local authorities to be conferred on combined authorities. The purpose of such a general power is to give the authority concerned the same scope and freedom of action as is available to any individual, such as you or me, subject to any specific legislative restraints applying to that authority.

To seek to prescribe to combined authorities how they should exercise this power would seem to be contrary to the essence of the general power of competence. It would place combined authorities in a more restrictive regime than that which applies to local authorities generally. There are no grounds for doing this in those situations where, as part of an agreed deal, it is considered right to give a combined authority the full general power of competence.

I recognise that these amendments appear to mirror some of the provisions that apply to the Greater London Authority. In the London context, the authority has the power to do anything which it considers will further any one or more of its principal purposes. In

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exercising this power the authority is required to have regard, for example, to its effect on the achievement of sustainable development in the UK and on the health of persons in Greater London. However, these specific powers which are given to the Greater London Authority are of a very different nature to the general power of competence, which, as I said, is the power for an authority to do anything which an individual can do, unless it is specifically prohibited. These are particular powers about promoting economic development and wealth creation in Greater London, promoting social development in Greater London and promoting the improvement of the environment in Greater London. It may be in a particular deal that similar powers are conferred on a combined authority, using the powers in the Bill under Clause 6.

Amendment 44DC provides that in preparing or revising any transport strategy a combined authority shall have regard to the health of persons in its area, the achievement of sustainable development in the UK and certain matters relating to national policies, international obligations and the available resources for that strategy. This amendment mirrors provisions which apply to the London mayor in respect of his general duties in relation to his strategies. However, such provisions are not appropriate to be included in an enabling Bill, which does not refer to any particular powers or duties a combined authority and its mayor may have. If, as part of a particular deal, a combined authority mayor is given a power similar to the Mayor of London’s in relation to certain strategies, then it may be right that, in the case of that combined authority, matters such as sustainable development and the health of the people in the area could be relevant considerations to be taken into account by the mayor when drawing up those strategies. The orders creating such an arrangement would be able to reflect this.

Whatever the importance of particular issues, and clearly the health of people in an area is of the utmost importance, it is not for this Bill to include either references to specific powers, or provisions which can relate only to specific powers. This is an enabling Bill and in our previous debates I have made very clear that the Bill is not a vehicle for setting out lists or descriptions of powers which may or may not form part of an agreed deal with particular areas. Accordingly, I hope the noble Lord will agree to withdraw his amendment.

Lord Berkeley: I am very grateful to the noble Baroness for her comprehensive explanation, which might be summed up with “good try”. As I said, it is a probing amendment. It has been an interesting debate, and I accept the comments of the noble Lord, Lord Deben, about the detail. The amendment was basically copied from a GLA Act, which seemed a good place to start, but he has made some very good points.

The noble Lord, Lord Teverson, reminded the Committee that we are still waiting for the Government’s strategy on cycling and walking, which came in earlier this year, and that will be good. My noble friend Lord McKenzie hit the nail on the head by saying that all this is fine but unless it is accompanied by funding—and, one could even add, an ability to raise funds locally—how

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important will it actually be? I will read the Minister’s comments with great interest. I may come back on this again, or I may not. I beg leave to withdraw the amendment.

Amendment 44DA withdrawn.

Amendments 44DB and 44DC not moved.

Amendment 44DD

Moved by Lord Warner

44DD: After Clause 9, insert the following new Clause—

“NHS responsibilities

(1) The Secretary of State may transfer to a combined authority any NHS responsibilities provided for in the Health and Social Care Act 2012 if he considers—

(a) that it is in the best interests of the authority’s population in terms of health outcomes; and

(b) that it will help fulfil his duty in section 2 of the 2012 Act (the Secretary of State’s duty as to improvement in quality of services) to improve the quality of health services.

(2) In making a transfer of responsibilities to a combined authority under subsection (1), the Secretary of State shall request that a memorandum of understanding between NHS England and the combined authority be agreed.

(3) The memorandum of understanding shall—

(a) be consistent with the duties and powers of the combined authority under the 2012 Act, and

(b) last for a minimum of 5 years, unless the combined authority fails to discharge its responsibilities under the memorandum, including its mandate from the Secretary of State.

(4) Any memorandum under subsection (2) shall have regard to the Secretary of State’s duty under section 5 of the 2012 Act (the Secretary of State’s duty as to promoting autonomy) by—

(a) promoting autonomy and avoiding placing unnecessary burdens on the combined authority, and

(b) specifying the key health outcomes to be achieved by the combined authority.

(5) The requirements in the memorandum shall be set out in regulations by the Secretary of State.

(6) A combined authority assuming NHS responsibilities under the provisions of this section shall publish an annual report on how it has discharged its responsibilities on the basis set out in the memorandum of understanding.”

Lord Warner (Lab): My Lords, we return to the issue that we discussed last Wednesday, namely the ability of combined authorities to assume NHS responsibilities under this Bill. Several things emerged in our last discussion. The first was that the Government currently have no intention of making any clear provisions in the Bill for combined authorities to assume NHS responsibilities. Instead, they wish to proceed on the basis that a combined authority could negotiate a deal with NHS England that would be enshrined in a memorandum of understanding covering a number of years. However, the Secretary of State would retain all his powers in the Health and Social Care Act 2012 to overrule actions by the combined authority in accordance with the memorandum of understanding, if he disagreed with those actions. No matter how much agreement there was between local bodies such as clinical commissioning groups, health and well-being boards and a combined authority, it would still be the Secretary of State’s view that prevailed. The Minister made it

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clear when I taxed her on the issue of local bodies replacing acute hospital beds with more preventive and community-based services that that was the position. I have reread


to make sure I did not misunderstand her and I did not.

6.45 pm

The second point which now seems apparent is that this position sits rather oddly both with the NHS’s Five Year Forward View, endorsed by the Government, and the devolution claims by the Chancellor for the Greater Manchester deal, announced with much fanfare in February. The Five Year Forward View made it absolutely clear that:

“England is too diverse for a ‘one size fits all’ care model to apply everywhere”.

That clearly means that NHS England expects variations between areas. Its five-year plan is very clear that the NHS balance should shift to preventive and community services and that funding incentives and systems should change. That was the purpose of my question to the Minister—what would happen if those sorts of changes took place and proved uncomfortable and controversial in some parts of the country? This is clearly a plan that moves activities and funding away from in-patient hospital care on an agreed local basis. That is very much reflected in the Greater Manchester plans, and the memorandum of understanding is consistent with that. It certainly gives the impression that once a deal is finalised with NHS England and local interests have agreed it, there will be no political interference from the centre.

The Minister’s utterances last Wednesday suggested something quite different. They also suggested a total muddle in the Government’s thinking on how this Bill sits with the Health Secretary’s powers under the Health and Social Care Act 2012. I can understand that the Government do not want to amend the 457 pages of that Act. Who would want to go through that agony again? What I cannot understand is why they want to undermine this broadly sensible Bill by failing to make it clear how NHS responsibilities can be transferred to combined authorities on an agreed basis that is consistent with the 2012 Act. All we have to go on regarding how things might work in practice is the current memorandum of understanding between NHS England and the Greater Manchester Combined Authority, which is not even the finished article—it refers to it being the build-up year—and the prospect of a ministerial order, the terms of which we have not seen. Even if we saw such an order, as I understand it from the Minister, there is no guarantee that the same arrangements would apply to subsequent deals. These would all be bespoke negotiations. What we do have is the Minister’s expressed view, which causes me the greatest concern, that the Health Secretary could overturn local agreements if he thought them wrong—or “bad”, in her words. In other words, agreements hammered out locally could be overturned by a Minister in Whitehall because he did not like the look of them or he had been got at by an adversely affected particular interest. I can assure the Minister, having been a Health Minister who sat in Whitehall and dealt with hospital closures and changes, that there is no shortage of people coming forward to tell you it is a thoroughly bad idea.

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That is the position we are in and it is not particularly satisfactory. I do not believe that we need to get to a point where we rewrite the Health and Social Care Act 2012 but this House is a scrutinising House. We should not allow muddled legislation to leave it without attempting to make clear how it relates to earlier relevant legislation. This means that we have to look at the Bill before us, which is concerned with the functions of combined authorities, and be clear about how those authorities could assume NHS responsibilities if that is what people at the local level wanted to do. This is very important, given the size and prominence of the NHS in British life, and means putting in the Bill processes that could be adopted across the country, not just in Greater Manchester, that are as consistent as possible with the terms of the Health and Social Care Act 2012. We should not pass the Bill with the current level of uncertainty and lack of transparency on those processes. That can only lead to confusion in the minds of the public, the NHS and its staff, and indeed in local government, and will inevitably lead to legal challenges when some interest or collection of interests does not like the look of particular local changes and tries to challenge those given the Health Secretary’s powers. In all likelihood, that would mean leaving it to the courts to try to work out what Parliament intended.

This is the context in which I have drafted my amendment, which has several subsections. It starts by clearly stating that the Health Secretary has the power to,

“transfer to a combined authority any NHS responsibilities provided for in the Health and Social Care Act 2012”—

so a link is established between the two bits of legislation. However, he must be satisfied that,

“it is in the best interests of the authority’s population in terms of health outcomes”,

and it must be consistent with,

“his duty in section 2 of the 2012 Act … to improve the quality of health services”.

