On a point of order, Mr. Speaker. Yesterday, you had occasion to reprimand the Home Secretary because she sought to make a statement at topical questions. You told her that if she wanted to make a statement, she should come to this House in the normal way. Today, the Government have published their youth crime strategy, and it is inconceivable that even this Government should publish a document to which they attach such importance without making an oral statement in the House. Have you had any indication of when we might expect such a statement? Will it be later today, tomorrow or Thursday, or is the Home Secretary so embarrassed by the fiascos of the past couple of days that she can no longer face the House?

Further to that point of order, Mr. Speaker. In view of what you have said on consecutive days, may I ask that you refer the whole question of topical questions to the Procedure Committee? The procedure is clearly not working as some would have hoped and is being abused by certain Ministers of the Crown. That is a very unsatisfactory situation.

We are almost getting to the stage where the Chair is being drawn into the argument. Yesterday, I gently reminded the Home Secretary that she could have made a statement, but I go no further than that. From time to time, I have to tell Back Benchers not to make speeches, so it cuts both ways. I will say to the right hon. and learned Gentleman and to Sir Patrick that Ministers come to make statements to the House and the Speaker does not bring them to the House to make speeches or statements, other than when there is an urgent question. It is up to the Home Secretary or any other Minister of the Crown to decide when they want to come to make a statement.

On a point of order, Mr. Speaker. I know the weight that you put on the accuracy of ministerial answers to the House. On 1 July, in answer to a question from the hon. Member for Stroud (Mr. Drew), the Minister for Local Government, who is in the Chamber this afternoon, said that the Department for Communities and Local Government had

“made no estimate of the likely costs or savings that would be incurred if Gloucestershire was to become a unitary authority.”—[Official Report, 1 July 2008; Vol. 478, c. 794W.]

Unfortunately, yesterday, his fellow Minister, the Under-Secretary of State for Communities and Local Government, the hon. Member for Gloucester (Mr. Dhanda), cast doubt on the accuracy of that answer in a radio interview. Has either Minister indicated to you an intention to come to the House and put on record which statement is accurate?

That is not a point of order. I know where the Minister is sitting—I know him well, so the hon. Gentleman does not need to point. It is up to Ministers what replies they give. From time to time, Ministers might give diverse responses. That is up to them, but it is nothing to do with me and is not a matter for a point of order.

Further to the point of order about topical questions, Mr. Speaker. I shall not touch on the issue of oral statements, but will you confirm that when the Modernisation Committee reported to the House about topical questions, part of its recommendation—as I recall, although I might be wrong—was that Ministers should open topical questions with a short statement of 50 words or so? That is what Ministers have sought to do.

I remember when the right hon. Gentleman, the Lord High Chancellor, as he is now, was Leader of the House and we used to have cosy talks in the Speaker’s study. He was the person who told me of the great value of topical questions and sold me the idea, saying that it would give Back Benchers the opportunity to get in.

I’m happy with it, anyway.

If Mr. Mackinlay, whose grandfather came from Springburn, is happy, that suits me. Yes, a Minister makes a statement in response to the first question—that is fine—but when several statements come up afterwards that is a concern for me. The regulars in the Chamber will note that I have run topical questions well over the time in order to get Back Benchers in, because I am not going to be unfair to Back Benchers. Here endeth the lesson.

I beg to move,

That leave be given to bring in a Bill to create offences in relation to breaches of the Press Complaints Commission’s Code of Practice; and for connected purposes.

I should like to begin by thanking those hon. Members who kindly agreed to sponsor this Bill, and all those colleagues who have given me their support in the face of potential threats, or of the consequences of taking on and challenging the British press. I should also like to express my gratitude and thanks to Lord Soley, who in 1993 tried to bring in a similar Bill but who was unfortunately unsuccessful.

This Bill would introduce a statutory method for protecting the general public from inaccurate and, at times, inflammatory reports in the press and media. It is not intended, either by design or omission, to restrict or in any other way curtail the freedom of the press. However, a free press must balance commercial considerations with its responsibilities to individuals and to society as a whole.

The press are beholden to ensure that what is reported is accurate and can be substantiated if challenged. As it stands, a high proportion of people living in the UK have some difficulty in believing even the racing results printed by some of our newspapers. Indeed, a recent survey suggested that only 7 per cent. of the general public trust tabloid journalists.

I want to make a clear distinction between the tabloid press and those in the journalism profession, such as the late Charles Wheeler and, of course, our own Alan Johnston. At tremendous risk to themselves and their crews, they have worked bravely to report from some of the most troubled hotspots in the world and to bring events to our television screens. I contrast that with those who perch themselves in the Press Gallery here, and who indulge in cowardly character assassinations by day yet by night moonlight with the old boys’ network of the BBC.

The Press Complaints Commission was established in 1991 by the newspaper industry to address increasing concerns that self-regulation of the press was failing adequately to protect the public, and indeed the industry itself. The PCC’s prime function is to put things right when they go wrong during the editorial process, and it seeks to police a voluntary code of practice that was drawn up by members of the industry. Its board has 15 members: seven are senior editors and the other eight are lay members. The PCC operates under the slogan “Fast, Free and Fair”, and its voluntary code states that the press must take all due care not to publish “inaccurate, misleading or distorted” information in text or in picture format. It also states that a

“significant inaccuracy, misleading statement or distortion once recognised must be corrected, promptly and with due prominence”.

