Question for Short Debate
My Lords, I hope noble Lords will find it helpful if I remind the House that the next debate is a time-limited debate and, with the exception of the noble Lord, Lord Noon and my noble friend the Minister, speeches are limited to four minutes. The right reverend Prelate the Bishop of Hereford has also requested to speak in the gap.
My Lords, the Government’s revised Prevent strategy was presented to Parliament in June this year. It is an integral part of the broader fight against terrorism and I welcome the opportunity to have this short debate about the implications of this strategy, and of extremism and integration. The thinking behind Prevent was that there needed to be a proactive response to the threat of so-called home-grown terrorists. I do not want to speak about the merits or failure of the original strategy. Other noble Lords, including my noble friend Lord Carlile, who provided the important independent oversight for the review of Prevent, are much more of an authority on this issue than me.
I am not a policy man, I am a businessman and I like to speak my mind in a straightforward way, which, in business as in life, is usually the best way. You may be aware that I have been a victim of deadly terrorist attack not once but twice. The extreme fear that I and my family experienced, the shocking uncertainty of being sandwiched between life and death, brought home forcefully the grief and devastation of the families who suddenly, unexpectedly lose loved ones. We have seen this horror here in the UK with the 7 July terrorist attacks in London. What is worse is that the 7/7 attack was carried out by young men born and brought up in the UK. The Prevent strategy is supposed to stop people from ever going down this path. It is about confronting people at an early point so that they do not become extremists.
Christians, Jews, Muslims, Hindus, Sikhs, Jains and Buddhists all have the right to practise their religion freely in Great Britain. The strong civil rights movement here ensures that we can express our religious and political beliefs freely. At the same time, there is a thousand years of tradition of the supremacy of the law—we must abide by the law even as we practise in private the faith of our choice. What has gone wrong is that a tiny minority refuse to accept that. Instead they wish to impose their beliefs on the majority. Noble Lords will agree with me that the majority of Muslims are law-abiding, peaceful and patriotic citizens, as was reported in the Sunday Times on 20 November. I see no conflict between practising Islam and abiding by the rules of the law of this country, and I speak as a Muslim.
I have expressed my views many times, in speech as well as in print. People who do not accept the British way of life should find another acceptable country where they can live happily, and leave us alone. Often they come here as economic migrants and then oppose our common values. In many cases, they are running away from harsh regimes that do not permit dissent. I am a staunch supporter of the British values of democracy, decency, fairness and integration. I say, live and let live. We should give a robust retort to those who oppose integration: we cannot have small, independent enclaves within our country that are a law unto themselves. I agree with the Prime Minister’s words in Munich earlier this year that we have not done enough in standing up to those who oppose our way of life.
I find it confusing that the Prevent strategy makes a distinction between two things. On one hand, the strategy says that having a strong sense of belonging and citizenship makes people more resilient to extremism. Then, on the other hand, it states:
“Policy and programmes to deal with extremism and with extremist organisations more widely are not part of Prevent and will be co-ordinated from the Department for Communities and Local Government”.
Could the Minister tell me what these wider policies and programmes are that are not part of Prevent? Surely these are things that promote cohesion, interfaith dialogue and citizenship. If the success of the programme depends on our sense of belonging—which is what I call integration—then how could this not be a part of Prevent? By separating integration and extremism, the Prevent strategy will create its own pitfalls. How do local councillors know what to do? Where is the guidance that explains how to know the difference between an extremist acting against our country and others who need support and direction to become more integrated? Where is the line drawn between dealing with extremists and promoting integration? Surely these are two sides of the same coin.
What about young people? How will the youth worker or the teacher know what to do? We need a strong initiative for the youth; after all, it is the youth who get lured into extremism at youth clubs and universities. The hunting fields for fresh recruits to terrorism are the stamping grounds of young people. That is where we need to be: to reorient them into a life of decency; to give them a sense of belonging; to make them proud to be British; and to make them see that using religion as an excuse for violence goes against its very tenets.
What about the police? I often speak to them on this issue. I ask them why individuals or groups who are violently opposed to our way of life and the laws of this country are allowed to be here. The police say that their hands are tied; they often have no case. It seems that the human rights of criminals outweigh those of the rest of us law-abiding citizens. Even when they manage to bring such a person to court, the Crown Prosecution Service tells the police that the criminal is the one who needs protection. It strikes me that in trying to make Prevent more focused, the Government have risked making it less effective. Even more seriously, I believe that this fudge makes things much worse. It risks further alienating those communities that feel the most stigmatised and targeted by Prevent, especially the Muslim community.
The danger of focusing only on a certain religious group was made clearer to us by the terrible events in Norway in July this year, when a right-wing extremist not only set off a bomb in the city, killing eight people, but then went on to shoot and kill 69 innocent children and young people who were taking part in a summer school. Such acts of extreme violence are not restricted to ideology, whether religious or political. Rather, these terrible acts are born of hatred, racism and ignorance. We ignore these risks at our peril.
In summary, I have a very simple bottom line, which is that preventing terrorism depends on strengthening integration. In my straightforward way of looking at things, there is definitely a problem because the strategy actually causes confusion about this issue. I welcome the idea that we need to confront people more when they express extreme ideas such as threatening to burn poppies, abusing our brave soldiers returning home from the front line in Basra or asking for Sharia law in this country. Let us not forget honour killing, although I do not know what honour there is in killing. Surely this is not acceptable. We need to go further. We need to ensure that we not only confront these people but that we actually deal with them in order to protect the citizens of this country. We need to be clear that this is about anyone who opposes our way of life, anyone who does not clearly stand up for democracy and freedom of choice. Integration is our greatest strength and we must not allow our resolve to protect it to be weakened by a muddled approach to extremism.
I am sure that noble Lords will have many further issues that they wish to bring to this debate, and I look forward to hearing them.
My Lords, first, I thank the noble Lord, Lord Noon, for initiating this debate.
9/11 and 7/7 changed Britain and the world. From London to Lahore, from New York to New Delhi, terrorism cannot be ignored. A new kind of terror emerged with 9/11, as we saw on 7/7, attacking the very basis and basics of British society—a society enriched by its secular democracy, multitude of faiths and diversity of communities. The terrorists used the ultimate weapon, destroying their own lives to take the lives of others. They sought legitimacy then, as they do now, 10 years on, by cloaking their vile and heinous acts in the name of religion—of Islam. Yet these criminal acts are far removed from the principles of Islam which, not only in its teachings but in the essence of its very name, stands for peace. Islam unreservedly and totally rejects all forms of terrorism and violence. Islam—indeed, all religions—cannot sanction violence and bloodshed of innocent men, women and children in the name of God. However, the reality is that there are some who seek to hijack noble religions and principles, to perversely interpret them and through their misguided actions, often fuelled by extremist preachers, seek to bring about terror. As 9/11 and 7/7 demonstrated, they succeed in carrying out such acts.
Against this backdrop of real and present danger which surfaced 10 years ago and continues to this day, we need to take action on prevention and, more importantly, a permanent and lasting solution to eradicating this evil from our society. Therefore, I welcome the new Prevent strategy, for it recognises the need to tackle the ideological challenge and the threat from those who promote terror and extremism. It is not aimed at those with legitimate religious beliefs. As my right honourable friend the Prime Minister has said, to be devout in faith should not be equated to extremism; indeed, if you are truly devout about faith you are anything but an extremist.
Prevent deals with all forms of terrorism, but I seek my noble friend the Minister’s assurance that, while wider programmes dealing with extremism and its implications do not fall under the regime of Prevent—they are co-ordinated by the Department for Communities and Local Government—there is no disconnect between the two, as the noble Lord, Lord Noon, has said. I would further ask that educational programmes aimed at curbing the rise of extremism in our future generations—such as the excellent 9/11 Education Programme, launched nationally in September this year and already rolled out to 20 schools, supported by many, including my noble friend Lord Fink—are also co-ordinated with a more cohesive programme. I would also seek the Minister’s assurance that stringent steps are taken to eradicate these extremist preachers who come to our shores to preach hate. There should be a simple message sent to them: they are not welcome.
Prevention of terrorism, integration of communities —as the noble Lord, Lord Noon has said—and education of our future generations are all part of the same equation. They are three essential components which form the basis of eradicating extremism, protecting the deep-rooted and long-established traditions of our country and providing the lasting solution we all greatly desire.
My Lords, the noble Lord, Lord Noon, has asked a most important question. In the short time available I want to focus on integration and make one point. I wonder whether the answer to the noble Lord’s question is partly characterised by the speakers list that we have tonight—10 speakers. How many of us are what my late noble friend Lord Jenkins termed “ancient Britons”? I think it is a fair bet that the eighth Baron Henley is. I do not want to make assumptions about the noble Lord, Lord Rosser, but excluding the Government and Opposition Front Benches, look at our names. Mine is because my family, not very long ago, came from Hama in Syria—a place where I am very glad not to be.
Is it that our speakers tonight feel a particular responsibility to take part, and should it rest only on their shoulders? Beyond this House, have we made assumptions about who should integrate with whom, about who needs to take active steps and who can sit back and dissociate themselves from the issue? Have we made assumptions about “us” and “them”? Have we made assumptions about what Britain today is or should be? It is not the same as when I was born. It is not the same as when Victorians ruled the world—and on that subject I have said before in the context of immigration that I find the term, “the brightest and the best”, whom we are seeking to attract, very difficult because of its implications. It takes us to the question of what we think is the Britain into which we are seeking integration. Integration, of itself, does not secure loyalty to a set of values or instil patriotism; they are more than learnt behaviours. It is about a view of society and one’s place in it, and perhaps we should be talking more about social cohesion in a wider sense.
I know that far more is going on than just the Prevent strategy. Both noble Lords who have spoken have referred to this, but I think it is important not to do anything to consolidate the widespread view that a particular ethnic background or a particular faith and terrorism are in any way synonymous.