I am sure the Minister is totally cognisant of all the provisions of that splendid piece of legislation. In making such a transfer,

“the Secretary of State shall request that a memorandum of understanding between NHS England and the combined authority be agreed”,

that is consistent with his duties under the 2012 Act and which will last,

“for a minimum of 5 years, unless the combined authority fails to discharge its responsibilities under the memorandum”.

The proposed new clause goes on to say:

“Any memorandum … shall have regard to the Secretary of State’s duty under section 5 of the 2012 Act (the Secretary of State’s duty as to promoting autonomy) by … avoiding placing unnecessary burdens on the combined authority, and … specifying the key health outcomes to be achieved by the combined authority”.

Finally, the amendment requires the Health Secretary to make regulations setting out the requirements in the memorandum of understanding, and requires the combined authority to publish annually a report on how it is discharging its responsibilities.

I am neither a proud author nor make any claims to being a parliamentary draftsman. This amendment was crafted rather rapidly after Wednesday’s discussion before I had to travel from London early the next day.

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I am sure it can be improved. It is designed to outline the kind of provision that needs to be in the Bill setting out a process for transferring NHS responsibilities to combined authorities that both reflects the spirit of the Bill and is as consistent as possible with the Health Secretary’s duties under the 2012 Act. I have retained the idea of a memorandum of understanding between NHS England and a combined authority, à la Greater Manchester. I relate the Health Secretary’s powers to transfer responsibility by order to his duties under the 2012 Act. But once he has signed off that order for five years, which is the period I am suggesting, he should not interfere with the authority’s actions unless it is failing to discharge its duties under the memorandum of understanding.

If we are to make a success of devolution, we cannot have agreements made in good faith between people at the local level and the centre being abrogated because of a bit of pressure put on a Health Secretary by a number of particular interests—often vested interests, some would say. It is essential to have an amendment of this kind in the Bill. I hope the Government will be prepared to discuss such a provision across the Benches. It is not intended to be a partisan amendment. Indeed, I do not even know at this stage whether it finds favour with those on the Labour Front Bench in the other place—they seem to have one or two other things on their minds. I support the purpose of the Bill and more devolution of health responsibilities to combined authorities but that has to be done through a transparency process consistent with the 2012 Act until such time as that legislation is amended. I beg to move.

Lord Hunt of Kings Heath (Lab): My Lords, I warmly welcome my noble friend’s amendment. I read with interest the debate in Committee last Wednesday about this very important issue, which goes right to the heart of the relationship between the combined authority and the National Health Service, and the integrity of the NHS as a national service providing uniformity of services across the nation.

Of course, our debate is mostly about Greater Manchester. I very much support the thrust of what is happening in Greater Manchester. I want to see the same in greater Birmingham. But we have to get to the bottom of the essential relationship between local authorities, the combined authority and the NHS. This is not an academic exercise. It would be all too easy for a Chancellor faced with enormous financial pressures, as he is, to transfer responsibility to local government or combined authorities and then deny responsibility, putting the blame firmly on local government and using local government legitimacy to defend the rationing of services to an extent that the NHS has never seen.

Of course, one can go back to the foundations of the NHS, to the arguments in the post-war Attlee Government between Morrison and Bevan. Morrison had been leader of the London County Council, which before 1948 had been the largest hospital authority in the world, and wanted local government to run the NHS, but Bevan was concerned that it would be a very patchy service. Bevan won the argument and we had a national NHS. So the arguments we are having today

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will be very familiar throughout the history of the NHS. The key question is: how do we get the advantage of local government leadership and democratic legitimacy while ensuring that we have what we would recognise as a national NHS? That is why this is such an important debate and why the Bill lacks clarity.

The Minister was very helpful on Wednesday and spelled out a number of principles. She said first that healthcare services,

“must remain firmly part of the NHS … and the position of NHS services in the area in relation to the NHS constitution and mandate cannot change”.

She said that,

“all national standards for health services … must … be complied with”.

I take that to mean that the NICE technology appraisals will be fully complied with as well. She said:

“The Greater Manchester deal does indeed put health as a function of the combined authority and not of the mayor”,

but that it will not prejudice arrangements elsewhere, which is a very important factor—for me, certainly—in relation to greater Birmingham, although very few of us in greater Birmingham actually want a mayor and very much object to the blackmail that is being put upon us by the Government forcing us to have a mayor in order to accept the greater responsibilities that would be given. We had a referendum in Birmingham not so long ago when we voted very clearly not to have an elected mayor. It is highly objectionable for the Government now to come along and say, “We don’t really care what the public thought, we insist that you have a mayor”. Significantly, the Minister went on to say that,

“in the field of health and social care, all decisions about Greater Manchester will be taken with Greater Manchester”,


“clinical commissioning groups … providers, patients, carers and partners to shape the future of Greater Manchester together”,

and that the Bill will give local authorities within the combined authority,

“the powers to participate in … strong, collaborative partnerships”.—[

Official Report

, 24/6/15; col. 1672.]

I would just say that they already have statutory freedom to enter into those partnerships.

7 pm

In principle, the key issue is that all decisions about Greater Manchester will be taken by Greater Manchester. The Minister referred to the two governance bodies which will prepare a strategic plan and commission Greater Manchester-wide services, but what is unclear is who on earth the decision-maker in Greater Manchester is. Where do decision-making authority and accountability lie? Which of the many bodies in that great region will be held accountable for NHS services and planning and strategic direction? One of the real risks here is that, far from giving Greater Manchester a huge opportunity to lead change in the health service and integration with social care using the fantastic life science base in the city of Manchester, an additional bureaucratic tier is being added.

No decision about Greater Manchester can be taken without Greater Manchester—but what does “Greater Manchester” stand for? Is it the Greater

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Manchester Combined Authority or is there a different definition of Greater Manchester? Does the Greater Manchester Combined Authority have a power of veto over the strategic plans and Greater Manchester-wide commissioning decisions of NHS commissioners? If it does not, does that mean that NHS bodies in Greater Manchester can ultimately ignore what the combined authority says? Does NHS England have a performance management relationship with the Greater Manchester Combined Authority?

We come to the point raised by my noble friend Lord Warner. The Minister said that if the Manchester authorities made a wrong decision, she was sure that the Secretary of State would have to intervene. The question is how. I remind the noble Baroness of Section 47 of the Health and Social Care Act 2012. This amends Section 253 of the National Health Service Act 2006, which relates to the Secretary of State’s power to direct NHS bodies and so is the crucial relationship. The 2012 Act does not give a general power to give directions to NHS bodies and an amendment was necessary to enable the Secretary of State to give power to direct NHS bodies—by reason of an emergency—in order to ensure that a service under the Act is provided. My assumption is therefore that if the Secretary of State transferred a function from an NHS public authority to a combined authority under Clause 6, the emergency power of direction in Section 47 of the Health and Social Care Act 2012 would and could be used in relation to the combined authority. However, this can happen only by reason of an emergency. The Government deliberately set the bar very high in the 2012 Act. I am not aware that this has yet been tested in the courts but my reading of the Act is that the power of intervention by the Secretary of State in relation to the combined authority is actually going to be very limited.

The Minister said on 24 June at col. 1672 that for the purposes of the Bill, NHS bodies are covered by Clause 6. That is highly significant because Clause 6 provides a very wide order-making power. Indeed, the second report of the Constitution Committee said that Clause 6 is broadly framed. It,

“would allow the Secretary of State to reallocate very extensive powers from central government to local government, … This equates to a significant extension of Ministers’ powers—powers which are so broadly framed that they could potentially involve the amendment of primary legislation by order, known as Henry VIII powers”.

That is why I am very suspicious of Clause 6. My reading of it is that the commissioning responsibilities in their entirety could be transferred to the combined authority and CCGs abolished. That may be a good thing—I am not arguing against it—but I want to know what the intention is. Can the Minister help with a definition of “public authority”? The clause defines public authority as including,

“a Minister of the Crown or a government department”,


“does not include a county council or a district council”.

Can the Minister tell me which NHS bodies are included in that definition? My reading is that it would be quite possible to abolish the Department of Health, and with it, of course, Department of Health Ministers, simply by taking an order through both Houses of

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Parliament. My noble friend Lord Warner and I may say there is an argument for that—indeed, there is a strong argument for pulling the Department of Health and the DCLG together; I remind your Lordships that Nye Bevan was Minister for Health and Housing—but a simple order-making power which could have such a draconian impact on the way the NHS is organised does not seem to me to be the way forward.

My noble friend Lord Warner elegantly sets out the kind of strategic framework that is necessary to enable this devolution and delegation to happen. The Minister must be clear about what is likely to be delegated or potentially devolved. For instance, is national speciality commissioning to be delegated or devolved to the Greater Manchester Combined Authority? Would that also involve the cancer drugs fund? Will that be devolved to Greater Manchester? Is resource allocation to CCGs to be devolved to Greater Manchester? Is CCG performance management to be devolved or delegated to Greater Manchester? What specific powers are going to be handed over by NHS England to Greater Manchester? The memorandum of understanding is clear that it is about devolution and the eventual delegation of responsibility. It is the duty of the Government during the passage of the Bill to spell out exactly what is going to be devolved and delegated.