If appropriate, an apology may also be published. The code continues by saying that the press, while free to be partisan, must be clear in their distinction between content, conjecture and fact. Finally, it also states that any publication must report fairly and in an accurate fashion

“the outcome of an action for defamation to which it has been a party, unless an agreed settlement states otherwise, or an agreed statement is published.”

That is the PCC’s voluntary code as it stands at the moment. However, despite its adoption, the number of complaints to the PCC is increasing. As recently as 2003, the total was up by 39 per cent. at 3,649 complaints, more than half of which related to the accuracy of reports. Despite that alarming rise, and against the backdrop of an increasing lack of trust in tabloid newspaper journalism, the PCC wrote to me, in response to the Bill, to establish its view that no review of its practices was warranted. The National Union of Journalists and I disagree with the PCC’s position on that matter.

The NUJ has for some time suggested that the PCC should be declared a public authority, to bring it within the scope of the Freedom of Information Act 2000. That would make for a more transparent system, in which the PCC’s workings were opened up to public scrutiny. At present, cases brought before the PCC are dealt with in secret, and only the final judgment is made public. The NUJ also argues that the best way to ensure adherence to the PCC’s code of practice is for journalists themselves to uphold it. However, many journalists are increasingly forced to violate the code as a result of commercial pressures, or pressure from editors, some of whom are members of the PCC.

The NUJ argues that if journalists had a contractual right to refuse to carry out assignments or tasks that required them to breach the code of practice, the result would be greater accuracy and less need for complaints. Such a “conscience clause” would perhaps be the biggest step towards a return to a fairer, free press. There have been suggestions from some quarters that if we made the press complaints procedure more accessible and effective, our newspapers would be full of nothing but apologies and retractions. That view is clearly absurd, as the only foreseeable reason why a paper would be full of corrections is that it had been full of inaccuracies in the first place. In addition, many countries such as Germany, Belgium, Norway, Sweden, Greece, Austria, Switzerland and France have just as robust, or even more stringent, systems to ensure that their citizens are afforded protection from inaccurate press reporting.

In the UK, the current voluntary code of practice leaves newspapers free to print what they like, irrespective of the personal consequences for those involved. In the majority of cases in which members of the general public are the victims of inaccurate reporting, they do not have the resources—financial or otherwise—to mount a legal challenge against those responsible. There is an increasing body of anecdotal evidence to suggest that in situations in which victims feel that they have a strong case, they are bought off with minimal out-of-court cash settlements, and with a small retraction buried in the depths of the newspaper. There are, of course, some high profile cases, such as that of the McCann family, whose lives have been made a misery, not simply because of their own actions, but because of subsequent unsubstantiated, and frankly outrageous, reports about their situation. In my view, the McCanns are due every penny of their successful claim.

However, what about the case of Mr. Murat, at one time the prime suspect in the Madeleine McCann case, who was cleared of any involvement, but whom the British media decided to convict, and whose life now lies in ruins? The principle of innocent until found guilty seems not to be held to by the tabloid newspapers, which choose to persecute people in the court of public opinion, although what they say has little or no basis in fact. There are many cases like Mr. Murat’s, and that must give Members of the House, and the public, great cause for concern, as anyone at any time could fall prey to the vicious practices of the often unrepentant British press.

A recent newspaper report was a prime example of inaccuracy; it made statements to the effect that a group of Muslims had attacked a house in Windsor that they thought was being purchased by four members of the armed forces returning from a tour in Afghanistan. The report was made despite the fact that there was no evidence to suggest that the vandalism was caused by Muslims. The story even included a quote from the hon. Member for Shipley (Philip Davies). Subsequently, evidence emerged that indicated that the local Army barracks had received three anonymous telephone calls the previous week from local residents who objected to the presence of soldiers, fearing that they would lower property prices in the area.

As I made clear at the start of my comments, I do not wish to restrict the freedom of the press in the Bill. A free press is an essential tool in maintaining any forward-thinking democracy, and in avoiding—

Order.

Question put and agreed to.

Bill ordered to be brought in by Jim Sheridan, Tony Lloyd, Ann Clwyd, Michael Connarty, David Taylor, Ian Lucas, Mr. Brian H. Donohoe, Mr. David Clelland, Mr. Mohammad Sarwar, Mr. Jim Devine, Mrs. Madeleine Moon, and Mr. Dai Havard.

Press Complaints Commission (Breaches of Code of Practice)

Jim Sheridan accordingly presented a Bill to create offences in relation to breaches of the Press Complaints Commission’s Code of Practice; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 17 October, and to be printed [Bill 138].

I have given careful consideration to the Lords amendments to the National Insurance Contributions Bill. I am satisfied that they would impose a charge on the public revenue which is not authorised by a resolution of this House. Therefore under paragraph 3 of Standing Order No. 78, the Lords amendments must be deemed to be disagreed to.