My Lords, I, too, want to thank the noble Lord, Lord Noon, for initiating this debate. The new Prevent strategy states that a clear distinction between counterterrorism work and integration strategy is necessary if it is to succeed and that the two must not be confused but, as has already been said, there is a fundamental link between fighting home-grown terrorism and creating a more integrated society. While the government strategy recognises that, we do not have a clearly understood and clearly articulated policy on how to develop a sense of belonging, how to create support for our core values or how to encourage integration. If anything, it is rather muddled.
Britishness was seized upon as a way of building a cohesive society, and multiculturalism was seen as divisive, but cultural diversity and pluralism do not threaten cohesiveness; inequality does. They are in fact the essence of Britishness. For a plural society to be successful, we need shared respect for and loyalty to the law of the land. In seeking to promote diversity, we must not stifle robust discussion or debate on issues that are of legitimate public concern, no matter how unpalatable they are. We need more, not less, freedom of speech to combat the propaganda promoted by extremism. We need open, frank dialogue and debate to enhance understanding between different communities and religious groups. We need to cherish diversity without undermining our common bonds of citizenship and respect for the law, thus helping what I call the evolution of a plural society through democratic processes. We need to work to inculcate this in our citizens, particularly the young. The Prevent strategy recognises the need to work with sectors and institutions where there is a risk of verticalisation. Universities are such institutions, not just as informers, though that may be necessary, but as promoters of free speech. Universities are reluctant, for they fear to be seen as curbing freedom of speech. Propaganda machinery must not be allowed to hide behind the pretence of freedom of speech and claims of human rights. Distorted and loaded messages that manipulate the young must not go unchallenged. Universities are well placed both to challenge propaganda designed to radicalise students, and also to provide experience of rational debate in safe spaces. As John Ruskin said,
“Education does not mean teaching people to know what they do not know—it means teaching them to behave as they do not behave”,
as members of the family, of the community, of the nation and of the world. To succeed in the long run we need to challenge and deal with those promoting extreme ideology, but also to provide safe spaces like universities and other educational institutions, where learning about citizenship can take place. We also need to develop a consistent narrative about what a vibrant, diverse and integrated society is. I hope the Government will promote that.
My Lords, this coalition Government spent over a year reviewing the Prevent strategy and produced a clear, focused strategy on tackling extremism, as well as focusing resources on key institutions like universities, prisons, schools and colleges. This strategy looks at countering the ideology rather than just the violent action of extremists. This is the fundamental difference between the previous Government and this one.
People who espouse extremist views may be more prone and susceptible to being primed and moulded towards extremism, especially if they live in segregated communities and have little interaction with other communities. Extremism is also based on people being excluded and separated, and these are ideas that we should not allow in our communities whether they are al-Qaeda inspired, or whether they are far right or EDL-inspired. Separation and segregation have no part to play in our modern state. These phenomena have been rejected globally and they must equally be rejected here. There is a link between extremism and a lack of integration, and we need to acknowledge this.
However we must be more nuanced in our understanding and approach towards communities. We must acknowledge that there are groups of individuals who are integrated in every sense of the word. They work, they speak English, and they are living quiet and happy lives in different parts of our country. Yet they choose not to engage with other communities and they may also feel aggrieved and angry at what is taking place regarding international or domestic issues that affect their fellow brothers and sisters. These people cannot be viewed as being non-integrationist, but they may hold extreme views. They may, however, not be patriotic about this country, though that is different from not being integrated. The link between extremism and a lack of integration is not clear in these cases, and we must be aware that there are a set of competing circumstances affecting different communities. I firmly believe that we have moved in the right direction in terms of the Prevent work, which is now being undertaken, which is much more focused on interventions and countering extremist ideology. There is no simple solution around integration, and we need to look at situations in different parts of the country and with different generational groups, through multiple lenses and not through one single lens of understanding. Yet a lack of integration may leave some persons more susceptible to manipulation and thereby be used to promote extremist ideology. Sometimes the lack of integration can be self-imposed and the individual concerned may be completely devoid of extremist narratives and ideologies. Yet we can all agree that communities need to celebrate being part of their local areas and do all they can to make these areas places where they feel that they have a future.
At the very least this is the healthiest option we can take. I would like to end by saying there was a survey published in the Sunday Times a few weeks ago which found that Muslims are more patriotic than the rest of the population. This shows Muslims have gone a long way towards integrating with society and shows Muslims in a different light compared with what is being portrayed in the media. Islam is a religion of peace and this philosophy is shown visually in my coat of arms.
My Lords, I am most grateful to my noble friend, Lord Noon, for having introduced this debate. Prevent is a very important strategy and one that I am very familiar with, having been asked by the previous Secretary of State for Committees and Local Government to undertake a rapid review of the original Prevent strategy. Over a period of several weeks, I visited 12 local authority areas and spoke to more than 700 people about their experiences of and attitudes to the Prevent strategy. The confidential report that I produced for the Secretary of State outlined a number of areas where I thought there needed to be improvements. Some of these issues have been addressed in the current revised strategy, which on the whole I welcome, but there are two particular issues which I believe need further clarification. Firstly, how are people, especially young people, engaged in Prevent? Secondly, how are professionals and elected officials being given the skills and confidence they need to challenge extremism and the way in which this causes further segregation between communities?
I shall speak first about the engagement of young people, and as the chairman of an organisation called the International Forum for Community Innovations, otherwise known as TIFCI. TIFCI works with a wide range of community groups across the country and has just finished a piece of work on extremism and the risks for young people from radicalisation. The work explored the issues for young people and the particular risks they face from radicalisation and extremism. During the course of the work TIFCI spoke directly to over 130 young people and children of both sexes, from a wide range of ethnic, religious and cultural backgrounds. In the first place, the risk they most strongly identified was that from the far right, particularly the EDL, which they perceived to be causing disruption and harm to their sense of belonging and community cohesion. We very clearly should not take our focus off the threats posed by the far right. But what struck me even more strongly was the near universal view that, as young people—a key group who are identified as being most at risk—they were not actively consulted or involved in finding solutions and strategies to deal with the problems. Many of them said, when commenting on the work programme of TIFCI, that it was the first time anyone had even asked them about this issue. Does the Minister agree that young people, especially those at risk, should, wherever possible, be involved in and actively engaged with any work undertaken in this area and could he say something about what is being done to encourage this?
From my experience, including the work that I did reviewing the previous Prevent strategy, I believe that the second key issue concerns the skills and confidence among professionals and elected officials on the ground and their ability to challenge people and to address some of the issues that divide our communities. I strongly believe that they have not been adequately equipped to do this. Sadly—I have seen evidence of this many times in my work on community engagement —there remain deep divisions in our society and too many communities live separate lives, having little or no contact with their neighbouring communities even within their same town or ward. I agree with my noble friend Lord Noon that it is this division, the lack of community cohesion integration that is the greatest threat to our security. It is in this failure to have people meeting and interacting with each other outside their immediate family and community networks that the greatest risks of extremism and radicalisation take hold. If we recognise this then we can start to move away from thinking simply about one religious group or another and begin to work with whole communities and finding solutions that truly promote integration and challenge extremism. This is going to take high quality training for professionals and elected officials and at local levels we need to see clear implementation plans that provide direction and leadership. I would be very grateful if the Minister in his closing remarks could explain what plans are being developed to implement training and capacity building for professionals, youth workers, social workers, and very importantly, elected officials, to ensure that they can take the leadership on addressing these important issues at a local level.
My Lords, I convey my tribute to the noble Lord, Lord Noon, for introducing this subject this evening. In 2011 we live in a world of extraordinary progress and opportunity and yet it is a world in which 1 in 5 people lives in abject poverty. One in 6 children never reaches their fifth birthday and 115 million children worldwide do not even go to primary school; and with poverty comes a multitude of other bad things. And yet, it is nothing like the only reason why one group resents another, but it is a big reason.
Poverty is also a reason for our concern about terror, and the real and perceived threat of violence, locally, nationally and internationally from radicalised or marginalised people. Their route to terrorism can be found in many things: in faith, ethnicity, culture, nationality, poverty, economic and political causes, and more. A lot of people readily associate terror with religious fundamentalism. Any religion can be vilified, and indeed in this country we have known militant Christianity and militant Islam. The great contradiction of fundamental politics—its epic flow—is that it cannot deliver on the greatest problem that provokes its rise, which is economic deprivation.
Rage is not an economic policy. Violence is not the antidote to economic progress. It can succeed at moments of high social stress, or public rage. Ordinary people hunger for bread, not guns. This is what keeps the overwhelming majority away from fundamentalism. The bad news is that it takes less than 1 per cent to wreak havoc upon us.
We have here in the United Kingdom a multi-religious and multiethnic society. Here dialogue is the only way forward for addressing our differences. We ought to celebrate our commonality and discuss our differences based on mutual respect and trust in each other. It is imperative that we engage in a continuing dialogue. This dialogue is no longer the luxury of a few well-meaning individuals. It has become a necessity, demanding action, without which only catastrophe stares us in the face.
The other message that should go out from us is that Islam, like other faiths, prohibits not only the killing of innocent people, but is most severe on the act of suicide. There is a clear Koranic instruction against taking one’s own life. Therefore, let me state clearly, for all to hear, that exploding bombs and firing bullets in an act of suicide, with the intent to kill, is totally un-Islamic and against the teachings of the Koran. All Muslims must therefore do everything to stop this evil depravity.
The 1.5 billion Muslims who live in this world are peaceful and law-abiding. They also make good neighbours and exercise responsible citizenship, and resent being stigmatised with negative religious profiling, which is inflammatory.
Finally, many Muslims believe that the savage cruelty and cynicism mirrored in the abuse at Abu Ghraib prison, Guantanamo Bay and at Bagram in Afghanistan, as well as rendition flights, waterboarding, and other methods of interrogation are not helpful in our pursuit to harmonise the radicalisation of young people because, more than anything, they are the best recruitment ground for the terrorists.