It would be wrong of this House to allow Clause 6 to pass in the current state of uncertainty when it could have such a dramatic effect on the National Health Service. I very much hope that the Minister will reflect on this before Report so that we can come back for a fully informed debate and deal with it broadly in the way suggested by my noble friend Lord Warner.

Lord Shipley (LD): My Lords, when I read the announcement about the decision for Greater Manchester and the fact that £6 billion of NHS funding would be devolved to that area, I asked myself two questions: how do they know it is £6 billion and who will make what decision as a consequence of this announcement? After listening to the last 20 minutes or so, I have come to the conclusion that I am none the wiser.

I pay tribute to the noble Lords, Lord Warner and Lord Hunt, for having so succinctly explained what the problems are and could be. I understand that there would inevitably be variations area by area and there needs to be some flexibility in the hands of Ministers to meet what is deemed to be right for a particular local area, but one cannot permit a situation to continue in which there is simply nothing in the Bill in relation to the powers of a combined authority. I think I noted the words of the noble Lord, Lord Warner, correctly when he said that we must make it clear how NHS responsibilities can be transferred to a combined authority and remain consistent with the 2012 Act. That seems to be one of the key points that we have to be clear about. Otherwise, a whole set of problems could arise as a consequence of that lack of clarity in the Bill. I sincerely hope that between now and Report the Minister considers the questions posed today so that we can have a set of amendments that the House might be able to agree upon.

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Lord Bradley (Lab): My Lords, very briefly, I support this probing amendment which has been so eloquently moved and spoken to by my noble friends Lord Warner and Lord Hunt. I said in our debate last week that I suspected that we would need a second debate for clarification of NHS responsibilities and their relationship with the combined authority. I know that the Minister will be anxious to come to the Dispatch Box to give us much clarification this evening, because that relationship needs to ensure that there is no confusion at local level between the combined authority and the NHS.

In our debate last week, I raised 10 questions with the Minister, which I am not going to repeat. I am sure that she will be writing to me with detailed responses, but I want briefly to refer to two of the questions which my noble friends raised again tonight. First, I said that we do not want to leave NHS organisations and their boards, which implement policies by the combined authorities, open to legal challenge that they are acting outside or in conflict with legislation. I am sure that the Minister will want to clarify that point again.

Secondly, I raised the issue of whether the Greater Manchester strategic health board and its relationship with the combined authority needed any statutory powers and whether there was any requirement to amend the Health and Social Care Act 2012. Again, the issue in that general relationship has been raised tonight and I am sure that the Minister will want to clarify that point further. This probing amendment is surely to ensure that the devolution which we all support for Greater Manchester in health and social care can be effected efficiently. We will reflect further on the questions raised tonight in the light of the Minister’s response as we move towards Report.

Baroness Williams of Trafford: My Lords, I thank all noble Lords who have made remarks this evening. A number of questions have been raised. Perhaps I might address the amendment generally and then come to specific questions that noble Lords asked.

Amendment 44DD makes specific provisions about the transfer of health and social care NHS responsibilities, as noble Lords have said, including a requirement for an annual report by a combined authority which has assumed NHS responsibilities. It is important to reiterate this evening what I have said in earlier debates. The Government are committed to the view that health and social care services in any area, whatever devolution arrangements are entered into, must remain firmly part of the National Health Service and social care system—the noble Lord, Lord Hunt, alluded to this—that all existing accountabilities and national standards for health services, social care and public health services will still apply, and that the position of NHS services in relation to the NHS constitution and mandate cannot change.

As we have discussed throughout our debates on the Bill, the context in which the Bill’s powers will be exercised is that of implementing bespoke devolution deals, agreed with individual areas and reflecting each area’s proposals and ambitions for devolution. The

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Bill is an enabling Bill and I do not believe that it is necessary to include specific requirements about how particular powers will be devolved. However, I hope that tonight I can provide more clarification on specific questions that noble Lords asked.

Within the legislative framework that the Bill is creating, the safeguards are to be provided by not making specific provision in the Bill, such as provision about any memorandums of understanding and their relationship with the National Health Service Act 2006, as amended by the Health and Social Care Act 2012. Safeguards are in fact provided by the requirement that the implementation of any particular devolution deal must be debated and approved by both Houses of Parliament.

7.15 pm

Lord Hunt of Kings Heath: My Lords, if I may intervene on that, of course I understand that an affirmative order allows Parliament to have a debate, but so what? Nothing else happens. I think that the number of affirmative orders that have been rejected is seven. It is certainly a handful, so in reality we are giving executive power to Ministers to make absolutely any decision they like. The fact is that parliamentary scrutiny is virtually nonexistent. Of course, if we were able to amend or delay statutory instruments, as the royal commission on Lords reform argued some years ago under the noble Lord, Lord Wakeham, that would be different—but we are not, so I am afraid that saying that an affirmative order is a protection simply is not true.

Baroness Williams of Trafford: My Lords, we have talked about the Secretary of State’s ability to intervene, which in itself is also a check and a balance. The orders will be debated through both Houses of Parliament. I will make some progress on this, and if the noble Lord wants to intervene further, he is very welcome to.

For the debates it will be important that full details of the deal concerned, how it was arrived at and the outcomes expected of it will be fully available to Parliament. As I said in the earlier short debate, I am ready to consider whether the standard Explanatory Memorandums are sufficient to ensure that Parliament has all the information it needs in this unprecedented process of devolution. As to a requirement for a combined authority to publish an annual report on its deal in relation to health, there will be a process, as I said in one of our debates last week, for evaluating the progress on each deal agreed with each area. For example, the Greater Manchester deal has an extensive programme of evaluation, with evaluations being public documents available to all with an interest in the area and the progress being made. I do not believe that it is appropriate to make a requirement about the reporting or evaluation of some particular aspect of a deal—an aspect which may not be in all the deals that are agreed.

I turn to some specific points that noble Lords have made. The noble Lord, Lord Warner, talked about the Secretary of State for Health overturning decisions if he did not like them. It is a bit more than that. I think he could intervene if he thought that

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decisions would be detrimental to people’s health or well-being. That was the point I was hoping to convey, but perhaps I did not do it articulately enough.

Lord Warner: I am being totally confused by the Minister. If she is saying that the detail of a deal is enshrined in regulations, the Secretary of State has signed off that deal. That implies that if there are any controversial issues around in, say, Greater Manchester, they will be dealt with in the orders that come before both Houses of Parliament and which he will have signed off. If he has signed off those orders and they have covered the transfer of resources, for example, from hospitals to preventative services, why should he need to intervene on such a transfer from a hospital to these other services? The Secretary of State seems to want to have it every which way: you agree the deal, you put it in an order and you still reserve the right to veto things on a subsequent level. That is what the Minister seems to be saying.

Baroness Williams of Trafford: My Lords, it is what I am saying but I am also saying that the detail of the deal, which noble Lords have requested full sight of, will go through both Houses of Parliament. It is important that the Secretary of State, of whichever department, can intervene in any matter which he feels is to the detriment of the public. That is what I am saying but maybe we mean different things by “intervene”.

Lord Warner: My Lords, this really goes to the heart of this matter. The Secretary of State under my amendment would have to assure himself that having a deal in the first place was for the benefit of the population of the combined authority. He is actually guided in that—also by the 2012 Act—so he cannot agree a deal that is likely to adversely affect that population. He would be in breach of his own duties and responsibilities. If he has then agreed a deal that is not abrogating NICE responsibilities or access standards or anything else, but is merely shifting the balance of resource provision and service provision between one set of services currently and another set of services that better meet that population’s need—which is indeed what the Five Year Forward View says should be done—and he signed that all off in an order, why does he need a power to intervene again during the duration of that order because he thinks something is wrong? He has agreed what they are going to do.

Baroness Williams of Trafford: Perhaps I have not articulated this—in fact, I wonder if the noble Lord and I are talking at cross-purposes. I am not talking about the Secretary of State intervening in the process of the deal and of the order going through both Houses; I am talking about subsequently, if matters went awry in a particular area. However, that would be the obligation of the Secretary of State whether it was for local government or health or whatever area we will be talking about. Perhaps we can leave that there and return to it in due course.

The noble Lord, Lord Warner, also made the point that it will always be the Secretary of State’s view that prevails. The noble Lord suggests that however great the local consensus might be, the Secretary of State has the power to override this. This argument lacks the

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essential element, which is how the Secretary of State will exercise his powers. These powers will be exercised reasonably, having regard to all relevant considerations, including local views and the NHS’s own plans in the forward view. In terms of service reconfiguration, the Government have pledged that all service changes should be led by clinicians and patients and not be driven from the top down. The Government have outlined strengthened criteria that decisions on NHS service changes are expected to meet. The criteria are: support from GP commissioners; clarity about clinical evidence bases underpinning proposals; arrangements for public and patient engagement, including local authorities being further strengthened; and the need to develop and support patient choice.