I am grateful for your ruling, Mr. Speaker; it clarifies this particular matter. I wish to make one point about the Reasons Committee. To quote the Financial Secretary, the main purpose of the National Insurance Contributions Bill was to align the upper earnings limit of national insurance contributions with the starting point of the higher rate of income tax. Since the Bill went through the House of Commons, when we broadly debated the matters to which the Lords amendments relate, it has emerged that it is no longer the Government’s stated intention to align national insurance contributions and income tax. Would it be appropriate for the Committee, in providing its reasons to the House of Lords, to give the reasons why the Government wish to proceed with the Bill, given that the stated policy intention no longer applies?

Ordered,

That a Committee appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendments Nos. 1 to 4; Jane Kennedy, Mr. Bob Blizzard, Mr. Jeremy Browne, Mr. David Gauke and David Wright to be members of the Committee; Jane Kennedy to be the Chairman of the Committee; Three to be the quorum of the Committee; Committee to withdraw immediately.—[Mr. Khan.]

I beg to move, That this House agrees with the Lords in the said amendment.

Does the Minister want to continue? He should be making his speech.

I was expecting, Mr. Speaker, that after what I said you would say that it will be convenient to consider the other amendments, and I would then continue. However, I am happy to make my points on the first group of amendments now, if that would be in order.

With this it will be convenient to consider Lords amendments Nos. 2 to 5, 24, 25 and 66.

Thank you, Mr. Speaker.

In my view, the scrutiny of the Bill in both Houses has been enormously constructive, helped by the fact that there was broad cross-party support for the principle of integration and a genuine commitment to getting the framework right. Increasing integration of, and collaboration between, health and social care are among the key drivers behind the regulation framework provided for in the Bill, and constitute a recurrent theme running through Government policy. We introduced this group of amendments to address some of the key concerns that were debated at length here and in the other place. They were put forward in discussion with the current commissions as well as with the National Consumer Council, the Picker Institute, and Which?, all of which have welcomed them.

Amendment No. 2 introduces a new main objective for the commission.

On a point of order, Mr. Speaker. I seek your guidance. Given that the Minister is now making his second speech on this amendment, does he need the leave of the House to do so?

The Minister needs to reply at the end of the debate.

As I was saying, amendment No. 2 introduces a new main objective for the commission. We have been clear throughout that the commission’s main priority should be the safety and quality of services, and I said early on that I thought that its key functions and responsibilities were already set out in what was clause 2. However, we recognise that many people thought that this was not expressed clearly enough. The amendment introduces a clear, succinct statement of purpose, which resists the temptation to stray into other territory and create for the commission additional broad functions that it would have been unclear how it was to deliver, or to include a long list of objectives that could duplicate the functions of other statutory bodies. Instead, it emphasises that the welfare of patients and people who use social services should be at the heart of everything that the commission does.

Amendment No. 3 amends the matters to which the commission must have regard and sets those out in a separate clause. We were initially cautious about creating too many general requirements in these areas that risked diluting the commission's priorities. However, we have been persuaded on two particular fronts to make changes that, through their careful construction, address key concerns about the regulator’s focus on people who use services, but still preserve the right balance. Those are the reference to Local Involvement Networks—or LINks—which relates to amendment No. 72 in the next group, and the expansion of the responsibility to promote and protect people’s rights.

Another key issue in both Houses has been the desire to secure patient and user engagement in the commission’s work. We set out from the outset to create a body with a strong user focus, just as the existing bodies have. I have put on record my expectation that the commission will not only work closely with LINks but will find ways to engage with people who use services on a broader basis. Through Lords amendments Nos. 4, 24 and 25, we have responded to requests for this expectation to be set out explicitly in the Bill. Amendments Nos. 24 and 25 make it explicit that the commission must demonstrate to Parliament, as part of its annual reporting, how it is delivering against its statement on engagement.

Amendment No. 66 also responds to one of the key themes of the debates—the importance of ensuring that social care and the commission’s responsibilities under the Mental Health Act 1983 are not neglected. We have given assurances in both Houses that that would not be the case, but various amendments were proposed to try to guarantee it by legislative means. In amendment No. 66 we have arrived at a solution that provides the reassurance that some people have been looking for without tying the commission’s hands. It will include a broad requirement for the board to include members with expertise relating to all three areas covered by the existing bodies: social care, monitoring the use of powers under the 1983 Act, and health care.

We believe that the amendments improve on what was already in the Bill to make much clearer what is expected of the commission, without telling it how it should approach its task, and I commend them to the House.

I welcome this group of amendments, which delivers some of the changes that we were looking for, notably the inclusion of LINks—Local Involvement Networks—carers and service users, and proper representation for those with experience of health care, social care and functions under the Mental Health Act 1983. Unfortunately, it still fails to give the full independence needed for an effectively functioning regulator.

Amendment No. 1, which simply creates space for amendments Nos. 2 and 3, is uncontroversial. Amendment No. 2 inserts a new clause on the commission’s objectives. I welcome that new clause, brought forward by the Government, as it responds to Conservative amendments from the other place and this House. I pay tribute to those on the Conservative Front Bench in the other place, particularly my noble Friend Earl Howe, on winning so many concessions from the Government. Indeed, a large number of the substantive Government amendments before us today come as a direct result of amendments tabled by Conservative Front Benchers in Grand Committee.

Members of the Committee in this House will well remember that amendment No. 2 was originally tabled, in similar terms, by me, supported by my right hon. and hon. Friends and others from other Opposition parties—and the Minister is now introducing it himself. In Committee in this House, the Minister said:

“we believe that the essence and desires behind the new clause are already in the Bill”

and called attempts to lay out the objectives

“flawed and unnecessary”––[Official Report, Health and Social Care Public Bill Committee, 15 January 2008; c. 186.]