My Lords, may I first thank the noble Lord, Lord Noon, for giving us this opportunity to say how we feel about this issue? It is a very important issue, and I have given it much thought, over a long period of time. There are now cities in this country with areas where no white people live and no white people go, and usually they are Muslim areas. It is very sad, because in fact the people who live there have no desire to mix with the white people. There is of course a reason for it, and I think the noble Lord, Lord Hameed, has very properly touched on it.
They feel they are disliked by us. The Muslims now feel that people of this country think of every Muslim as a terrorist. That has had a very important and negative effect on relationships. We all know, of course, what Islam is like, but do they know what Islam is like? I am surprised that none of your Lordships has mentioned what happens in mosques, which are the crucial areas where recruitment and extremisation of people takes place.
I will get you evidence, but I do not have it to hand at the moment. I hope you realise that it is happening. Schoolchildren go to mosques every day; they have no time to do their homework and they are falling behind in education. What is wrong with seeing that the imams are properly educated, that they can speak English and that they know what Islam teaches? One of the most important aspects of starting integration is making sure that people who go to a mosque are taught Islam in the proper way, as has been spoken about in this Chamber. I am sorry to say this is not happening.
The second point, which I am very keen on, is that the young—young men in particular—are not skilled in anything. It is time we started programmes for skilling them. Education is important, and they are lagging behind in it, but if we can give them a skill to earn their living, we might see a change in their lives. We do not want young people to not get jobs, to live on benefits all their lives and then start the trend again. Their fathers may be on benefits, they are going to be on benefits, their children will be on benefits. This is what happened in Northern Ireland. We must stop this somewhere. We have to start doing programmes, we have to skill them, and we have to make sure that they are capable of holding proper jobs. This will give them self-respect and respect from other people as well, which is very important. I repeat that we must make sure the imams in the mosques are properly educated and are teaching the people proper Islam, not what they think is Islam. If you talk to young Muslim people, they do not think like that. They do not say “Islam is a religion of peace”. They say that they want this country to become Islamic; they want to change this country into an Islamic country.
I am also very concerned about the advent of Sharia, particularly because it is discriminatory against women. That is not the way we live in this country. We have an Equality Act, yet we allow Sharia, which is totally discriminatory to women, to deal with family situations. No boy over seven is given to the mother—he automatically goes to the father. Property rights are not respected. I hope that your Lordships, especially those of you who are Muslims, will do your best to change these things.
My Lords, I am grateful for the opportunity to contribute to this debate. The first objective in the Prevent strategy is,
“challenging the ideology that supports terrorism and those who promote it”.
It slightly surprised me that the word “ideology” is used in the singular, when, as other noble Lords have said, there are—sadly and tragically—many ideologies that, in their own different ways, support terrorism. The counter to any bad ideology, whichever it may be, is not no ideology but good ideology. The report refers to core values. The counter to bad core values is not no core values but good core values. The counter to bad religion is not no religion but good religion.
This begs questions for us: how do we learn our good ideologies and our good religion? As we know, these things are not just taught but caught. Therefore, the approach has to be surely one that covers the areas that the report refers to: education, and all the aspects of that to which reference has already been made, but I would also love to see a greater emphasis on the sense of relationship, community-building and integration to which the noble Lord, Lord Noon, and others have referred. There is the need for us to make sure that not only are good ideology and good vision caught, but there are plenty of examples and that people have the opportunity to catch them because they see them and hear them. I also endorse the truth in the report that this is about process. The catching and the teaching are always about the process, not single steps or single actions. This therefore also emphasises to me the need for integration and cohesion, to which reference has been made by many noble Lords.
Isolation in all its forms needs to be countered. Where individuals or small groups of people are cut off from others, it can help contribute to and provide a soil in which extremism, and the distorted thinking that goes with any kind of extremism, whether it leads to terrorism or in any other way, can more easily flourish and grow. Again I would totally endorse the comments that have been made about the way in which poverty, among other social ills, provides that isolation.
One strategy does not stand alone. I would be delighted to hear the Minister talk about the way in which this strategy sits alongside other strategies and work on community cohesion, the development, building -up and strengthening of our communities and the avoidance of those social ills that cause the very divisions that can further isolate. A strategy like this has to be put within a total context that helps us to strengthen the relationships within communities. As others will know, a research project was undertaken by Vivien Lowndes and Leila Thorp on the Prevent strategy. They identified a community safety focus, a community cohesion focus and a community development focus in three different cities. All of these are about developing community.
Again, the Minister may wish to comment on those insights and help us to understand more about how the Government are working to overcome people’s isolation, identify those most at risk to stop them being isolated and stop the unemployment and the other things that help fuel the isolation so that the integration—the interfaith and Muslim forums and so on—can all play their stronger part in helping stronger communities and cohesion and therefore community safety for us all.
My Lords, I add my thanks to my noble friend Lord Noon on securing this debate and for speaking in such a forthright way about his personal experiences and his strong concerns and reservations. Following the bombings in London in July 2005, much work was done on the development of Prevent—work which was largely breaking new ground since it was needed to disrupt the process of radicalisation when there was no previous experience to draw on. The strategy was launched in 2007 and its objective was to seek to stop people becoming terrorists or supporting terrorism both in the UK and overseas. It was the preventative strand of the then Government’s counter-terrorism strategy.
In view of the fact that it was breaking new ground, there was clearly going to be a need to review and update the Prevent strategy in the light of experience, including experience of the different approaches adopted. This Government have undertaken such a review as part of their wider review of counterterrorism. An independent oversight of the Prevent review was provided by the noble Lord, Lord Carlile of Berriew. In his preface to the Government’s Prevent strategy, the noble Lord said, among other things, that generally, Prevent had been productive.
The Government have said that their Prevent strategy will involve work with sectors and institutions where there are perceived to be risks of radicalisation which need to be addressed. On this point, perhaps the Minister could say what has happened since the review was published in June. We know that the Secretary of State has healthcare providers and universities in mind, so what is she expecting the NHS and universities to do that they have not previously been doing? What has been their response, bearing in mind previously expressed views by Universities UK and the BMA on this issue?
Last June, the Secretary of State said that Prevent was about acting on information from the police, security and intelligence agencies, local authorities and community organisations to help those specifically at risk of turning towards terrorism. Since it involves the security and intelligence agencies, can the Minister say whether the Intelligence and Security Committee will be involved in evaluating the effectiveness of the Prevent strategy? Could he also say against what criteria and objectives will the Government assess the effectiveness or otherwise of the Prevent strategy?
The Government have said that Prevent depends on a successful integration strategy, which will be the responsibility of the Department for Communities and Local Government. What kind of financial resources will be available next year and in future years, since there have already been significant cuts from the Prevent funding for local councils this year and there appear to be further cuts to come? Police budgets and numbers are also being cut. What kind of priority have police forces committed themselves to give to the Government’s Prevent strategy, since the Government have said that Prevent is about acting on information from the police?
The Government have also said that public funding for Prevent must be rigorously prioritised and comprehensively audited. What does that statement mean in terms of the amount of funding for Prevent—not least on training and personnel—that will be provided in future from the Home Office and other departments? Will funding be going up or will it go down? What link-up will there be between the Home Office initiatives and the DCLG integration strategy to ensure that they complement each other? In the House of Commons on 7 June, the Home Secretary said that the Government’s Prevent strategy,
“will stop the radicalisation of vulnerable people. Above all, it will tackle the threat from home-grown terrorism”.—[Official Report; Commons, 7/6/11; col. 54.]
Note that the Home Secretary did not say that the strategy was designed to achieve those objectives, or that it would make an important contribution to achieving them. She said it would achieve those objectives. If it remains the Government’s view that their Prevent strategy will single-handedly and without doubt achieve those objectives in full, then I fear that the Government have underestimated the complexity and difficulty of what they are quite rightly seeking to achieve, or that they are as interested in rhetoric as they are in seeking to build on, develop and update in a consensual way the work that has already been done under the Prevent strategy.
My Lords, before I deal with the major part of this debate, there are three points I want to make. The first is that my noble friend Lady Hamwee, looking at the names on the list of speakers, possibly said that I was a very ancient Briton. The important thing to explain at this stage is not that I am an ancient Briton, but I am about as Anglo-Saxon as you can get. I will go on to say that I live in a village which I think has a Norse name; my nearest town, the county town of Carlisle, has an old British name; and I live in the county of Cumbria. As the late Lord Cledwyn of Penrhos—a great friend of mine and of noble Lords opposite—always reminded me, Cumbria is exactly the same word as Cymru. They are of the same etymological origin.
I make this point not for any flippant reasons, but to point out that in the United Kingdom we have experienced immigration of one sort or another for many, many years. We have adapted and have place names that reflect the vast array of different people who have come here at different stages and different times. We have gone on accepting immigrants from year to year and over the years. This is something that we should be proud of: the Huguenots who came here, the Jews who had been expelled, and others such as the Normans who came here under rather different circumstances. Possibly we objected to that at the time, but we got used to it later on. These things have been going on for some time. We are all mongrels in this country, and it is something that possibly we should all be proud of. I hope that we can all continue to integrate in the best possible way.
The second point that I want to make before I get on to the substance of the debate relates to the remarks made by the noble Baroness, Lady Prashar, about the need for more freedom of speech, particularly in universities. This touched me particularly as a former spokesman for higher education in this House, both quite recently and before 1997. I certainly agree with her that at times the universities should be faintly embarrassed by what they have or have not allowed to happen in terms of freedom of speech. We should all take note of that point, and I am very grateful to the noble Baroness for reminding us of it.
The third introductory point that I want to make refers to the opening remarks of the noble Lord, Lord Noon, when he talked about that 1,000-year tradition of the rule of law. Whether it is a 1,000-year tradition I am not sure. Sometimes that has wavered a bit, and there have been weaknesses here and errors there. However, I think that he is right to point out that there is something that we can be proud of, something that we should sing about and shout about, and something that, certainly in promoting this country and everything that goes with it, we should talk about and be proud about.