The MoU between the NHS England and Greater Manchester makes it clear that plans for devolution will align and support the objectives set out in the Five Year Forward View. The forward view sets out the NHS’s own plan for the next five years, supporting local areas to take forward plans for transformation, including an increased focus on prevention and integration of services. On the aspect of the 2012 Act that noble Lords have asked about, we have been very clear that existing NHS standards and accountabilities will be upheld. The NHS Act 2006 as amended by the 2012 Act sets out clear duties held by the Secretary of State in relation to the health service. For example, the 2006 Act puts a duty on the Secretary of State to,

“have regard to improvement in quality and reducing inequalities”,

and the duty is exercised in a way that supports local areas. He and other noble Lords asked about the compatibility between the 2012 Act and what has been proposed here. I can confirm that they are compatible with each other.

The noble Lord, Lord Hunt, asked who actually takes the decisions in Greater Manchester. The memorandum of understanding between NHS England and Greater Manchester provides that decisions are to be taken by the partnership between the local authorities and the health bodies—in other words, the Greater Manchester joint commissioning board as a board would operate. This reflects the principle that decisions are devolved to the most local level that is most effective and beneficial for patients and communities.

Lord Hunt of Kings Heath: Who do I sue then? Who is accountable in this great mushy edifice that has been created? Who is the accountable officer? That is what we are trying to get to—who can you point the finger at and say, “You are responsible ultimately for what happens in Greater Manchester’s health system”? That does not seem to be coming through at all in this.

Baroness Williams of Trafford: My Lords, there is a partnership board. Who you would actually sue on that board I do not know. It might be the chairman. I imagine that the ultimate accountable person, who you would actually sue, is the board itself because it is jointly responsible for the decision-making. It is a partnership board.

Lord Scriven (LD): In a previous life I have been both a senior NHS manager and a leader of a council. This is as clear as mud. If, for example, the partnership board decided it wanted to reconfigure local healthcare

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and a hospital was to be closed, who would be held responsible ultimately by the public for that decision? Would the Secretary of State ultimately be able to stop that decision? Coming back to what the noble Lord, Lord Hunt, said, where would specialised commissioning fit in? It would not be a national standard, but would what the Minister calls the health partnership be able to move away from decisions made by NHS England on specialised commissioning? If it did, who would be able to overturn that decision? Who would be able to ask for a review of that decision, and to whom?

Baroness Williams of Trafford: My Lords, I can confirm that the accountable body is the partnership board.

Lord Warner: We are going nowhere, my Lords. Let us have another go. Let us follow up the issue of the closure of 50 beds in a Manchester hospital because the money is going to be used for preventive services and more services in the community. The partnership board has agreed that, and the consultants in the hospital affected take umbrage at that. They wind the public up—this is a well-tried and tested form of action in the NHS—get some money from a pro-bono lawyer and, under the provision of the noble Lord, Lord Hunt, they sue somebody. The Secretary of State has signed off the partnership board’s deal. Are they going to sue the partnership board? Are they going to sue the chairman of the trust affected for letting his 50 beds go? Are they going to sue the Health Secretary? Or are they going to sue the chairman of NHS England for agreeing this deal? I think we need to know who. This is not an implausible case I am giving; it is everyday bread-and-butter stuff in our British NHS.

Baroness Williams of Trafford: My Lords, as I understand it, it is the partnership board. I cannot add any more to this. As I understand it, the accountable body is the partnership board.

Lord Scriven: Is the partnership board a statutory body?

Baroness Williams of Trafford: Sorry, could the noble Lord repeat that?

Lord Scriven: Is the partnership board a statutory body or a corporate board in law, or is it just a partnership?

Baroness Williams of Trafford: I would imagine it is a statutory body. May I confirm that, because I am not entirely certain? I will confirm that either during this debate or after the dinner break on subsequent amendments.

Lord Beecham (Lab): I would like to help, if I might, because the noble Baroness is obviously in difficulty. This question is a health issue and not her department. When we are talking about suing, we are talking not about suing for damages; we are talking about judicial review. I therefore suggest that somebody gives the Minister some advice, not necessarily now but certainly before we get to Report, on where and against whom action for judicial review might be issued in relation to decisions taken around the health service by whomever is responsible under these deals.

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That is the best way to clarify the position. I do not expect the Minister even with the assistance of the Box to be able to answer that now, but it should be answerable before we get to Report.

Baroness Williams of Trafford: I thank the noble Lord very much indeed for that intervention.

Finally, the noble Lord, Lord Hunt, asked me to define “public authority”. It is any authority in the public sector, including all public bodies and NHS bodies, Ministers of the Crown and government departments. New subsection (4) in Clause 6 provides that, in the case of the Bill, it,

“does not include a county council or district council”.

With that, I ask the noble Lord to withdraw his amendment.

Lord Warner: My temptation is to say, “You must be joking”. This has been a very interesting and illustrative debate. I do not think that many people, not just on the Labour Benches but on this side of the House, have found illuminating some of the answers to the questions that we asked. I want to make a helpful suggestion to the Minister. I strongly suggest that she facilitates a meeting between some of us with herself and Health Ministers—and possibly even NHS England—to explore this issue as quickly as possible. We are in danger of creating total confusion, not just among ourselves but among people in the outside world and in the NHS, who will read these debates and be thoroughly confused as to what is going to happen to them in the coming years. I suggest that we have a meeting and, on that basis, I beg leave to withdraw my amendment.

Amendment 44DD withdrawn.

House resumed. Committee to begin again not before 8.31 pm.

Sierra Leone

Question for Short Debate

7.32 pm

Asked by Baroness Hayman

To ask Her Majesty’s Government what is their assessment of the current situation in Sierra Leone, and what are their plans to assist the country to recover from the effects of the Ebola outbreak.

Baroness Hayman (CB): My Lords, I am grateful for the opportunity to introduce this Question for Short Debate and to the numerous organisations and individuals who have provided briefing material. In the time allotted, I fear that I cannot do justice to the breadth of issues they have raised, so I am particularly glad to see the number and expertise of other noble Lords who will be contributing tonight. I also remind the House of my interests in health and overseas development, as set out in the register.

The Ebola outbreak in west Africa has disappeared from headlines in the United Kingdom, but the devastating effects of that outbreak are still being felt every day by the people of Sierra Leone. For a start, unlike in Liberia, Ebola cases have not disappeared. For the last

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few weeks, the number of cases has been bouncing along the bottom, as epidemiologists predicted, with up to 15 new cases a week being reported in June, and with a worrying number of those cases coming from unknown transmission chains. Some 1,100 people in Sierra Leone are still under quarantine restrictions, and we are now beginning to tally up the costs, not just of the epidemic itself—not only the 3,900 deaths from Ebola that we know of, and many more that we do not—but in other areas of health, where thousands more are estimated to have lost their lives because of the collapse of the already impoverished health services that existed before Ebola, and the collapse of community trust in those services.

It has been estimated that use of government health services has declined from 80% to 50% of the population since the first Ebola case was identified more than a year ago. Most experts agree that, in that year, more people will have died from the absence of treatment for malaria than from Ebola. The effects on maternal and perinatal mortality are equally if not more devastating. Services for pregnant women have virtually ground to a halt because of the particular risks for healthcare workers in treating women giving birth. There has been a terrible toll of stillbirths. The Maternal and Newborn Health Unit of Liverpool School of Tropical Medicine and VSO are even now working to bring forward a programme to build again maternity services that in the past were so inadequate that the maternal mortality ratio in Sierra Leone was the worst in the world.

There are also problems in terms of services for HIV and tuberculosis; cholera is always a risk in Sierra Leone; and there have been reports of measles outbreaks as a result of plummeting immunisation rates when patients simply stayed away from clinics. I welcome the mass drug administration programmes for malaria, and the vaccination campaigns for polio and measles that have taken place recently, but the situation remains precarious. Building sustainable universal health coverage in Sierra Leone will be an enormous long-term challenge for a country that had only 100 doctors and 1,100 health workers before the outbreak. Nearly one-third of those health workers contracted Ebola and 224 died during the epidemic.

Beyond health, the effects of the outbreak were far reaching. Schools were closed for nearly a year, and many pupils will not only have lost that part of their education but will never return to school. As so often, girl children have suffered most, with reports of increased sexual exploitation, early marriage and teenage pregnancy. Those girls will have great difficulty in ever establishing independent and free lives for themselves. Agriculture was also impacted and, while showing signs of recovery, needs further technical and other assistance if it is to contribute to economic growth and address the needs of the 35% of children in Sierra Leone who are chronically malnourished.

The effects on the wider economy were devastating—and I am sure that the noble Lord, Lord Giddens, will speak about this. The World Bank estimated that Sierra Leone will have lost $920 million from its projected GDP in 2015, and has revised its estimates of growth from 8.9% to minus 2% this year. Rebuilding that economy will be an enormous challenge, as will

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getting into place an appropriate tax structure, particularly in relation to the extractive industries, to provide a robust tax base for government spending on health and social services.

I should like to highlight one decision of the UK Government which contributed to the economic problems—halting direct flights to and from the country. I believe, along with the Public Accounts Committee in its report last Session, that the Government were wrong to halt those flights, not least because indirect access to the UK actually makes it more, not less, difficult to track and screen travellers. I strongly support the recommendation of the Public Accounts Committee that direct flights to Sierra Leone should be restored as soon as possible. In its response in March to the Select Committee, the Government said that they would keep the situation under review. I hope that the Minister will tonight give us some cause for optimism that licences to fly direct to Freetown will be restored in the very near future.