I hope that the Minister will take the opportunity to explain to the House why his colleagues in the other place disagreed, and whether he still considers such an amendment “flawed and unnecessary”. Surely it would have saved much parliamentary time to have accepted the amendment in Committee in this place.

My hon. Friend is making an important point. Does he have any explanation for the flip-flop, or U-turn? Is this a rare occasion when a Minister has listened and realised that he was wrong?

The best I can say to my right hon. Friend is that I would like to think so. I recall saying at the outset of the Committee that as we were aiming for as much consensus as possible on health and social care—not areas that are normally given to the playing of the party political game—I hoped that the Minister would avoid being tribal or having pride of authorship in the Bill. It was clear to us during the course of the Committee that accepting any Opposition amendments would cause the Minister physically to wince, so he did not accept one. Now we are back, mainly to implement the Conservative amendments, conceded in another place, that we presented in Committee. In answer to my right hon. Friend, there is a genuine question about what the price of saving face, or the price of not thinking quickly enough on one’s feet, is. As so much parliamentary time could have been saved had the amendments been accepted when they were first proposed, it is fair to ask precisely what has changed the Minister’s mind in the interim.

There are indeed some questions about the new clause. A number of hon. Members, and their lordships, have expressed concerns about the picture of the Care Quality Commission painted by the report “Developing the NHS Performance Regime”, recently published under the aegis of the NHS chief executive. Paragraph 150 states:

“The main responsibilities of the CQC are to: register health and social care providers; carry out a periodic assessment of all NHS…patient pathways or into other areas of concern or risk in terms of patient safety; carry out investigations into specific organisations where CQC believes that user safety is seriously at risk; and gatekeeping and proportionate regulation.”

The report continues:

“However, the principal role of the CQC will be to register health and adult social care providers.”

Paragraph 153 states:

“The registration system will be a key function of the CQC. In operating this, the regulator will register, monitor compliance and take action in relation to healthcare providers’ adherence to the registration scheme.”

Furthermore, paragraph 100 states that

“the CQC’s approach to assessing the performance of NHS organisations includes their assessment of quality and of financial performance. Our expectation is that the CQC will continue to work closely with the Audit Commission on the latter”.

However, what is the expectation for the former—assessment of quality?

The document not only flies in the face of the amendment, which does not mention registration, but drives a massive wedge between the CQC’s social care and health care responsibilities. The NHS chief executive wants the health care side to be divested of performance monitoring, but presumably such monitoring will be built into the social care side. The chief executive reveals his hand in paragraph 100, which says:

“we cannot have the same organisation being identified as ‘weak’ by the CQC and not identified as ‘underperforming’ by SHAs as performance managers”.

Could that be construed as the chief executive wanting to keep the dirty laundry in-house instead of supporting the quasi-independent CQC?

It remains clear that our model of separate independent regulation of quality and finances, which, sadly, was rejected in Committee, is much more transparent, effective and likely to support world-class patient care. I hope that the Minister will take the opportunity to explain the contradictory messages that the Bill and the Department are conveying.

I welcome most of Lords amendment No. 3. Again, I pay tribute to the Conservative Front-Bench team in another place, whose amendments in Grand Committee inspired it. I am especially glad that Local Involvement Networks have finally made it on to the face of the Bill. I know that hon. Members in other parties will also welcome that.

I welcome Lords amendment No. 72, which is in the next group, and adds the commission to the list of those to whom Local Involvement Networks must send copies of their annual reports. Again—I do not want to cause too much controversy—the Minister was strident in his opposition to the inclusion of LINks. He told me in Committee:

“I do not think that the amendment requiring a statutory relationship with LINks is the right way to go about the matter… I am not sure that singling out LINks for special treatment in the form of a statutory relationship…is the right way of going about it.”—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 152.]

On Report, he said:

“we do not believe that it is appropriate to dictate to those statutory and independent bodies the way in which they should involve LINks in inspections or consultations.”—[Official Report, 18 February 2008; Vol. 472. c. 88.]

What has changed? Of course, a late concession is better than none, but the Minister should have been prepared to change his mind when we discussed those matters in Committee, rather than waiting until such a late stage and taking up the House’s time.

I welcome proposed new subsection (1)(d) in Lords amendment No. 3, which recognises that the commission has a responsibility

“to protect and promote the rights of people who use health…care services”

and I remind the House that we debated that matter in Committee, and again the Minister was unwavering about it. The Government previously extended the provision only to children and vulnerable adults. Conservative Members believed that the CQC should promote the rights of all people, including those groups, but not excluding others. I am glad that the Government saw reason in another place. Again, I regret that the Minister did not see it sooner.

I regret that the Government have retained clause 2(4) in proposed new subsection (2) of Lords amendment No. 3. As the provision is drafted, the CQC must still

“have regard to such aspects of Government policy as the Secretary of State may direct.”

That makes nonsense of the idea of independence. I accept that the Minister has made several concessions to the independence of the bodies that the Bill creates or modifies—but those leave the provision that I have just cited looking rather out of place. Through it, the Secretary of State retains significant control over the CQC. In addition, clause 42 provides that the Secretary of State

“may direct the Commission to devise indicators”

of quality.