The substance of the debate from the noble Lord, Lord Noon, is on integration and extremism and how they will be affected by the Prevent strategy. There is good evidence that, by international standards, the United Kingdom has a relatively well integrated strategy. That is why I wanted to start with what might have seemed flippant remarks about where I lived in Cumbria and the mixed nature of that over the last 1,000 years; that will happen again in the future. We are told that 92 per cent of people across all ethnic groups say that they feel part of British society; 86 per cent feel that people from different backgrounds get on well in their area; 88 per cent say that they get on well with their neighbours; and 97 per cent agree that it is everybody’s responsibility to obey the law. These figures show that we have much to be thankful for and that the Government’s approach to integration is building on solid foundations that, again, we can be proud of in the citizenship of this country.
Of course, those figures do not tell the whole story. There are differences from area to area and within areas. For example, a high proportion of people in country towns are likely to say that they get on well with their neighbours, but in some inner-city boroughs the proportion can fall below half. Again, that obviously needs to be addressed. It is in those areas with a lower level of integration that the greatest challenges have to be faced.
It is also in these less well integrated areas that the advocates of extremism are often most active. Groups like the English Defence League and the recently proscribed Muslims Against Crusades seek to spread fear and mistrust in order to generate and perpetuate division and separation rather than integration. Successful policies to promote integration must also, therefore, be capable of countering extremism, in non-violent as well as violent forms.
My right honourable friend the Secretary of State for Communities and Local Government plans to make a Statement to Parliament and publish a document setting out the Government’s approach to integration later this year. I hope that the noble Lord, Lord Rosser, will be able to wait for that Statement. In the mean time, the elements of that approach are beginning to take shape. It will be an approach that emphasises what we have in common rather than what is different; draws out the responsibilities that we have to each other and to society; enables people to realise their potential to get on in life; gives people opportunities to work together and to take decisions for themselves; and ensures a firm response to threats to integration like discrimination, extremism and disorder.
These objectives cannot be achieved by top-down design by the Government. Government can create the conditions which enable integration but it is for people themselves in neighbourhoods and in voluntary and community organisations to take responsibility for making it happen in their areas.
To illustrate what Government are doing to create the conditions that support integration, let me give three examples, which have also been touched on by a number of other noble Lords in this debate. First, without a common language, integration will always be constrained and so we are looking at what additional support we can offer to local areas to help isolated women in particular and other priority groups to learn English. Secondly, understanding and co-operation between people of different faiths is pivotal to integration and that is why the Government awarded £5 million to the Church Urban Fund’s Near Neighbours scheme, which fosters precisely these ends. Thirdly, we have made integration one of the three objectives of the National Citizen Service. In 2012 this will enable up to 30,000 16 year-olds from different backgrounds to meet each other, to break down the misconceptions that put up barriers between them and to get on together.
As I have said, intolerance and extremism are a threat to integration and to initiatives that support it, such as those I have described. Therefore we must challenge extremism in all its forms, both violent and non-violent, and whether manifested through propaganda, public disorder or incitement to hatred and violence.
If extremists break the law they will feel the force of the law, but even if they keep within the law we shall not stand by. Extremists will be challenged if they use public spaces to promote their ideology and if they publish offensive material on the internet members of the public will be able to ask the police to investigate.
Integration and the Prevent strategy are not the same thing. They are linked but distinct. In the past the distinction between them became blurred and that is partly why the Government initiated a review of the Prevent strategy late last year. The review found that the old Prevent strategy was too far-reaching. It confused counter-terrorism with social cohesion and “securitised” social policy. It was in danger of stigmatising Muslims—a point made by various noble Lords—and reinforced a misperception that all Muslims could be extremists. It created division between Muslims and other communities. It was unfocussed and wasteful of resources. It was concerned only with Islamist terrorism and not other forms. It generated allegations of being a cover for spying on communities. It treated some extremists as allies rather than as part of the problem. It was unable to show that it was effective in preventing terrorism.
The new strategy published in June this year deals with these shortcomings by reaffirming Prevent’s place within CONTEST, as part of the United Kingdom’s counter-terrorism strategy. In common with the rest of CONTEST, Prevent now deals with all forms of terrorism and extremism, whether violent or non-violent, that contribute to support for terrorism. This includes extreme right-wing and Northern Ireland-related as well as al-Qaeda-inspired terrorism. At the same time, the Department for Communities and Local Government has taken responsibility for integration and non-terrorist related extremism.
These changes mean that Prevent should no longer be seen as “securitising” integration. Rather than ranging far and wide, as it did previously, it is now more tightly focused, proportionate and prioritised. It is a national programme concentrated on certain localities and sectors, concerned with extremism conducive to terrorism, including non-violent forms as well as terrorism itself, is based on allocation of resources according to risk and will use law enforcement, regulation, civil challenge and support as appropriate.
I will conclude, as my Whip is beginning to kick my legs to indicate that time is running out. Although they are linked, we make it quite clear that integration and prevention of terrorism must not be conflated. With the new Prevent strategy the Government have taken decisive action to ensure that they are not. Prevent is now able to concentrate on what it is supposed to do, to stop people from becoming or supporting terrorists, while the Department for Communities and Local Government is enabled to get on with creating the conditions in which integration can grow and extremism can be challenged and reduced.
Health and Social Care Bill
Committee (9th Day) (Continued)
156: Clause 22, page 29, line 2, at end insert—
“( ) Subsection (1) shall not apply to any providers who have any financial interest, directly or indirectly, in the provision of any service that the clinical commissioning group may be required to commission.”
My Lords, I also speak to my other amendments in this group. Over supper my noble friend reminded me that the late lamented Lord Carter, a previous Government Chief Whip, used to say to Ministers and others that if we needed to save time, the thing to do was to speak only from every other page and see if anybody noticed. What I intend to do is to try and speak from every other paragraph.
These issues deal with the serious potential conflicts of interest that GPs will face in their new role as commissioners of health services. When this group of amendments first started out it contained only two amendments but it has now, quite rightly, grown substantially to address the major concerns of transparency, integrity and patient confidence and the issue of trust that must be addressed in their new role. In passing, I would say that the publication of the Government’s recent draft guidance on commissioning, Developing Commissioning Support: Towards Service Excellence, in effect decrees that by 2016 the real work of CCGs will be outsourced, presumably to large private providers, which makes me start to question what is left for CCGs to worry about. However, the issue that these amendments deal with is a fundamental issue of the Bill.
We all have high regard for our GPs and we trust them as experts and advisors. We know from the evidence that they do a cost-effective and good job. Our national system of GPs may be quirky, half in and half out of the NHS, but it works. At its best, it is the very best system in the world.
We are concerned that the Bill endangers the trust that patients have for their GPs and, essentially, these amendments seek to explore and to test that. GPs are going to be decision-makers across the whole breadth of commissioning, making decisions about priorities and standards, things that may often be unpopular, and reconfigurations of service. They will handle huge amounts of money, own budgets and get bonuses for good financial performance. So patients need to be assured that they can continue to trust their GP and that their GP will always act in the patient’s best interest. This concern has been flagged up by the BMA and the Royal College of General Practitioners, so I hope that the Minister can tell the House how we will be able to protect the image and reputation of our GPs after the first CCG goes wrong. Amendment 156 starts with the obvious necessary safeguard that providers of primary medical services who have a direct or indirect financial interest in the provision of services that a CCG is required to provide must not be members of the CCG. Amendment 161 is also key in requiring the Secretary of State to issue guidance which must be incorporated into CCG constitutions on how conflicts of interest must be dealt with by consortia as part of their decision-making. Transparency and clarity about how potential conflicts of interest would be managed is essential if the confidence of the public is to be maintained.
Openness and transparency are supported by Amendment 176A, requiring CCGs to maintain a publicly accessible register of all potential conflicts of interest of individuals involved in any part of their commissioning process. Taken together, Amendments 176A and 224 reinforce this, and call for regulations to stipulate that no provider should be a member of a CCG if they have any financial interest in the provision of any service the CCG is required to commission; in other words, open book accounting.
We do not think it is enough, as Amendment 228 proposes, for a CCG member merely to declare their financial interest in a commissioning decision being taken by their CCG, or absent themselves from decision making on that provider. We expect our councillors to operate under this regime. We should expect other people responsible for public money to do the same. Indeed, this transparency and openness, and the declaration of interests, should be extended to their families, in the same way that it is for other public servants.
Finally, I want to underline that we recognise that extending GP commissioning and setting up CCGs has the potential to give GPs freedom to innovate, improve services and use commissioning to develop new models of care in the interests of the communities they serve. The safeguards against conflicts of interest proposed in these amendments are not designed to shackle CCGs. As I have said, the Department of Health commissioning guidance already does that. The safeguards will ensure that they abide by the reasonable rules, regulations and codes of practice that we would expect of any statutory body responsible for taxpayers’ money worth millions of pounds.
The public needs to be assured that robust governance arrangements are in place for commissioning consortia, and that conflicts of interest will be managed effectively. I beg to move.
My Lords, I have a great deal of sympathy with the intention behind this amendment. Noble Lords will remember that from the very beginning of the discussion about this Bill, there has been a great deal of concern about the conflict of interest that could so easily arise. Many of us recognise that the relationship between patients and general practitioners crucially depends upon that relationship being one of trust. The same will apply, if the commissioning groups work well, to the relationship between them and the patients who are within the practices of which they are part. So I sympathise very much with what the noble Baroness, Lady Thornton, has proposed, and also with what the noble Baroness, Lady Finlay, has proposed in Amendment 161.
Our concerns on this side of the House are not with the whole motivation behind this. We believe that that is extremely important and we completely share it. It is our feeling, rather, that the remedies are not adequate to the scale. We feel, for example, that one of the weaknesses of both amendments is the lack of any effective sanctions against those who breach what would be a relationship of trust. At the moment there is not provision within the Bill for effective sanctions, which can be used to ensure that these high-minded and perfectly proper principles are lived by.