I visited Sierra Leone in February this year and saw for myself the commitment of UK volunteers, particularly in the health area, through UK-Med and other agencies, to helping Sierra Leonean colleagues and those from all over the world in the fight against Ebola. I know that many are keen to continue to support the health service in that country so that it can provide resilience against further outbreaks and basic health rights for the population. However, there are a number of issues about how that commitment could be maximised and how the Department of Health and the NHS could better support medical volunteers. They include looking at the impact on training programmes when people leave their jobs for a time, pension contributions, and the possibility of pre-release agreements with employing trusts.

Across the world, in the global response to epidemics such as this, every country, as well as the world community, needs to put in place resilient and immediate measures that can be brought forward in the case of need, and not have the sort of delays we saw with Ebola. The Royal College of Paediatrics and Child Health has, along with other colleges, put forward suggestions in this area, as has Dr Oliver Johnson, who led the outstanding work of King’s Health Partners at the Connaught Hospital in Freetown and beyond. I hope that the Minister can tell us that discussions are ongoing between her department and the Department of Health to progress these issues.

Just as the Ebola crisis went much wider than health, so did the UK’s contribution, with crucial programmes delivered by many NGOs, supported by the British public’s generous response to the Disasters Emergency Committee’s first ever health appeal. I particularly highlight the work of young Sierra Leoneans in the wide-ranging community-based social mobilisation programmes which were central to halting transmission through unsafe burial practices and to persuading people to notify the authorities of cases, providing food for families in quarantine, caring for some of the 8,000 children who lost their parents to Ebola and supporting Ebola survivors who suffer both from stigma and from long-term health effects of the disease. No one visiting could fail to be impressed by the work of

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our High Commission, led by Peter West, the staff of DfID, many of whom put their own lives and families on hold for months at a time, and, of course, the British military presence, which was so crucial to setting up the national emergency response centre and district centres throughout the country.

I also visited the Sierra Leone Parliament when I was in the country, and heard of the challenges in strengthening scrutiny of government and democratic accountability in the complex society, with many parallel power structures, that is Sierra Leone. I know that the CPA UK branch and the Westminster Foundation for Democracy are looking at how they, as partners, can, together with the FCO and DfID, aid this process and support, in particular, women Members of Parliament who feel very estranged from the levers of power in their country.

President Koroma showed real and effective political leadership throughout the crisis, but institutions in the country were put to the test—as, indeed, were international institutions such as the WHO—during Ebola, and no one can deny that there were real problems of both leadership and governance. At the EU meeting in Brussels this year, the leaders of the affected countries recognised the need to improve public administration and financial compliance and requested international support for long-term recovery and development plans for the region.

Just as the challenges for Sierra Leone are multifaceted and its national recovery plan will entail long-term commitment, so are the opportunities for the UK; from our science contributing to the search for vaccines, diagnostics and medicines to health service strengthening; from governance and financial advice to promoting the rights of women and children. Some great collaborative work was carried out during the Ebola outbreak. I hope that the Minister can assure us tonight that Her Majesty’s Government intend to bring all the strands together and put in place a long-term, funded and comprehensive plan of support for Sierra Leone, working alongside its Government and people.

7.43 pm

Lord Patel (CB): My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate. She has already said much of what I might have said, so I will deviate from what I was going to say and pick up some of her points and hope to enlarge on them.

One lesson we must learn from the Ebola crisis is that whatever we did in the past to support poor countries to build their health systems and their societies has not worked, otherwise this would not have happened. I repeat the noble Lady’s commendation of the volunteers who went from this country and others, at great risk to their own health, when the death rate from this infection was 90%. They took that risk and they need to be commended on it. Mostly, they were young people.

The noble Lady also mentioned the WHO response, which was initially poor. It did not have enough experts on the ground to do the necessary surveillance. It was slow in declaring an international emergency. It may have been preoccupied with the damage that the crisis

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might do to the economies of these countries, rather than declaring an emergency, which would have protected citizens. Yes, the death toll could have been higher if it had not been for the international response, including the United Kingdom’s, which was immediate. None the less, the WHO failed in that, so the first thing we need to ask the Minister is, what are the Government now doing to work with the WHO and the expertise that we have in the United Kingdom and countries such as the USA to help the WHO build in future a more resilient system of surveillance?

The noble Lady’s next remarks were about the health system. The health system in that country, which was fragile to start with, has now collapsed. She referred to maternity services. The maternal mortality rate in Sierra Leone is 1,100 per 100,000. Last year 1,200 women died during childbirth. Neonatal mortality is 49 per 1,000. Under-5 infant deaths are running at 160 per 1,000. The maternal mortality rate has gone up by 20% due to the complete collapse of emergency obstetric services. She mentioned the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine which is helping to build assistance and which needs to be supported. So does the Royal College of Paediatrics and Child Health, which is trying to build services and train doctors, who are now very few—200 health workers have died, some of them doctors, and others have left the country. We need to support these organisations.

Health systems are linked to the economy of the country. Sierra Leone spends $25 million on health and $32 million on education. It gives away 10 times the health budget in tax incentives to overseas companies, some of them British. These are dollars that it could use for building health and education systems, but it does not have it. Is it not perverse that while people die in these poor countries, companies from richer countries seek tax incentives? Should not part of our help in assisting Sierra Leone now to recover include some advice and assistance in the ability to use its own domestic resources, including help with tax policies, so that the country can have better financial resources to support its health system?

The noble Baroness referred to the fact that more deaths are now occurring because of the collapse in the health system due to tuberculosis, malaria and HIV/AIDS. Referrals to doctors and the health system have completely failed. Fewer than 20% of pregnant women now seek help during pregnancy or attend antenatal classes. If this is not stopped, maternal mortality will keep rising, as will stillbirths and neonatal deaths. I ask the Minister about our response to the WHO, our help in building health systems and our help in building the economy of Sierra Leone.

7.48 pm

Lord Giddens (Lab): My Lords, as the noble Baroness, Lady Hayman, has indicated, the fact that the Ebola outbreak in west Africa has gone from being everywhere in the news to nowhere is an example of the capricious nature of the media. This debate is, therefore, very timely, because we have to keep public attention focused on the issues, and I congratulate the noble Baroness for having initiated it so ably.

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Unless aid and assistance continue to flow to Sierra Leone and other affected countries, far more people could die from the knock-on effects of the epidemic than have perished from the disease itself. The level of disruption to infrastructure, including but not limited to the health system, has been quite staggering. This is in spite of the wonderful work of overseas volunteers, to which other noble Lords paid tribute, including from this country.

A sustained economic recovery will be crucial but will be very, very hard to achieve. Of the three countries affected by the epidemic, Sierra Leone has suffered by far the most on an economic level. In 2013, having recovered from years of internal strife, Sierra Leone ranked second in the world in terms of GDP growth. It was an extraordinary moment. The country started from a low base of course; nevertheless, to achieve a ranking of second in the world in terms of economic growth after all those years of disruption was a quite remarkable phenomenon.

Since then, the country’s economy has more or less collapsed. According to the World Bank, this year Sierra Leone faces an acute recession, with a negative growth rate of no less than 23.5%, which I can assure noble Lords is catastrophic in terms of its size and implications. Let us compare that with, for example, Liberia, which is projected to have a positive growth rate of 3%. In the case of Sierra Leone, foreign capital has mostly fled the country, as have some of its richest citizens.

I have three sets of questions that I would like the Minister to comment on, recognising that she will not necessarily be able to answer all of them. First, in April this year the World Bank promised no less than $1.62 billion for Ebola response and recovery. What is the status of this money? Is it merely a promise? Does the noble Baroness know how much of that sum is there? On the surface, it is a substantial amount but I was not able to discover its exact status. What is the timescale by which it will be invested? It is clear that upfront investment is needed and that a great deal is needed very rapidly. What proportion of that money is likely to go to Sierra Leone? I could not find that in the World Bank literature either. If the UK is making a direct contribution to that sum, how much is it contributing, and how would the questions that I have just asked in relation to the World Bank apply to the UK’s contribution?

Secondly, the presidents of the three countries affected by the outbreak have requested that international donors cancel their debts. Has any progress been made on this? It is quite crucial because the level of aid was substantial. If this could be done, it would provide enormous economic leverage for Sierra Leone. If the UK Government have a position on this issue, it would be good to know it.

Thirdly, a recent UNDP report rightly emphasises that women need to be at the centre of all efforts to achieve recovery. Women made up a large majority of the labour force prior to the outbreak of the epidemic, and, as in many other countries but especially in Sierra Leone, were doing two jobs: looking after the family and working pretty much full time, especially in small-scale micro-entrepreneurial enterprises. The female labour force was absolutely crucial to the statistics that I gave

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earlier, which showed that the country was entering a period of quite significant economic take-off before the epidemic broke out. The latest figures show that more than 40% of women in the labour force at the time of the epidemic have withdrawn. Many have gone back to their families, devoting themselves to care rather than to the economy. Most of the women who have left the labour force were in agriculture, which is still the backbone of the economy in Sierra Leone. What strategies does the Minister know of that are in play to target investment efforts specifically at women in the labour force?