That is a retention of politically motivated targets, and the Bill is peppered with similar phrases.

Dame Denise Platt stated in her powerful evidence:

“We think that the independence should be clear. The body should have the opportunity to think, initiate and comment and to be accountable to parliament for what it does”—[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 14, Q18.]

I am not sure that the Bill provides for that sort of independence. It contains many phrases along the lines of “with the agreement of the Secretary of State”.

Speaking about clause 41, the Healthcare Commission stated in its submission:

“there is a risk of conflict with the independence that the Bill envisages for the regulator”.

It added:

“We do not think that the Government should determine operational priorities for an independent regulator.”

The independence of the regulator is key to freeing our NHS from political meddling. It is sad that the Government have not taken the opportunity to work towards that. The regulator will have the full confidence of the patients and front-line staff only when quality is its sole driver, not the political desires of the Government of the time. I am glad that we have won that and other concessions, but until the Secretary of State’s power as set out is removed from the Bill, it does not go far enough.

As for LINks, I welcome Lords amendment No. 4 and its focus on service users, which has yet again been underpinned by amendments from the Conservative Front Bench in another place and a new clause proposed by me in Committee. I welcome the fact that, through Lords amendments Nos. 24 and 25, the CQC will be required to report on user involvement. The Minister rejected our proposals in Committee on the grounds that the advisory committee that the commission must establish under schedule 1 could allow such involvement. I am glad that he has changed his mind, but I would be grateful to know why.

Is all this not just more evidence that the Government cannot get away from centralised, target-setting, interfering bossiness, messing up the health service and not allowing innovation and professional choice?

My right hon. Friend reaches for the overarching principle that lies behind the mindset that informs Bills of this type. The Government have an opportunity to pick up on the enormous amelioration that we could have, in resettling the basis on which the NHS can deliver, organically and from patient-driven demand, improved health care outcomes, rather than having an input-driven, target-setting approach. That is set out in our autonomy and accountability Bill, which has been drafted by the Opposition and is ready to go. I am grateful to my right hon. Friend for giving me the opportunity to ensure that, if that opportunity had slipped the Government’s mind, it is now before them again.

We also welcome the explicit mention of carers at the end of Lords amendment No. 4. However, I note the circularity that persists in the Bill, in Lords amendment No. 5, which states that in Chapter 1,

“‘health and social care services’ has the meaning given by”

clause 3, entitled “The Commission’s objectives”. Clause 3 defines “health and social care services” as

“the services to which the Commission’s functions relate.”

However, clause 2(1) states:

“The Commission has the functions conferred on it by or under any enactment.”

The Government have failed to investigate not only public health and health inspections, but adequate protection in the areas of cosmetic surgery, needs assessments for care, and health-related assessments for work, as regards the personal capacity assessment and health assessments in custody.

Lords amendment No. 66, the final amendment in the group, ensures that the commission includes representatives of health care and social care, and action under the Mental Health Act 1983. I am glad that the amendment has been tabled, because the Minister strongly resisted such a proposal in Committee. We might have progressed through the opening clauses of the Bill much more quickly had the Government made that concession then. I note, for example, that in oral evidence the Mental Health Act Commission made clear the need for

“adequate organisational and personal accountability at board level for the monitoring of and reporting on the needs and rights of detained patients.”––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 9, Q9.]

The Minister rejected our overtures, saying that our proposals

“specify a great deal more prescriptive detail than we feel happy with…We believe it should be for the commission itself to establish the organisational structures…That should extend to the executive team it chooses to have…Specifying that the commission must have executive officers and committees that lead on different client groups could undermine the commission’s ability to adopt that integrated approach”.––[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 134-35.]

I would be interested to know what has changed the Minister’s mind, in terms of the content of Lords amendment No. 66, between then and now.

It would be churlish not to welcome the amendments, particularly those that reinforce the importance of social care. Given that most parties have tried to work together on some of these issues, it is a little churlish of the hon. Member for Eddisbury (Mr. O'Brien) to claim that every amendment in the other place resulted from the efforts of the Conservatives alone. I have read the Lords Hansard, and that is not quite my perspective—but I will move on.

I share the slight disappointment of the hon. Member for Romsey (Sandra Gidley) at the ungracious tone adopted by the hon. Member for Eddisbury (Mr. O'Brien). We made it clear throughout Committee that we were in listening mode, and open to constructive suggestions as to how to improve the Bill further. The hon. Gentleman referred to the contribution of his noble Friend Earl Howe when the Bill passed through the other place—and Earl Howe described the Government amendments as diamonds and gems. If the hon. Member for Eddisbury wants me to outline the exact differences between these amendments and those that he proposed in Committee, I shall be happy to do so, but let me say that his amendments were closer in form to stones and pebbles than to diamonds and gems. That is why we tabled our own amendments; if we had not, he would have criticised us for not listening and not improving the Bill. Thanks to the contributions of noble Lords from the Conservative, Liberal Democrat and Labour parties, as well as Cross Benchers in the other place, the Bill has been considerably improved, and I had hoped that the hon. Gentleman would have found it in himself to welcome that.

The hon. Member for Romsey asked about rights. The answer to her question is that the rights include human rights, but are not exclusively about them.