The Nolan principles have been very effective in local government—as we all know—and increasingly effective in national Government. There are references to those in the course of the Bill, but there is no specific determination that members of the partnership groups or the CCGs would be dealt with, if they were in breach of the requirement that they should not ever put their own interests ahead of those of their patients.
I suggest to the noble Baronesses, Lady Thornton and Lady Finlay, and her associates in moving these various amendments, that they would look at the amendment we have put down—and I suggest this with due humility—which effectively brings into practice powerful sanctions. We believe these will be effective in ensuring that this relationship of trust is upheld, and also that powerful requirements lie on every CCG, as well as on the board itself, that it would be absolutely clear that all interests must be declared publicly.
These will ensure that once people’s names are on the register, and they have made a declaration of the appropriate kind about their own interest never being put forward as the reason for a decision, there are then effective measures that will enable the whole issue to be dealt with in detail, with appropriate requirements of sanctions and of effective punishment for those who breach them. We believe this to be absolutely central to the working of the clinical commissioning groups and to the whole relationship of doctors to their patients.
So, with those few words, I hope I can persuade the noble Baronesses, Lady Thornton and Lady Finlay, to have a look at the proposals that we have put forward, which, I am pleased to say, have at least to some extent the support of the noble Baroness, Lady Finlay.
My Lords, I certainly support the amendments tabled by the noble Baroness, Lady Williams, who has just spoken, and they go further than the amendments to which I have added my name. I would just draw the attention of the House to the conflicts of interest guidance from the General Medical Council, which makes it quite clear that doctors,
“must be honest in financial and commercial dealings with employers, insurers or other organisations or individuals”.
It goes on to say:
“If you have a financial or commercial interest in an organisation to which you plan to refer a patient for treatment or investigation, you must tell the patient about your interest”.
I would also remind the House that the ultimate sanction is to be struck off, and that if you are struck off, you lose your livelihood. I have a concern that when it comes to the implementation, warnings may actually be issued rather than stronger sanctions taken against those who might breach such guidance, because this is guidance, and it is therefore subject to interpretation.
This whole group of amendments has really gone to the heart of the problem of conflicts of interest, both for the individual general practitioner, who would be on a clinical commissioning group, but also their families and all those others around. It may be friends of theirs, who they know really well, with whom they are inclined to place some commissioning contract, or enter into some arrangement. There is a really fine line between having a personal interest, and going to that person because professionally you think that they are the best person to do the job.
Of course, I will say as a doctor, we all know the doctors that we would like to be referred to, and we all know the people who we want to work with in our teams. That is human nature. It is a mixture of competence and attitude, but there is also something about having a shared set of values, and so on, because you tend to gravitate towards people who share the same set of values as yourself. The highest principles and values would of course fall, I would hope, outside of the conflicts of interest, but financial interest is a really difficult one.
While I would suggest that none of these amendments are absolutely perfect, this group of amendments illustrates the fact that we need to come back to this at Report with a definitive amendment that really crystallises the whole problem around conflict of interest in commissioning.
My Lords, I spoke on an earlier amendment this afternoon about issues that come round and round, and this one comes round across Bills. We had a great deal of quite difficult discussion on these matters in the Localism Bill—now the Localism Act—and achieved what we hoped will be a satisfactory compromise in the Bill.
It is all about standards in public life and the importance of all bodies that deal with public funds and public functions being part of the regime of standards in public life. I assume that clinical commissioning groups, while not part of local government, are certainly part of local governance, or they will be part of local governance as far as the health service is concerned. They will deal with a lot of authorities that have the standards of public life regime as part of their own practice. I wanted to go very quickly through the basic principles that need to be established in my view before this Bill is finished. First of all there have to be clear rules. In The Localism Act they are set out in Part 1, Chapter 7, across 11 pages and in parts of the schedules. There need to be set out on the face of the Bill so that everybody knows where we are.
There needs to be a code of conduct, whatever it is called, which is based on the Nolan principles. We came to the view in the Localism Bill, now the Act, that those principles needed to be set out again on the face of the Act: selflessness, integrity, objectivity, accountability, openness, honesty and leadership. In my view they ought to be set out on the face of this Bill.
There needs to be a system which members of commissioning groups have to register appropriate interests and again in the Localism Act some of these were pecuniary interests, going back to the old wording which is now on the face of the new Act. There are interests other than pecuniary interests which also need to be registered even if they do not debar people from taking part in decisions. If we are going to be open about what interests people have, then they ought to be there on record. There needs to be a register of interests—there is no point in registering if there is not an open public register. Then there needs to be a system in which people taking decisions and taking part in decision-making meetings have to declare interests at the point of that decision, as in the system that we have in your Lordships’ House. As the noble Baroness said, it needs to involve close families and partners as well as the individuals concerned.
Then there is no point in having that unless you have a system of dealing with complaints. It needs to be very clear what the system is, how such complaints are investigated and what penalties there are for breaching the rules. There may be different penalties for different rules. Clearly breaching the system in relation to financial pecuniary interests is much more serious than breaching one for non-pecuniary interests.
The penalties need to be clear and understood and the system for judging on them needs to be clear. The whole system has to be in the public domain. The system itself has to be open and transparent and all the actions taken under the system, whether it is just registering an interest or dealing with a complaint and the results of that complaint, have to be open, transparent and in the public domain. It seems to me that those are the principles. The details will quite rightly differ according to different organisations and different contexts. I am not suggesting the details of the local government scheme, although the amendment of my noble friend Lady Williams picks up some of the wording from the Localism Act, I think. Clearly CCGs are different from local authorities, but they are not sufficiently different that the basic principles should not apply, or the basic rules and regulations about avoiding conflicts of interest and declaring those interests when they exist and enforcing those interests within the framework of a broad code of conduct. That in my view has to apply and I hope that when the Bill leaves this House, it will incorporate sufficient detail to give those assurances.
My Lords, I just wanted to make a couple of observations and ask the Minister a question on this group of amendments. First, this is a not a new area that we are getting into. The same issues arose with GP fundholding and with practice-based commissioning. We have managed, as I recall, to sail through those two areas where we have involved GPs in the commissioning of services where there was potential for conflicts of interest without any great scandals. Has the department looked at the experience on this issue of conflicts of interest with practice-based commissioning and GP fundholding and seen whether there was a major issue? My recollection of all this from the research on GP fundholding was that there was not an issue and it was handled perfectly sensibly.
Secondly, if we actually have bigger clinical commissioning groups—and I promise the Minister I am not going to reopen the debate we have already had, no doubt to much relief in your Lordships’ House—the smaller the risk, I would suggest, of conflicts of interest. There is a different set of considerations if you have got a clinical commissioning group for a population of 18,000, where inevitably there is going to be much greater potential for a conflict of interest, to one in which you are commissioning for 400,000. There is a different order of magnitude and I wonder whether that is an issue that the Government have looked at.
Thirdly, if there is concern about sanctions, the thing which really counts with doctors is the prospect of being reported to their professional bodies. It is the GMC and professional misconduct which is the big issue. We should not invent a system which is based too much on local government. It should be bedded into the professional body and the misconduct issues, because that is likely to be the way that it will have most effect with doctors involved in commissioning.
My Lords, I rise to speak to Amendments 175E, 176AA to AD, 213C and 220A, all in the names of my noble friend Lady Williams, the noble Lord, Lord Patel and myself, and in the case of 220A in the additional name of my noble friend Lord Clement-Jones. The purposes of these amendments are first to secure on the face of the Bill a thoroughly robust regime to avoid conflicts of interest sullying the commissioning process, and secondly to ensure transparency in the commissioning process to the greatest extent that is commercially possible. Taking the point made by the noble Lord, Lord Warner, a moment ago, that this is not an entirely new area, I suggest that the arrangements for commissioning proposed in this Bill risk raising the threat level from conflicts of interest in the commissioning process from “moderate” to “severe”, if I may use the intelligence services’ scale. That is because of the greater involvement of practitioners in the commissioning process, which is of course to be welcomed for many reasons, and the increased likelihood that many practitioners may also be providers of other healthcare services or have interests in such providers.
Our task is to reduce the threat at least to “substantial”, and then to manage the threat in such a way as to avoid commissioning decisions ever being skewed by the private interests of those making the decisions. Much of what we propose ought to be uncontroversial, and merely represents good practice, but we suggest, and in this I agree with my noble friend Lord Greaves, that it is important that our commitment to best practice is made clear on the face of the Bill. Amendment 220A would impose on any provider of medical services who is also a member of a CCG a duty to declare any financial interest in a commissioning decision—a bare minimum proposal, I suggest. Amendment 213C would impose on the NHS Commissioning Board a duty to refer a member of a CCG to his or her relevant professional body for material breach of the provisions or of the guidelines we propose. I entirely agree with the further point made by the noble Lord, Lord Warner, that this is an appropriate way of dealing with offending by practitioners. It should not be for the board to act as, or to set up, a disciplinary tribunal, but it is sensible and a greater deterrent, I suggest, for the professional bodies to do so.
However, the meat of our proposals is in Amendments 176AA to 176AD. We propose a thoroughly transparent regime as the best and most effective way of protecting commissioning from the insidious effects of conflicts of interest. I say insidious—and this is a point in which I pick up on what was said by the noble Baroness, Lady Finlay—because it is not only when a public decision-maker acts deliberately to favour his private personal interests that conflicts arise and threaten the system. It is also when the decision-maker at least persuades himself that his interests and the public’s interests coincide. It is only public scrutiny of the process that can properly test that.
The provisions in the Bill permitting some public access to the meetings of governing bodies of commissioning groups are, I suggest, over-cautious and too limited. The system should be made more open. The public should not be excluded from governing body meetings during the all-important discussions involving a choice between potential providers. I entirely accept that that would involve a new openness about commercial transactions and decision-making. However, these decisions are about choices between providers at public expense; I question the need for meetings to be held behind closed doors in relation to them.