If you put these three things together, the international community seems on the surface to be coming up with substantial resources, but, as we know from many other situations, these tend to evaporate in the face of actuality. Therefore, is there anything that the Minister can say about the reality of these sums of money, especially the World Bank investment programme, which is designated as a sort of Marshall plan for the country? If that had some substance, it could be very important for Sierra Leone’s future and recovery.

7.55 pm

Baroness Masham of Ilton (CB): My Lords, I thank my noble friend Lady Hayman for having secured this debate on the catastrophic epidemic and its results in Sierra Leone, one of the countries in west Africa affected by the Ebola virus. With cases of this very infectious condition still appearing, it is clear that the epidemic is far from over. The efforts to end it must not be relaxed.

The medical personnel who have been helping in Sierra Leone rightly have the admiration of many people. It was good news that the nurses who developed Ebola and came back to be treated in the special unit at the Royal Free Hospital recovered, but I take this opportunity to ask how, with all the training that they had had, they became infected. It is important that that is known so that others learn from it. Prevention of infection when working first hand with infected people is vital.

A total of 869 confirmed cases of health worker infections have been reported from Guinea, Liberia and Sierra Leone since the start of the outbreak, with 507 reported deaths. It is said that the initial response by WHO regional staff was slow and poorly targeted, and it has since been heavily criticised as one of the contributory factors in the early expansion stage of the epidemic. It is notable that the WHO Global Outbreak Alert and Response Network, which had such a pivotal role during the SARS outbreak, was mobilised at a late stage after other groups, including Médecins Sans Frontières, had been in action for weeks or months. Even at that point, the WHO concentrated on advisory support rather than mobilising logistics, and clinical and diagnostic support. Several UK agencies, including Public Health England and the Defence Science and Technology Laboratory, were among the European groups to get specialist manpower on the ground at an early stage.

I cannot stress enough how important microbiology and pathology are in combating infection. I think that sometimes the value of their contribution to tackling

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epidemics is not highlighted enough. At the latest G7 summit, responding to lessons from the Ebola crisis, G7 leaders pledged to help strengthen the world’s ability to prevent, detect and respond to disease outbreaks. I quote from the Society for General Microbiology:

“Emerging zoonitic diseases … pose an increasing global health and economic security threat. Recent outbreaks include Ebola, H1N1 swine flu and severe acute respiratory syndrome … An interdisciplinary ‘One Health’ approach involving human and animal science, health and policy is vital for mitigating this threat”.

There is a huge need for public health improvements. Acute infectious diseases remain the leading causes of mortality, and children under the age of five are disproportionately affected. Since the Ebola outbreak, the impact of malaria has almost certainly increased owing to reduced and/or delayed access to treatment, leading to increased case fatality rates. There is only one paediatrician in the whole of Sierra Leone. Maternal morbidity rates are very high. Over 70% of the population live in poverty and, therefore, the majority of the population’s basic need for food and water is not satisfied. Half the population in Moyamba drink from unsafe water sources. There are few areas with adequate sanitary facilities. One-third of children are stunted; malnutrition is common and under-recognised. During the Ebola outbreak, when the need has been great, the supply of supplementary food has stopped. Thus, unmet nutritional needs of the population have increased.

The current Ebola outbreak is reducing and efforts will continue towards its elimination from the country, but the population will remain at risk of future outbreaks. There is a desperate need for ongoing education. Changes in behaviour such as hand-washing and safe burial practices reduce this risk but the population risk profile has not dramatically altered. There is still a high consumption of bushmeat in Moyamba and other rural areas of the country. I congratulate BBC Media Action on its programme “Kick Ebola out of Sierra Leone”, which it is producing in partnership with Cotton Tree News, broadcast on 40 radio stations across the 14 districts. In recent months, the programme has evolved to focus on concerns about complacency.

I hope the Government will give money to this very poor country. There are successful, rich countries which are getting our support: why not give it to these countries in west Africa?

8.02 pm

Lord Crisp (CB): My Lords, like others I congratulate my noble friend Lady Hayman on this very important and timely debate. I also, like others, congratulate the many people from the UK who are playing, and have played, a significant part in tackling these dreadful events. I also note that this is a devastated country. The health issues go far beyond the direct effects of Ebola and there are the economic impacts which we have heard described so fluently. These impacts have been on business, tourism and trade in a country which already had a fragile infrastructure.

When I talk to friends working in Sierra Leone, they tell me that the first thing that the UK and other donors need to do is maintain continuity of support. They pick out three particular areas. The first is sustaining

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help for local communities to achieve better hygiene and infection control, otherwise there are—as we know—going to be continuing new outbreaks. The second thing they advocate is using some of the money which is now available to continue supporting the salaries of health workers in Sierra Leone and to redistribute some of those health workers to rural areas. The third area is surveillance. We still do not have a very clear picture of what is happening throughout the country and a major effort is still needed there. The final point which has been made—on which I have asked a Written Question and received a reply from the Minister—is about research on rapid diagnosis and other technologies which are starting to be available and the importance of deploying them. A lot of it is just about continuing what we are doing now.

My second point is about learning lessons. I congratulate everyone but I hope that the British Government and others will be listening to the frustrations and learning frankly from many people about problems that have occurred—not just the well-publicised problems with the WHO, but the problems of co-ordination and communication between different agencies and how we can do that better. I also hear some disquieting things about competition between donors and agencies for credit or resources. Those are very worrying aspects of what has happened.

In addition to the existing support, there is a real need for integrated action from the many British agencies that want to help. My noble friend Lady Masham has already mentioned BBC Media Action. Various other people have written to us to say what they can do to help with support. Perhaps the biggest need is for more health workers, a point which the noble Baroness made in introducing the debate. I note the offer from the Royal College of Paediatrics and Child Health to bring together the royal colleges on training more health workers. I will come back to that important point, because this is about Africa, not just about what we Brits can do. It is worth noting that Ebola was stopped in its tracks in Uganda, Nigeria and even in the DRC without external intervention. People had just enough skills and abilities to do that. Africans have contributed an enormous amount to this and there is some fear about directive intervention from outside as a result of these problems. There is a danger that we will—with the best will in the world and the best intentions—be imposing our solutions from outside rather than from within.

There is a considerable African response; there is great community knowledge. We should be able to draw on African leadership and not perpetuate the dependence which is too often associated with aid. It is interesting to note that the World Bank, and others, have picked up on the important point of developing and training community health workers: local people who understand local customs and are better able to institute and support changes in customs that may be dangerous and to introduce new habits and norms to promote health, well-being and hygiene. I hope the Government, and others looking at this, will think about education and training in terms of three levels. The first is the need for community health workers who are local people—very often village women—who are trained to identify and support things at a local

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level. Then there is the need for classic, African, mid-level nurses and other workers who are doing things that doctors do in our country. There is also the need, proposed by the Royal College of Paediatrics and Child Health, for the specialists: more paediatricians and clinicians of various sorts. There needs to be an integrated education and training plan but, importantly, this also needs to involve the development of institutions. The noble Lord, Lord Giddens, referred to a Marshall plan. There is a need here for the sort of approach that recognises that it is not a matter of training a few health workers, or providing a few drugs and facilities: it is institution-building and supporting the development of the economy.

Finally, I hope the UK will play a major role here. We have so many people who are willing and able to help, coming from all sectors of our community. It would be interesting to hear from the Minister about how this will be handled but I suggest that there is a great deal to be gained from bringing together some of these people, who may be outside the normal DoH and Department for International Development systems, and challenging them on how they can help, always bearing in mind my point about African leadership. This is about Sierra Leone, but it could also be about showing what can be achieved by a determined global effort in a country that needs global solidarity.

8.08 pm

Lord St John of Bletso (CB): My Lords, it is always a pleasure to follow my noble friend Lord Crisp, with his deep knowledge and passion for healthcare improvement in Africa. I join him in thanking my noble friend Lady Hayman for introducing this topical debate on a subject that, sadly, has had very little media coverage of late.

Although much of the recent World Heath Organisation report on the Ebola situation in Sierra Leone makes encouraging reading, major challenges still lie ahead to eradicating the disease, particularly preventing cross-border traffic between Sierra Leone and Guinea. More needs to be done to contain the threat in the northern provinces of Port Loko and Kambia. The Sierra Leone Government, with their limited police force and army, are severely restricted in fully monitoring checkpoints.

There is no doubt that the long-term effects of the Ebola outbreak will linger for many years to come, posing challenges not just for healthcare workers but for communities right across the country that are left with many hundreds of thousands of orphans. The charity Street Child UK is to be commended for its incredibly impressive and great work supporting those orphans. For the immediate future, one of the greatest challenges facing the country will be youth unemployment. Although there have been a number of initiatives to create jobs and kick-start growth in the country, this is an uphill battle. With extensive mobile coverage right across the country, I believe that a lot more can and should be done to provide affordable broadband, particularly in Freetown.