Lords amendment agreed to.

Lords amendments Nos. 2 to 5 agreed to.

Clause 13

Cancellation of registration

Lords amendment: No. 6.

I beg to move, That this House agrees with the Lords in the said amendment.

With this it will be convenient to discuss Lords amendments Nos. 7 to 23, 26 to 31, 53, 54, 67 to 72 and 84.

This group consists of concessions, where we have listened and responded carefully to debate, and some minor technical amendments. Amendments Nos. 15, 16, 18 to 21 and 28 to 31 make it explicit that, as has always been our stated intention, the new regulator must conduct periodic reviews of care commissioned by primary care trusts or local authorities. Amendments Nos. 18 and 19 mean that, following a special review or investigation, the regulator must consider whether the report raises issues on which it should advise the Secretary of State.

Tabled in response to discussions on the independence of the new commission, amendments Nos. 17, 23 and 26 would moderate certain powers that the Secretary of State will have. We have also put on the record the fact that the commission can decide for itself when it begins its special reviews.

Finally, amendments Nos. 8 and 72 make even more explicit the need for providers to learn from complaints, and require LINks to send their annual reports to the commission. Amendments Nos. 53 and 54 result from recommendations of the Delegated Powers and Regulatory Reform Committee, while the remaining amendments are simply technical and are intended to improve the Bill. I hope that the House will support them.

I shall use precisely the same words as I used in my opening remarks on the previous group of amendments. I welcome—the Minister and the hon. Member for Romsey (Sandra Gidley) both seemed to miss my saying that—the majority of the amendments, which again pick up on points made by Conservatives in both Houses. It does not matter how much the Minister and the hon. Lady wish to deny that they were Conservative initiatives, they were indeed proposed by us in both Houses. I am pleased to say that some of them were supported by other Opposition parties.

I am glad that the complaints function is addressed in regulations, although I fear that there are unresolved issues for patients, particularly for self-funders in social care. I am glad of greater scrutiny for prison and defence health care, although I retain some concerns about the powers of the Executive over that. I am glad of the amendments that limit the powers of the Secretary of State, but I am disappointed that no substantive amendments were achieved on malnutrition, given the powerful debates on that both in Committee and on Report.

Amendments Nos. 6, 7, 9 and 11 are not controversial. Amendment No. 8, however, merits a bit of discussion. In addition to the handling of complaints and disputes, it enables regulations to make provision for the application of lessons learned from them. I am pleased to see the amendment on the amendment paper. It recognises that an effective complaints process includes a performance management output, so that mistakes are not repeated and loopholes are closed. I again pay tribute to my noble Friend Earl Howe for championing the amendment in another place, and I am pleased that the Government made the concession. However, it comes nowhere close to addressing the serious concerns that remain about the complaints arrangements both within registered providers and on a national scale through, inter alia, the parliamentary and health service ombudsman. I draw the House’s attention to cross-party concern on that.

The hon. Member for Luton, North (Kelvin Hopkins) made a number of powerful speeches on the subject in Committee, saying:

“A number of my hon. Friends, not necessarily members of the Committee, are concerned about changes in patient representation and procedures for patients making complaints in recent years.”—[Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 346.]

He was supported by the hon. Member for Tamworth (Mr. Jenkins) in holding the Government to account for their failure in that respect. The amendment fails to address three issues—resourcing the ombudsman, monitoring trends, and supporting complaints by social care users.

If you remember, Mr. Speaker, the Committee had three evidence-taking sessions before it considered the Bill in detail. In the ombudsman’s written evidence, she said:

“I have already explored with the Treasury the additional funding I am likely to require”.

However, no figure has been put on that. This is a serious issue, as the saving made by the Care Quality Commission will no doubt be reported as a gross saving by the Department, but could be a net loss to the taxpayer.

I must remind the Minister that at column 348 of our Committee proceedings he promised to write to me with “the exact figure”—a promise that his letter MS (H) 103035 failed to deliver on, dealing with the issue only in the broadest terms. It is disappointing that the Bill has reached its final stages, with this amendment, without that information coming before the House. I complained about that on Third Reading, but have had no response from the Minister.

Looking at the complaints that the Healthcare Commission has received, the ombudsman faces a potential elevenfold increase in her work load. How much will that cost? We need to know whether the cost is admitted by the Treasury, or is it in denial of the costs of its very own legislation? Has the ombudsman been given the assurances and budgets requested and required? If not, why not? If the Minister does not know the answer, then after all this time, why not? If he does, but will not give it, surely we are right to place the question on the record.

Associated with my hon. Friend’s comments is the fact that I am still unclear—I wonder whether he or, eventually, the Minister can clarify this—how some of the lessons learned and how the complaints procedure generally, whether it is through the Care Quality Commission or the ombudsman, will translate into changes of policy in either health or social care?

My hon. Friend touches on an important point—how we benefit from the processes. That has not been particularly well thought through, not least because of the absence of, for instance, the great bed-watch campaigns that the old community health councils could collectively inspire. Indeed, the second of the three areas that I was discussing in relation to amendment No. 8 and our concerns, which remain unaddressed but have been part of the debate that has led us to this point, was monitoring the trends. For a regulator, local or national trends revealed through complaints can be a useful bellwether—precisely the point made by my hon. Friend—in directing its inspection activity. The amendment, however, fails to establish a mechanism for the monitoring of complaints trends at national level—as did the old bed-watch campaign, until it was summarily scrapped.