Secondly, in the case of other decisions where the public are excluded from governing body meetings in the public interest, then a record of decisions made should at least be published, and quickly. That is the subject of Amendment 176A.
Our amendments set out a code for dealing with conflicts of interest in new paragraphs to go into the schedule. There would be a requirement for a register of interests of all CCG members. That register should be kept up to date. It should be kept available for public inspection. Then there would be a provision to exclude from the governing body of any CCG a director of a healthcare organisation or anyone with a significant financial interest in such an organisation if there is a contract in existence between that CCG and that organisation.
Thirdly, there would be a provision to ensure that a member of such a governing body who would be excluded if such a contract came into existence would have to stand down from the governing body while any negotiations for such a contract were in progress.
Finally, our amendments import the admirable guidelines produced by the General Medical Council, entitled Good Medical Practice. Those are the guidelines to which the noble Baroness, Lady Finlay, referred. I am grateful to the GMC for producing a document of such clarity and for welcoming our use of it in these amendments. The emphasis of the guidelines is on honesty and openness; that is what we are trying to achieve in this Bill. I believe it is what the Government are trying to achieve in this Bill. These are probing amendments, intended to give the Government an opportunity to consider how they might import such guidelines into the Bill at Report stage. However, our central point is this: we believe that the present provisions of the Bill do not display the seriousness, the clarity or the robustness that are required to meet the risks posed by the new arrangements. I suggest that the Bill cries out for a code in this area such as the one we have proposed.
My Lords, there is an additional area which I think means that the provisions in this Bill have to be different from other previous legislation. We face a huge financial challenge across the whole of healthcare, with budgets squeezed in a way they have not been squeezed before. So the potential for conflict of interest will go up as very difficult decisions are made. One can envisage the situation where somebody on the governing body of a clinical commissioning group will have a relative with a certain condition—and I refer back to the example I used previously, motor neurone disease. Say that person needs end-of-life care, and say that is a clinical commissioning group that has decided that it is not commissioning it in its area. There would be a direct personal conflict of interest, because that person would obviously want that care for their relative, but they would need to stand back. With the financial stringencies, the proposed amendments become even more important. While they are probing amendments, I hope the Minister in responding will recognise the importance of this area and agree to come back to it—hopefully, with a Government amendment—at a later stage.
My Lords, in brief response to the noble Lord, Lord Warner, I am not suggesting in any way that the regime should be identical to the local government regime, but that the decision-making body in clinical commissioning groups will be the board. Under the new Section 14A, the board will include lay members and possibly other people. So merely relying upon professional standards and professional systems of discipline will not be sufficient.
My Lords, I know full well that noble Lords have some concerns about the potential for conflict of interest in a system of clinical commissioning groups. Those are natural concerns, but I hope to show that the approach that we are advocating has some very specific and robust safeguards within it, which meet the intentions of the amendments in this group.
The CCG constitution provides for dealing with conflicts of interest and specifies arrangements for securing transparency about the decisions of the CCG and its governing body. The governing body must in turn ensure that the group has arrangements in place to ensure adherence to relevant principles of good governance. The CCG’s governing body will have responsibility for ensuring that the CCG adheres to relevant principles of good governance. The Secretary of State can also make regulations for CCGs under Clause 71 of the Bill, which are designed to ensure that in commissioning, CCGs adhere to good procurement practice. These regulations may impose requirements relating to,
“the management of conflicts between the interests involved in commissioning services and the interests involved in providing them”.
These regulations can also confer on Monitor powers to investigate suspected non-compliance. These are the safeguards that the Bill puts in place. My view is that it is unnecessary and indeed undesirable to go further.
Requiring CCGs to adhere to examples of good practice in managing conflicts of interest, such as declarations of interest; or maintaining a register of interests; or the monitoring or registration of hospitality received by members is a temptation, but one that should be resisted. We have got to be very careful about encumbering the Bill and CCGs with inflexible prescriptions as to how CCGs should operate within the statutory framework, or procedure about how they specifically manage potential conflicts of interest. This does not mean that these are not reasonable safeguards. Requiring the governing body to discuss in public choices between potential providers, or publish any decisions made in camera, for example, would remove a necessary discretion around ensuring that sensitive issues, either relating to contract values or performance, or staff matters, were given the appropriate level of confidentiality. I would urge in particular that we do not—as proposed in Amendment 175CC—put restrictions on those from whom a CCG can commission services. Given the importance we attach to ensuring that services are delivered in an integrated way, we cannot afford to cut CCGs off from being able to commission services from local GPs with a special interest, for example, who could deliver secondary care services in a community-based setting.
Will the noble Earl acknowledge that there is a conflict of interest there? There must be a potential conflict of interest there. How does the Bill mitigate that? How does the Bill deal with that? I cannot see from what the noble Earl has said so far that that is going to happen.
Before the Minister responds, I wonder if he could also explain why clinical commissioning groups would not necessarily have to have a register of hospitality, conflicts of interest and so on? Those of us who work for NHS trusts certainly have to complete a register, and if we receive hospitality above a minimum amount or major gifts, not only do we have to declare them, but we actually have to decline them. I think we would be subject to severe discipline if we breached that code.
I do not disagree with any of these principles, but I am not sure whether the noble Baroness understood what I said earlier: there have to be arrangements for securing transparency about the decisions of CCGs, and governing bodies have to ensure that CCGs adhere to relevant principles of good governance—think of the Nolan principles, for example, and many other ways in which good governance can take place—but there is no need to specify all this in the way these amendments suggest because the arrangements provided for in the Bill will cover these things. As the noble Lord, Lord Warner, said we are not in new territory here. There are very well established procedures for tackling conflicts of interest when they arise. There might very well be a conflict of interest in the kind of situation to which the noble Baroness, Lady Thornton, has alluded, but there are ways of addressing and coping with that.
The key to this is to have in place a rigorous framework of requirements, approved by the board as part of the CCG establishment process, to ensure absolute transparency and to manage conflicts of interest, subject to oversight—the oversight must be proportionate, but it has to be there. We can put on the face of the Bill, as Amendment 176AD would have us do, a detailed list of behaviours that we would expect members of CCGs to observe. Obviously I cannot disagree, as I say, with the stipulations on this list, but they are already provided for in the Nolan principles and indeed the GMC code Good Medical Practice, to which the noble Baroness, Lady Finlay, referred—and adherence to that is a condition of registration for medical professionals. The noble Lord, Lord Warner, was absolutely right: this code is what GPs and doctors in general fear to transgress. Of course, if one looks at that set of behavioural requirements, they are actually only an ideal and they have no specific system in place to ensure that they are met. The sanction on doctors is the threat that they will be referred to their regulator.
The NHS Confederation was very clear about this, and I have to say I agree with it. The Bill has to allow flexibility for the way that conflicts of interest are handled and developed over time, rather than being rigidly set in law. What the NHS Confederation told us was that conflicts of interest need to be managed effectively otherwise,
“confidence in the probity of commissioning decisions and the integrity of the clinicians involved could be seriously undermined. However, with good planning and governance, CCGs should be able to avoid these risks”.
I agree with that. There is a balance to be reached, and we believe the system that the Bill would introduce for managing conflicts of interest—the key points of which I hope I have described—provides that.
My Lords, I thank the Minister. He will know, as will all those who have been Ministers, that when we are first appointed, we are told—the noble Baroness, Lady Williams, will remember this—that not only must we declare all our interests and have probity about the way we conduct ourselves, but we have to be seen to be doing it. A lot of these amendments are about being seen to do the right thing, and in terms of the relationship between GPs and their patients that becomes even more important. I agree with the noble Baroness, Lady Williams, and the noble Lord, Lord Marks, about their amendments and the need to have proper safeguards and remedies on this.
I think that if we co-operate, the noble Baroness, Lady Finlay, and I can probably crystallise these into something on the face of the Bill. I was disappointed that the noble Earl feels that this is satisfactory in the Bill at the moment, because I think the noise outside this Chamber and the comments from GPs tell us that people are very concerned about it. We need to address that in the Bill. I am happy to withdraw this amendment, but we may need to return to this at a later stage.
Amendment 156 withdrawn.
Amendments 157 and 158 not moved.
159: Clause 22, page 29, line 33, at end insert “providing that it can demonstrate that it can meet the requirements of commissioning competence specified by the Board”
In moving Amendment 159 I shall also speak to Amendments 160 and 164 in my name. I start by emphasising that this is a package of amendments that relates to many concerns that have been expressed to me and others—namely, that we need to make very sure that we ensure the assessment of competence of CCGs is sound and open before they undertake the commissioning of services that this Bill will enable them to do.
My earlier Amendment 157 enabled us to debate the number and population size of clinical commissioning groups, both of which considerations have a considerable bearing on the issue of competence of CCGs. I will not rehearse those arguments again except to emphasise that if the Government go ahead with such a large number of clinical commissioning groups, as it seems may well happen, then it is even more necessary to tighten up the Bill’s provisions on proof of competence and the ability of the National Commissioning Board to reject applications where competence is in doubt. It is for those applicants to take on the role of a clinical commissioning group to prove that they are competent to take on this task and to safeguard the public money that will be entrusted to them.
Amendment 159 makes it clear that in submitting an application to the board, the clinical commissioning group applicant must demonstrate that it can meet the requirements of commissioning competence specified by the board. If its application does not do so then the board should be able to reject it out of hand. The onus is on that group to show that it is competent to undertake the commissioning. It seems to me that clinical commissioning groups will have had plenty of time to assemble their case and to prepare for their application. The Bill should make it absolutely clear that a demonstration of competence should be mandatory in submitting an application. If I can put it crudely, we do not want to see people taking a punt. They have to be able to demonstrate that they can actually do the job, otherwise public money and safety will be put at risk.