With commodity prices having collapsed over the last few years, the mining sector in Sierra Leone is currently not sustainable, with a chronic lack of adequate

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infrastructure and access to power. However, as the noble Lord, Lord Giddens, mentioned, the agricultural sector has a chance for hope in the future. The agricultural sector, where most of the population works, unfortunately has very disheartening statistics showing that coffee, cocoa and all types of tropical fruit are rotting on the trees, with lots of fields remaining fallow, as local farmers do not have adequate equipment either to harvest or to take the produce to market.

My noble friend rightly mentioned the problem of malnutrition. I recommend that assistance be given to finance a form of co-operative among the farmers, not just by helping them to finance their equipment but by training them to potentially build more food processing factories for the local market. I believe that there is huge scope for more beneficiation within the country. If one goes into Freetown, one will see that the supermarkets, many of which are run by Lebanese traders, offer tropical fruit cartons and bottles, but almost all of these are imported.

Sierra Leone desperately needs more clean water, not just for Freetown but in the villages and provinces. In the dry season, the main water sources are rivers, streams and abandoned mine workings. Most of these sources are contaminated, which is a major source of high mortality for the very young, the very frail and the elderly. Solar-powered water pumps in the villages could be a major boost for the provision of clean water.

On a brighter note, Sierra Leone is blessed with some of the most beautiful beaches in the world, comparable to those in the Caribbean and the Seychelles. I believe that, in the future, once the outbreak has been tackled, there is huge potential for the tourism industry.

In conclusion, our Government, in conjunction with our European partners, have played a pivotal role in tackling the epidemic and, just as importantly, in putting measures in place to reduce the chances of another Ebola outbreak. We have been instrumental in rebuilding the political and socioeconomic infrastructure after the civil conflict that ended in 2001. In March this year, west African leaders called for a “Marshall plan” to help with regional reconstruction after Ebola, saying that the region is “coming out of a war”, with its economy and public services decimated. One of the key lessons from this devastating EVD disaster is the need for the Government of Sierra Leone, as well as the international community, to take proactive measures to prevent another disaster.

8.14 pm

Lord Collins of Highbury (Lab): My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate.

The Government’s response to Ebola has been positive, providing more than £200 million for treatment, facilities, expediting NHS staff who have heroically volunteered, helping to finance trials, and developing new treatments and vaccines for Ebola. The role of the volunteers has been significant, and I, too, very much welcome the Government’s decision to provide a new medal that will recognise their bravery and hard work.

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Sierra Leone is one of the poorest countries in the world and had one of the most fragile health systems. Over decades, it has had insufficient investment in infrastructure, the healthcare workforce, the health information system, and medical supplies and equipment. Therefore, has the department, in considering the lessons of the outbreak, reversed or rethought any planned funding cuts to Sierra Leone?

Universal health coverage can make countries more resilient to health concerns such as Ebola before they become widespread emergencies. I therefore welcome the clear commitment given by Ministers in the House in recent debates to support universal health coverage, free at the point of access, in the language of the health goals in the forthcoming negotiations over the SDGs.

Last week, I attended a meeting with Professor Chris Whitty, chief scientific adviser to DfID. A key part of the discussion was the impact of Ebola on other diseases, highlighted by the noble Baroness, Lady Hayman. It is clear that the gains made against malaria, for example, are at risk as health systems are pushed to breaking point and people avoid using them because they fear contracting Ebola. As we have also heard, many children have missed out on routine vaccination services, and since 2014 measles outbreaks have been reported in the country, mostly among children under five. I, too, welcome the commencement of mass vaccination programmes, including those for measles and polio for children under five, which are going into all districts and should benefit more than 1.3 million children. However, what steps have been taken to ensure that we are offering other health services alongside the strategies for containing and eliminating the Ebola virus in Sierra Leone?

According to Save the Children, nearly half the population of Sierra Leone is under the age of 18, and the impact of the Ebola crisis on their lives now and on their future opportunities has been far-reaching: no school, loss of family members and friends to the virus, and changing roles and responsibilities in the home and community. What steps has the department taken to support the Government of Sierra Leone in developing a comprehensive strategy aimed at getting the country back on track to meet development targets?

As we have heard in the debate, building the economy is another critical factor. The impacts of the Ebola crisis are likely to linger well into the future, and economic recovery will hinge on understanding which sectors and groups need the most support to get back on their feet, as highlighted by my noble friend Lord Giddens. Private sector investment is critical, and it is good to see the CDC leading the way on this. However, when supporting the private sector, prioritising those industries that provide much-needed infrastructure to the health system, such as communications and energy providers, is important.

One other clear lesson highlighted by the noble Baroness, Lady Hayman, has been the vital role of community engagement, which all too often has been regarded as a soft and relatively non-technical add-on to medical interventions; the noble Lord, Lord Crisp, also highlighted this. The Social Mobilisation Action

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Consortium brought together BBC Media Action, Centers for Disease Control, FOCUS 1000, GOAL and Restless Development, all funded by DfID. Through working with young volunteers, community and religious leaders and partner radio stations covering every district in the country, it has achieved tangible behaviour change around safe burials, early treatment and the social acceptance of Ebola survivors. I urge the Minister to take the opportunity of this community engagement infrastructure and the large-scale behaviour change achieved in this crisis to address other issues such as child marriage, teenage pregnancy and female genital mutilation.

If we are to stop this threat, we must continue to support the Government of Sierra Leone to develop their capacity, address corruption and ensure that they have the technical and administrative support to work effectively.

8.19 pm

The Parliamentary Under-Secretary of State, Department for International Development (Baroness Verma) (Con): My Lords, I join noble Lords in congratulating and thanking the noble Baroness, Lady Hayman, for securing this debate, and I commend her on her long-standing commitment to international development and health. All noble Lords’ contributions today have highlighted the passion and commitment that we in the UK place on the challenges and plight faced by those who face such tragic circumstances. I thank the noble Lord, Lord Collins, for his supportive opening words on the Government’s response, and welcome his noting of our wish to honour those courageous people who put themselves at the forefront of supporting the recovery from such a crisis.

As we continue to work with the Government, the people of Sierra Leone and the region to defeat Ebola, it is right that we come together at this time to discuss the situation on the ground and how the UK is supporting recovery. We recognise the loss of life, and I agree with the noble Baroness, Lady Hayman, the noble Lord, Lord Patel, and other noble Lords that the bravery of and personal risk taken by front-line workers in tackling this disease show the need for continuity as we continue.

As noble Lords will be aware, the UK has played a major role in successfully responding to the devastating Ebola virus in Sierra Leone. Ebola case numbers have reduced from a peak of more than 500 in the final week of November 2014 to an average of fewer than 10 new cases a week. That is still 10 cases too many, but the numbers have come down dramatically over the past two months. The UK has shown incredible leadership, mobilised the international community and efforts to tackle Ebola in Sierra Leone and helped to halt the spread of the virus within the region and beyond.

A number of questions have been asked today. Given the time, if I do not manage to get through all the responses I will undertake to write to noble Lords on the questions that have been posed. The challenging circumstances presented by this outbreak of Ebola demonstrated the UK Government’s ability to work together, drawing in—as noble Lords have highlighted today—capacity and expertise from across DfID, the

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MoD, the FCO and the Department of Health, delivering impact greater than the sum of its parts. These efforts have not only saved countless lives in west Africa but helped to prevent a health crisis that could have been far deadlier than it was and presented a greater health risk to the UK and the world.

Liberia was the first country to overcome the disease, with the WHO declaring it Ebola-free on 9 May this year. While the epidemic is still not over in Sierra Leone and Guinea, we are well on the way to zero and are acutely focused on finishing the job. President Koroma of Sierra Leone has ordered a renewed drive to accelerate the pace and to get to zero in chiefdoms where the disease is proving to be the most intractable due to community resistance and often very poor living conditions. Surge activities are involving paramount chiefs, traditional healers, women, religious leaders, youths and particularly social mobilisation. We will make every effort over the coming weeks to get to and sustain zero as soon as possible.

Beyond these areas, the vast majority of the country has seen no new cases for weeks, if not months, and recovery planning is getting under way. The Government of Sierra Leone have developed a transition and early recovery plan for six to nine months to get health and education services up and running again and to kick-start economic growth. It focuses on building back better and increasing the role of the private sector in economic development, a point made by a number of noble Lords. I will come to some of those comments if I have time.

I am pleased to say that we have allocated £54 million for early recovery that will focus on these areas, including a focus on women and girls, as was so rightly pointed out by the noble Lord, Lord Giddens, and the noble Baroness, Lady Hayman. We are using the upcoming UN Secretary General’s International Ebola Recovery conference on 9 and 10 July to encourage partners who played an important role in tackling the epidemic to help the country to get back on its feet and commit to fund the gaps in the plan. As recovery gets under way, we will work with the Government of Sierra Leone on their longer-term development objectives and shape DfID’s programming in line with those.

I also draw noble Lords’ attention to the important work we are doing to learn from this crisis and improve global health security. During the Ebola crisis, DfID funded research with the Wellcome Trust, the Medical Research Council and others to develop new vaccines, therapeutics and diagnostics on a scale not seen in previous health crises. This helps to build longer-term resilience against diseases with epidemic potential and supports better identification and understanding of future epidemic and disease threats.