I do not propose to go through the amendments at length, as we support most of them because they improve the Bill and make changes that we sought to secure in Committee.

I particularly welcome the amendments that strengthen the role of the commission with regard to commissioning. My interpretation of Lords amendments Nos. 15 and 16 is that they would allow for the commissioning to be reviewed. I was very taken by the comments of Lord Warner on Report in the other place. He has considerable experience of health matters, and he said:

“In the past, there has been a considerable reluctance on the part of the NHS, and often of the Department of Health and Ministers, to act when commissioners are failing. They are much more willing to act when providers are failing. The Bill is strongly focused on providers, with a registration system and a set of sanctions accordingly.

I do not want to put the noble Baroness, Lady Young, in a difficult position in her future relationships with Ministers and SHAs, but there is an issue about whether, in the Bill, the commission should be able to require some action from the performance managers”.—[Official Report, House of Lords, 24 June 2008; Vol. 702, c. 1349.]

Try as I might, I could see that there was a provision to review, but it was hard to see what sanctions were available if the commission felt there were problems in any area of commissioning. As it is a variable beast that works well in some areas of the country and less well in others, I felt Lord Warner raised a valid point that Lord Darzi did not fully address in his summing-up comments. It would, therefore, be helpful if the Minister were to add to them today, and put some flesh on the bones.

I particularly welcome the many amendments that take out the reference to the Secretary of State—in respect of modifying reports, for example. Although there are still some provisions for the Secretary of State, it is pleasing that his role seems to have been almost totally emasculated by the other place. That will be welcomed by those who query whether the new body will be truly independent. It is still not perfect, but it is much better than it was, and it is clearer that there is less provision for Government interference of any kind.

On the issue of costs and the ombudsman, the hon. Member for Eddisbury (Mr. O'Brien) will know that the health service ombudsman for England is independent of Government, and she has made it clear that she has plans in place to ensure that her office is prepared to handle the expected increase from 1 April 2009. She has been exploring the funding that she is likely to require directly with the Treasury, rather than with my Department. She also made it clear in the memorandum that she tabled for the Committee, which has been shared with hon. Members, that she would be happy to provide them directly with any further information.

The Minister rightly confirmed that the first legislative opportunity would be taken to introduce access to these arrangements for self-funders—we all hear and accept that, as he acknowledges. Given that such provision was not identified as part of the draft legislative programme recently announced by the Government, has the Minister had any indication as to whether we might expect it in the forthcoming legislative programme—after all, it was only a draft that was announced—or soon after? Alternatively, does he see it as a more distant horizon?

No, we want to do this as soon as we possibly can. I am sure that the hon. Gentleman will accept that no Minister can stand at the Dispatch Box in July and say exactly what will be in the next legislative Session. As I have said, it is certainly our intention to legislate at the earliest opportunity.

As for the Care Quality Commission’s commissioning role, I do not think that we could have made it clearer, both during the passage of the Bill and in changing its wording in the other place, that the CQC’s role would include reviews of the process of commissioning. The hon. Member for Romsey (Sandra Gidley) made an important point about the overall importance of improving commissioning and the primary care trusts’ capacity to commission. It should not be forgotten that alongside the role of the CQC in improving the quality of commissioning through regulation, we also recently announced in the primary and community care strategy—and before that, in our proposed performance and failure regime—how PCTs’ commissioning could be better performance-managed. The Bill contains a power for the CQC to call on the Secretary of State to intervene where it believes that a PCT’s commissioning is not up to standard.

The Minister gave my hon. Friend the Member for Eddisbury (Mr. O’Brien) a perfectly valid and stock answer under the old regime. However, given that the Government have changed the regime in favour of transparency and have published a draft legislative programme, why can the Minister not define what the earliest possible moment is? Why can he not assure the House that it will be in the next Session of Parliament, as opposed to giving a vaguer answer—we would have expected that before the change to greater transparency?

Although we have, as the hon. Gentleman graciously acknowledged, improved the level of transparency through the process of publishing a draft legislative programme for consultation, he will know that that is not an exhaustive list of Bills and that the fact that a Bill has been published in the draft legislative programme does not necessarily guarantee that it will have a place in the final programme. As I said, I am not in a position—he has been here long enough to know that no Minister would be in this position—to say in July what will be in the next Queen’s Speech.

Lords amendment agreed to.

Lords amendments Nos. 7 to 31 agreed to.

Clause 111

Powers of Secretary of State and devolved administrations

Lords amendment: No. 32.

I beg to move, That this House agrees with the Lords in the said amendment.

With this it will be convenient to discuss Lords amendments Nos. 33 to 36, 52, 55 to 60, 62, 73 to 83 and 85 to 89.

This group of amendments reflect areas in part 2 of the Bill where arguments put forward in the other place merited serious consideration. We have also tabled amendments to achieve a new policy, which I will turn to first.

Amendments Nos. 36, 60, 75 to 78 and 85 to 89 were introduced at Grand Committee stage in the other place to meet a Government commitment to abolish the Hearing Aid Council by April 2009 and to transfer the regulation of private hearing aid dispensers to the Health Professions Council. This group of amendments is intended to achieve that by paving the way for a future Order in Council under the section 60 provisions of the Health Act 1999, in addition to ensuring that public hearing aid dispensers can be regulated in the same way in the future.