Amendment 160 is linked to Amendment 159. It requires that when the board publishes information for applicants, that information document must specify the competencies required to commission health services. This problem of specifying competencies in commissioning has bedevilled the whole movement towards commissioning over several decades. Mark Britnell’s attempts at world-class commissioning ran into the same problem—we were not sufficiently clear about what competencies would deliver good quality health services from commissioners. So this competency issue is at the heart of making clinical commissioning groups work. It is vital that the board is left in no doubt of its responsibility for doing this and that applicants are in no doubt that the competency hurdle that they have to clear is put very clearly to them before their application can be accepted. What we do not want to see, if I may put it this way, is a load of well meaning waffle coming out of the board about commissioning. We want to have articulated the competencies that have to be met before applicants can be successful. Amendment 164 rounds the whole process off in terms of applicants showing that they can discharge clinical commissioning group functions “competently”, which is the word which it adds to the Bill.
These amendments make it clear that Parliament regards competence in commissioning as the yardstick by which the success or failure of applications to become clinical commissioning groups will be judged. This issue should be uppermost in the mind of the board when it makes decisions, and wording that makes this clear should be on the face of the Bill. Competence in commissioning has been missing in the past and we are in danger of repeating the mistakes of the past by not making it absolutely clear in this Bill what is required of the applicants to be clinical commissioning groups. I beg to move.
My Lords, I have a number of amendments in this group. I will start with Amendment 159A which questions why, on page 9, line 36, it is possible for non-providers of primary medical services to be eligible to apply to establish a clinical commissioning group. Particularly in the light of my noble friend’s comments on Amendment 159, one would surely only want applicants who had experience of providing GP services to be able to apply to form a clinical commissioning group.
Amendment 160A requires the board, before considering an application to form a clinical commissioning group, to consult with the general public, the relevant local authority, the relevant health and wellbeing board, and patients receiving primary medical services from providers within the clinical commissioning group. The noble Lord, Lord Greaves, raised some pertinent questions about transparency in the formation of clinical commissioning groups. It is extraordinary that there seems to be no process by which putative CCGs consult with their patients before they make an application. The decision is, essentially, being made by bureaucrats within the National Health Service system—who put constraints on CCGs,—and the GPs themselves. Where on earth are the public in all of this?
From reading the Bill, it is only when two or more are gathered together that they can make such an application. So the noble Lord is quite right. The amendment is seeking assurance that there will be public consultation and consultation with patients. We are told this is all about patients. Can patients therefore be consulted before GPs commit themselves to forming a clinical commissioning group? Or are we just to be told at some stage, “That’s it, you are in that clinical commissioning group because you are in that practice and you have no choice”. It is remarkably high-handed for it all to be done with no public involvement whatever. It is remarkable how many changes are already being made without any statutory authority given by this legislation.
I want to continue the theme of consultation, because I have a number of amendments in this group which come back to the same point: Amendment 164A in relation to the board’s determination of applications; Amendment 166 in relation to variations in the constitution of clinical commissioning groups; Amendment 166B in respect of variations made in the area covered by a clinical commissioning group, as specified in the constitution; Amendment 167A in respect of mergers, and Amendment 167B as regards the dissolution of clinical commissioning groups.
If I as a patient am part of the clinical commissioning group, one would have thought that I would have a role in deciding whether it is appropriate for that clinical commissioning group to be dissolved, or is that again just for the GPs to decide? What about Amendment 216ZZA as regards commissioning plans? Perhaps I have misread the Bill and there are crucial points which would envisage members of the public and patients within a CCG area being consulted on all these matters.
On the question of parliamentary scrutiny, many of the rules concerning the application to become a clinical commissioning group are to be covered by regulations. I would have thought that, in view of their importance, these ought to be affirmative. Amendments 164B, 166A, 166C and 167C provide for that.
Over and above matters to do with application of parliamentary scrutiny are questions as to what CCGs are actually going to do and how we can ensure that they understand that their responsibility is to provide comprehensive provision to their patients covered by clinical commissioning groups. My Amendment 163 seeks to cover that. Under proposed new Section 14C to be inserted in the 2006 Act, the board must grant an application if it is satisfied as to a series of matters set out in proposed new Section 14C(2). In proposed new Section 14C(2)(e), the board has to be satisfied that a CCG is able to discharge its functions. What functions are these? This takes us back to Clause 10, whose functions on CCGs are dissipated from the functions set out in Section 3 of the NHS Act 2006, which encompass comprehensive revision.
This is vitally important. What are we entitled to as patients from our local clinical commissioning group? This is very important when it comes to any potential rationing by those CCGs in terms of treatments that we can receive. I, for one, prefer the safeguard that is contained in Section 3 of the 2006 Act, unamended, as opposed to the proposals in this Bill.
Amendment 166ZA is concerned with applications to vary the constitution of a clinical commissioning group and asks for the board to determine and publish, after consultation, criteria which Government are granting as a variation to the constitution. It is not unreasonable for us to know under what criteria such a variation may be granted.
My Amendment 167BA makes the same point in respect of the dissolution of a clinical commissioning group. My Amendment 220ZC will also provide for patients covered by a clinical commissioning group to be consulted in any proposed dissolution. Amendment 167D relates to property transfers in the event of a dissolution or variation of the constitution of a CCG and again requires the board to consult before a property transfer can take place. Finally, my Amendment 165 provides that when a clinical commissioning group is granted an application, it is wholly committed to assume the duties under Section 3 of the NHS Act 2006.
My Lords, I congratulate the noble Lord, Lord Hunt, particularly on Amendment 160A. The idea that patients whose GPs are serving on the Commissioning Board, or are part of a commissioning group which represents that board, should be consulted and we should hear what their own experiences have been, is innovative and interesting. He should be congratulated on putting it forward. It means involving patients as individuals in their own assessment of the service that they have had. Time and again the Bill reflects the demand that that should happen—no decision without me, and so on. This actually makes that real. It gives the words flesh, and I congratulate him on that. It is quite an exciting idea and I hope that it is one that will commend itself to the Government, given the Government’s wish to involve patients.
I am not so happy about Amendment 163B. I fear that the opposition Front Bench has not taken on board as much as I hoped that it might the idea that regulations should not go straight to Parliament, even if they are affirmative, but should go by way of the Health Select Committee. The noble Lord will be familiar with the argument—that the Health Select Committee has a huge range of expertise and knowledge. As a former Minister he will know—as well as I or the noble Baroness, Lady Thornton, knows—that the regime of regulatory scrutiny is not very effective. If there is an individual Member of Parliament in another place who knows a great deal about it and is concerned about it, you can have a real debate and that real debate can affect the outcome with regard to regulation. However, nine times out of 10, there is no great debate. In the case of the negative resolution procedure, there is often no debate at all.
I fear that this is a very weak safeguard for the huge amount of regulation that is built into the Bill. I therefore hope that I might commend to the House, and not least to the opposition Front Bench, the idea of looking again at the proposal, which is also radical and new. It is an idea that really ought to commend itself to those of us who believe strongly in accountability to Parliament and in the need to strengthen Parliament’s power vis-à-vis the Executive across the whole world.
My Lords, perhaps I can come back to that. On Amendment 160A, I am grateful to the noble Baroness for her support. I am not even sure that I got it right. I am also trying to get at the fact that so much is happening now without any consultation. The CCGs are essentially being decided by the system and then at some stage there will be a formal application process. I am long enough in the tooth in the health service to know about NHS consultation. Frankly, we all know that the traditional NHS consultations make the decision and then consult. I fear that, with CCGs, this is what is happening. While I welcome the support for the involvement of the public in a formal application, I find it perplexing that so much is now being decided and that the public are not involved at all.
I listened to the noble Earl before supper talking about this being bottom up. That is not what is happening. I do not think that he understands quite how much this is being driven by the centre. It is quite extraordinary. You can call it guidance, but putative CCGs are being given such clear steers about what will be acceptable. I feel that we will reach a situation where, at some point, it will all be a done deal and the consultation will simply not be realistic.
On the noble Baroness’s comments about making the regulations affirmative, I accept that, even if they are affirmative, there is a limit to what parliamentary scrutiny can provide—although that does provide some safeguards. I would be interested in debating the idea of giving the Health Select Committee a role, although excluding your Lordships’ House from it would be a problem. I say to the noble Baroness that I think it a pity that the House did not adopt my suggestion about a mandate for a kind of national policy statement approach. There is an argument for having a more interactive debate, if you like, about some of these matters. I very much take to heart her constructive comments on this and the Select Committee role. It could be a very useful debate for the future.
My Lords, lest it be thought that we were all wholly of one mind on these Benches in regard to some of these proposals, let me say that I am much more cautious about the propositions. My noble friend Lady Williams of Crosby has described the propositions for consultation with patients as novel. She is quite right. When the noble Lord, Lord Hunt, says that he recognises NHS consultations from the past as decisions first and consultation afterwards, he recognises how the previous Government carried out their business. As somebody who was in the health service at the time, I was very familiar with it.
We must be realistic about some of the propositions that come forward for consultation. Think through what is actually involved in doctors coming forward with proposals to fulfil the requirements set down in legislation in all its various aspects passed by Parliament, and then being asked to consult with the patients as to what exactly they think. Think through what exactly that might look like for general practitioners and their patients—those patients who would choose to back the general practitioner in his application to go along with the proposals, or would start to run a campaign against their GP. Is there really a thought that this will be something that serves the interests of helping general practitioners and their patients to move forward together? It is an interesting and novel proposal from the point of view of debate in your Lordships’ House. However, I am not at all convinced that it has been thought through in terms of how one might actually implement such a thing, and in terms of working with patients and patients working with their general practitioners.