Improved global health security will also benefit from safe, effective and affordable health technologies and strong health systems. In Guinea, Liberia and Sierra Leone we saw the impact of weak, ineffective health systems and the failure of these countries to meet their obligations under international health regulations. Building effective national health systems is key, and DfID along with other government departments will draw on the Ebola experience to strengthen our work on global health security, which

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is a prime-ministerial priority. I hope that that gives the noble Lord, Lord Patel, an assurance of our commitment to a longer-term solution.

We have heard some outstanding comments on the challenges that the Ebola crisis has posed for west Africa and globally. We can be proud of how UK citizens from the Armed Forces, the health service and charities, and government officials, have supported the people of Sierra Leone to combat the crisis and now begin along the road to recovery.

Before I conclude, I have time to go through some of the questions that have been posed, the first of which was a general group of questions alluded to by almost all noble Lords. The noble Lord, Lord Patel, and the noble Baroness, Lady Hayman, asked about our planning for early recovery and what our support would be. The priority for the UK Government has always been to get to zero cases as soon as possible and to prevent outbreaks in any new countries. The crisis has brought healthcare, education and economic activity to a halt in the affected countries, so we need to try to rebuild them. That is where our priority will remain: on recovery and transition plans, with the £54 million that we have committed. We will mobilise a team of people from McKinsey to work with DfID staff and UK military planners to help the President of Sierra Leone to develop the plan. We will support the building back of better services and help the Government to make the reforms needed for strong and sustainable development.

The UK is the largest bilateral donor to Sierra Leone, and as the Prime Minister set out at the G20 meeting we are committed to supporting long-term recovery across the region. We do not want to make short interventions, and we are supportive of the President’s long-term plan. This is a real moment for change, because we will be able to help to define how international assistance can make the best contribution to tackling poverty and accelerating development over the coming years.

The noble Baroness asked about direct flights. The response from the Government must first and foremost be the safety of the British people. The decision not to commit to direct flights was part of the Government’s overall strategy to mitigate the risk of Ebola entering the UK. The change in the Government’s position is only possible once we are content that there is no risk to the British public and that the risk has been sufficiently reduced.

A number of noble Lords asked about the reform of the WHO and what we are doing. We have been driving WHO reforms since 2010 following the Ebola crisis. We have reassessed ongoing reforms and accelerated progress to improve its effectiveness alongside ongoing improvements in human-resources processes, including the adoption in January of this year of the new staff mobility policy and a much more robust performance management policy. We will continue to highlight with organisations such as the WHO, where we need to, the need to make sure that they are delivering and responding quickly and effectively to countries so they do not have to wait for assistance.

On 7 June this year, the Prime Minister announced that the UK will establish a new group of six to 10 expert staff, mainly infection control specialists and

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infection control doctors, who will be on permanent standby, ready to help countries respond rapidly to disease outbreaks. We will ensure that the UK’s rapid reaction unit and the deployment of reservists through DfID-funded UK-Med will complement WHO’s global emergency workforce to ensure a co-ordinated response on the ground.

I have run out of time and I have a pile of responses yet to deliver, so I undertake to write to all noble Lords. This is a journey that we need to make together to build a better future for countries such as Sierra Leone.

Cities and Local Government Devolution Bill [HL]

Cities and Local Government Devolution Bill [HL] 1st Report from the Delegated Powers Committee1st Report from the Delegated Powers Committee2nd Report of the Constitution Committee

Committee (3rd Day) (Continued)

8.32 pm

Amendment 44DE

Moved by Lord Teverson

44DE: After Clause 9, insert the following new Clause—

“Function of making representations on transport issues

(1) The Secretary of State may by order provide that it shall be a function of a combined authority to make representations about transport issues affecting the area of that authority.

(2) If a combined authority has the function described in subsection (1), that authority shall be consulted on relevant transport issues.

(3) In this section “transport” means—

(a) rail,

(b) roads falling within the competence of the Secretary of State,

(c) airports, and

(d) ports.

(4) In this section “transport issues” includes—

(a) proposals for new transport infrastructure within the area of the authority, and

(b) changes to proposals or decisions previously announced by the Secretary of State on transport infrastructure within the area of the authority.”

Lord Teverson (LD): My Lords, this amendment was put forward by my noble friends Lord Shipley, Lord Scriven and Lady Pinnock. As we know, one of the key tasks of combined authorities—and one of the key areas where we expect there to be strong synergies, better co-ordination and economic stimulus—is transport and changing transport arrangements. We have seen how in London transport is absolutely essential, and an important part of the mayor’s role; in fact, many people would say it is perhaps the only effective part of the mayor’s role in London. Although we are not comparing London with the other metropolitan areas, it is still a very important area—we have seen that from the recent debate in terms of the northern powerhouse and all the transport arrangements around the Greater Manchester authority, and the others proposed in the north, and indeed joining up those combined authorities that are likely to happen in the north of England.

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The purpose of this amendment is simple. Given that this is such a core element of any proposal for combined authorities and the relationship between the Government and those authorities, there should be a very clear form of communication, consultation and exchange of information between those authorities and the Secretary of State. As and when those combined authorities come about, there is then an obligation, once it has been entered into, for the Government and the Secretary of State to communicate transport issues—whether that be rail, roads, airports or ports—with the combined authority, and for a consultation to take place. Clearly, this is important and part of what will happen.

This has been shown to be very important because, since we had the debate on the northern powerhouse and the transport elements and connectivity of that, already we have had a major change. The following week we heard that a core part of the northern powerhouse strategy—the electrification and improvement of the line on the TransPennine Express between Manchester and Leeds—is postponed. We hope that it is only postponed but it appears that we will all have to catch our breath and wait during the whole of the summer until Network Rail, in conjunction with the department, decides the fate of something that was seen to be absolutely core to the northern powerhouse and the new potential combined authorities.

There is no better illustration than this of why such a change in the Bill is required, in order that there will be real communication, advance warning and consultation between those authorities, the Secretary of State and the department, let alone all the public who are affected. That announcement, which was made so soon after we had the debate, and was apparently a surprise and a new announcement, came very soon after all the big promises and the energy that the Chancellor and others put into the concept of the northern powerhouse. This amendment is nothing more than a sticking plaster but we hope that it would work better for the future and ensure that such an incident does not happen again. I beg to move.

Lord Beecham (Lab): My Lords, there is a good deal of sense in this amendment. Of course, there are areas—my own is one of them—in which transport issues were effectively run, so far as the Metro system is concerned, for many years by the local authorities before the combined authority came into being. The combined authority currently oversees the function. In relation to roads in particular, I said at an earlier stage of the Bill that, in my part of the world at any rate, the experience of local authorities with Highways England—as I now understand it to be, as opposed to the Highways Agency—is far from satisfactory. What would be the relationship there? Would it be a direct relationship with the combined authorities—Highways England is not really organised on a basis comparable to local government—or would it be via the Secretary of State? It is a matter that needs clarifying. The general thrust in this is one which we would support.

Lord Scriven (LD): My Lords, I am pleased to put my name to this amendment and I thank my noble friend Lord Teverson for outlining the reason why it is

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necessary. On the face of it, it would not seem necessary to have such an amendment, apart from the announcement made last week with regard to major transport infrastructure and electrification of all the rails in the north of England. Let us assume that we have this new system of decentralisation or devolution, and a number of combined authorities and mayors are making significant investments in their areas with regard to the environment and the economy, having been promised that major infrastructure will be invested in to make their rail system faster and the major cities of the north connected, and to help economic activity and to speed up the way in which commuters and other people can travel.

Let us further assume that, with no consultation or prior warning, the Government pull that major investment, or pause it or kick it into the long grass—whatever phrase is used. For several years, combined authorities and mayors might have been making strategic investments about the location of economic zones or other infrastructure that fits on to the railways in which the Government said that they would invest. That is why the provision needs to be in the Bill. The Minister said that such things would of course be discussed and a requirement did not need to be written into the Bill, but we now have a real case in which dozens of leaders in the north of England have not been consulted about a major change in government infrastructure funding.

We have gone from the northern powerhouse to the northern power cut in the blink of an eye. We are talking about devolution and decentralisation in which significant responsibilities and money for transport will be handed down to local areas, and strategic decisions will be made not in a vacuum but in relation to national government infrastructure. Local areas will be not only consulted but seen as equal partners so that their investments and plans are taken into consideration when the Government invest; and so that the Government keep local areas informed truthfully, openly and honestly about decisions on infrastructure, whether roads, rail, ports or aviation. This is not a made-up scenario; it is a real scenario that happened last week. It is important that it is written into the Bill that areas that have devolved powers should be consulted or warned about government transport infrastructure decisions, and that the area’s ideas are fed into the national plan.

I am happy to support the amendment and I ask the Minister to accept it. Last week shows exactly why the amendment needs to be in the Bill. We need to enable not just the Government but combined authorities, which will be making significant decisions about their local transport systems, to make strategic decisions.

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Williams of Trafford) (Con): My Lords, I will respond first to the point made by the noble Lord, Lord Scriven. I will talk later about the Northern Hub and my perspective on it, having worked on it some years ago.