In psychiatry, for example, I think of how much discussion and consultation there has been with patients about who their sector psychiatrist might be, never mind all sorts of other important decisions about them. The fact is that it is not a way in which one can possibly run these things. It is important to have consultation with the public in general, but to try to divide it up so that patients are consulted on whether their GP should follow decisions taken in line with decisions that Parliament set down is wholly another matter. My noble friend was right to describe it as “novel”, but I am much more cautious about the proposal than she is.
I thought that what the noble Lord said about the last Government was a cheap shot. I was talking about the NHS consultation in my experience over 40 years. It has not been a wholly satisfactory situation. It is quite remarkable what the noble Lord seems to be saying. The health service has strong corporate governance and strong processes for consultation, but suddenly we are bunging £80 million to GPs and they do not have to consult. Are they in such a mystical position that they do not need strong corporate governance; that we can trust them, even though some of that money will be spent with the GPs instead of on other parts of the health service? Suddenly we think that they are jolly good chaps and we can trust them. We can trust them simply to form these clinical commissioning groups, in which in theory they will have great power, and there is no consultation whatever. It is quite remarkable what the noble Lord is saying.
My Lords, let us be clear. It was no cheap shot. It was a comment on how the previous Government carried through their policies. He will know very well that I sat on those Benches and asked the questions of him. I am very much aware of it. What I said had nothing to do with corporate governance. It was the specific proposal that GPs’ patients should be asked to express a view on the proposition that their general practitioner be part of a clinical commissioning group. As though there was some serious alternative to it, and that it was something that could be carried through willy-nilly without any potential disadvantage in the GPs’ conduct of the practice.
What I pointed out was that this is not something that has any kind of precedent; it was, as my noble friend said, “novel”. What I said about it was quite clear. It has not been tried and I am not persuaded that it is something that has been well thought through. It could be very divisive within a practice. That is not at all to say that other elements of corporate governance are not appropriate. I wholly support them and the proposal. I was addressing a specific issue and I notice that it was the one issue that the noble Lord did not respond to.
So I as a patient have no right to say or comment on which clinical commissioning group my GP wants to join? It is nothing to do with me and just up to the GPs to decide? That is what he said. On the question of general consultation, let me remind him of the NHS plan. If this Government had done this properly, they would have published a Green Paper. They would have gone through a process of working with the health service, they might have spent six to nine months doing it and they would have got much greater buy-in. It shows that they have dealt with these reforms in a high-handed manner. The result is that there is no buy-in whatever and that is why the Government are in the trouble they are. I pray in aid the way that the NHS plan was dealt with and the fact that 500 people came together on a number of bases to work on the plan. That is why it had so much greater ownership.
My Lords, I addressed one specific proposal, not the whole world and the whole conduct of the Bill. I addressed one specific proposal, and the noble Lord comes back and tells me, “Has a patient no right to express a view?”. Of course the patient has a right to express a view. There will be public consultation. That is not the issue. The issue is that the noble Lord produced a specific proposal. One of my colleagues found it novel and interesting. I find it novel, but I am not at all persuaded that it has been well thought through, and I am interested that the noble Lord jumped so immediately to defend not the proposal but his posture.
My Lords, I thought that I might get up to say one sentence to stop this conversation from going further. My name is on several amendments, particularly those proposed by the noble Lord, Lord Warner, about competency. I have a simple question, which I am sure the Minister will be able to answer easily. What competencies do the commissioners have to demonstrate before they are authorised to become commissioners? I know that there will be guidance, but what competencies will be looked at that demonstrate that they can be commissioners? I am being very brief today because of being chastised for talking too long; but now I have evidence that suggests that I was not the worst, so I will carry on another time.
My Lords, I want to say one or two things about the consultation and go back to what I was saying before dinner. The question of patients is a bit of a red herring. To that extent, I think that the noble Lord, Lord Hunt of Kings Heath, was asking to be tripped up over it. Everybody is a patient to some extent, but the important thing is that the residents of an area, or citizens—whatever they are called nowadays—should know what is going on and that there should be an opportunity for a public debate to take place in the normal places—local newspapers, local radio, public meetings—about the future, structure and organisation of the health services in their area.
The noble Lord, Lord Hunt, was absolutely right when he said that there is a huge amount going on at the moment. It is not going on in complete secrecy; people involved in it know what is happening and are telling other people, and people in local authorities and others are having some discussions. However, by and large, there is not a proper process for providing people with open and full—or even partial—information about the proposals that are taking place. I do not think that it is a question of patients being able to tell their doctors which CCG they want to be part of, because the CCGs will be area-based, as we all know, and the doctors will be part of the CCG in their area. The questions are: what area is that going to cover, where is the CCG going to be, and how is it going to fit in to the health service? That is a fundamental question. So to that extent the noble Lord, Lord Hunt, is absolutely right. I think that the question of patients is a red herring.
Whenever I go to see my doctor, I consult him about what is happening in the health service, he consults me about that and all sorts of other things, and occasionally we get around to talking about my health; but I do not suppose that I am a very typical patient. That is a fact of life. However, it is a fundamental problem, and the source of a huge amount of the mistrust about what is going on at the moment is that people simply cannot find out what is going on. That is not in the amendments to this Bill. The Minister and his colleagues simply need to tell the health service to be a lot more open and transparent about what is going on and allow local debate on it.
My Lords, these amendments are all concerned with the process of the establishment of CCGs or changes to the established organisation. The Bill lays the groundwork for the NHS Commissioning Board to establish CCGs. Ensuring the competence of an applicant group to exercise the functions of a CCG is a key part of that process.
In the first instance, the board may publish guidance on the making of applications and this may include details of how it will assess the fitness of CCGs for establishment and therefore their suitability to assume responsibility for exercising their commissioning functions. That is really what Amendment 159 is trying to get at. The whole process is intended to ensure that the CCG has made appropriate arrangements to discharge its functions competently. If the board is not satisfied about that, it will not grant the CCG’s application, or else it will grant it subject to conditions under the transitional arrangements.
I can confirm that we intend to make provision in regulations to require the NHS Commissioning Board to take the views of the shadow health and well-being board into account when they consider the establishment of a CCG. Health and well-being boards will be able to provide insight into the willingness and ability of a prospective CCG to be involved in partnership working and engaging with the local population. That is the theme of Amendments 160A and 162.
However, in my view, wider mandatory consultation with the public, either by a prospective CCG or by the board on receipt of an application to be established, would be completely disproportionate and add unwarranted delay to the establishment of new arrangements. We already have intelligence that early implementer health and well-being boards are engaging in constructive dialogue with CCG pathfinders about the right size, area and configuration to best meet local patient needs. That is fine, but problems arise when you start to mandate it. I am very uncomfortable about that. Consultation with the public has its rightful place but I was completely unconvinced by the argument of the noble Lord, Lord Hunt. For my money he simply has not made the case.
We also need to ensure that we do not have a cumbersome process for agreeing changes to CCGs, which may evolve over time as organisations and may choose to merge formally or to adapt their constitutions, which of course would need to be agreed with the board. A number of amendments in this group seek to require consultation, with the public, the relevant local authority, the relevant health and well-being board and patients receiving primary medical services from providers within the CCG, for different processes: establishment, variation, merger or dissolution of CCGs. The Bill as it stands would set clear duties for patient and public engagement in new Section 14Z. CCGs would have to engage the public in their planning of the commissioning arrangements; in the development and consideration of commissioning proposals, which would have an impact on the manner in which the services are delivered to the individuals; and in the range of health services available. They would also have to engage on decisions of the CCG affecting the operation of the commissioning arrangements where implementation of the arrangements would impact on individuals or the range of services available. The CCG would also have to consult the patients it is responsible for on its commissioning plan. That is quite right and proper and I hope that, in that area at least, there will be some agreement across the House.
As regards local authorities and health and well-being boards, these boards will include representation from the local authority and CCGs. I suggest that is the ideal forum for CCGs to discuss proposals such as mergers with their fellow members. However, it would not be appropriate to impose an explicit requirement for CCGs to consult the board on such matters.
Turning to Amendments 164B, 166A, 166C and 167C, tabled by the noble Lord, Lord Hunt of Kings Heath, I commend the report of the Delegated Powers and Regulatory Reform Committee of your Lordships’ House. These amendments would make the resolution procedure for certain regulation-making powers relating to applications between CCGs and the board affirmative. This approach was rejected by the DPRRC, which found that the negative resolution procedure would give noble Lords ample opportunity to consider regulations laid before the House covering determination of applications for establishment of a CCG, for variation of CCG constitutions and on dissolution of CCGs.
The noble Lord, Lord Patel, asked me about competencies. In September the department published Developing Clinical Commissioning Groups: Towards Authorisation, which sets out our current thinking on the domains that the Commissioning Board may wish to use as indicators to judge the competencies of prospective CCG commissions.
While I know that there will not be a meeting of minds over this, I hope that I have at least fleshed out what the Government’s intentions are. There will, obviously, be opportunity for further reflection on these matters.
My Lords, I was not convinced by the noble Earl’s views on the number of clinical commissioning groups in our earlier debate. I was even less convinced by what he had to say about competencies. There was a lot of talk about, “The board may wish to do this”, and, “The board may wish to do that”, on competencies. The problem of healthcare commissioning in this country has actually been the lack of competency. That has been the problem for 10 to 20 years, under successive Governments. If we miss the boat again on this issue, we are making a great blunder.
I do not want to go over the ground about consultation with the public at all. I am interested in having in the Bill that the critical requirement of becoming a clinical commissioning group is competency to do the job, and that the board is required to specify what those competencies are, before people make an application. My noble friend Lord Hunt has made the perfectly sensible observation that while we are sitting, chatting about this Bill, people out there are doing the business about who will be clinical commissioning groups. That is what is actually happening. We need to make sure that they are under no illusions that competency is the yardstick by which they will be judged. I am not satisfied with the Government’s response and wish to test the opinion of the House.
[For the continuation of today’s proceedings, see Official Report, 1 December 2011.]
[Continuation of Official Report from col. 340, of Wednesday, 30 November 2011.]