I accept that it is not ideal that this House did not have the opportunity to consider this provision in its deliberations in Committee. I hope, however, that hon. Members will forgive the fact that this is a late addition to the Bill in recognition of the very real benefits that this measure will bring for patients and consumers. First, this will provide improved protection for the hearing impaired and simplify the regulatory framework for hearing aid dispensers. Although the council has done a fantastic job over the past 40 years, it is operating under legislation that is increasingly outdated with gaps in consumer protection. The Health Professions Council, established in 2001, has modern and comprehensive legislation that will provide for a much more complete service to patients and consumers. As a multi-professional statutory regulator, it can provide greater resources while charging considerably smaller fees to the profession. Secondly, and importantly, the Hearing Aid Council itself, the Health Professions Council, the Royal National Institute for Deaf People and the British Society of Hearing Aid Audiologists are all fully supportive of this move, and are working together to ensure that the transition will be as smooth as possible.

I turn now to the amendments that we have brought forward as a result of debates in the other place. Amendment No. 32 addresses concerns that the Secretary of State’s power of direction over the Council for Healthcare Regulatory Excellence in the Bill, as originally drafted, could be perceived as undermining the independence of the CHRE. The reason for including it in the Bill was as a mechanism to help the CHRE to prioritise its workload in busy periods, but having discussed it with the CHRE we are now confident that it can be dispensed with.

On clause 116, I was persuaded by arguments put forward in the other place that the Bill could be strengthened to ensure that the careers of health care workers are not damaged by malicious or untrue allegations. Amendment No. 35 therefore requires the appropriate Minister to have regard

“to the importance of avoiding unfair prejudice to health care workers against whom unsubstantiated allegations are made”

when making the regulations setting out in detail how information can and should be shared.

I have great sympathy with the Minister on that point because unsubstantiated allegations can ruin people’s lives. What would be the process for ascertaining whether they were indeed unsubstantiated?

That will depend on the evidence.

I turn now to the issue of the Office of the Health Professions Adjudicator. Amendments Nos. 52 and 56 respond to concerns that the piloting of legally qualified chairs might be unfair to individual practitioners who appear in front of OHPA’s fitness to practise panels. Although I am clear that that can be done fairly, we have brought forward amendments Nos. 52 and 56 to ensure that if OHPA makes rules that include piloting provisions, these rules will be subject to the affirmative resolution procedure. That means that Parliament will have the opportunity to debate OHPA’s detailed proposals for the pilot, and will be able to reject them if it is felt that they are unfair.

Amendments Nos. 33, 34, 55, 57 and 59 implement recommendations of the Delegated Powers and Regulatory Reform Committee. They provide that when the first regulations are made under clauses 114 and 115, conferring responsibilities and additional responsibilities on responsible officers for the first time, the regulations will be subject to the affirmative resolution procedure. Finally, amendments Nos. 62, 73, 74, 82 and 83 are technical and minor.

Amendment No. 32, which leads this group, would remove the Secretary of State’s power of direction in relation to the CHRE. It is exactly the same as my amendment No. 207, which was tabled at the Commons Committee stage. The Government conceded after the point was raised again by my noble Friend Earl Howe. Of course, we welcome it and thank the Government for listening, even if they did take the whole process of the Bill to do so.

Lady Justice Smith told the Committee during its oral evidence sessions:

“it is important, particularly in the health sphere, that the adjudicatory body should be seen to be independent of Government because the Government are a huge customer of healthcare; the biggest customer of healthcare. Therefore, it is important that there should be no suspicion that the Government are in a position to pull strings behind the scenes, as to what goes on. Absolute clarity and absolute independence are really important.”––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 42, Q82.]

The Minister rejected my amendment in Committee on the grounds that there was

“no intention to fetter the body’s freedom”

but

“to ensure that, where necessary, a Secretary of State can ask the council to prioritise certain areas of its work load over others: for example, in cases in which there is particular public concern”.––[Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 421.]

That is as clear an admission of the political meddling that the Bill enables as one is likely to get.

I am glad that the Government have conceded that point. I would be grateful if the Minister outlined why and how his views have changed since the Committee stage and why it was not possible to concede the points at that time. Exactly the same points were made to advance that argument in this House as were made in the other place, as the Minister mentioned.

Amendments Nos. 33, 34, 55, 57, 58 and 59 were tabled in response to the Lords Delegated Powers and Regulatory Reform Committee and to Conservative amendments tabled by my noble Friend Earl Howe. The DPRRC recommended that regulations conferring responsibilities on responsible officers under new section 45B of the Medical Act 1983, as inserted by clauses 114 and 115, should be subject to the affirmative resolution procedure on their first exercise by each of the appropriate authorities. I note that the DPRRC made three specific recommendations and that the Minister accepted them all.

The Minister will be aware that we called for regulations under clause 114 to be subject to the affirmative resolution, along with all the other regulations in the Bill. The House will recall that a quarter of the clauses in the Bill are dependent on regulation—a high proportion. In addition, there are a number of Henry VIII clauses that enable the amendment of primary legislation by secondary legislation, although the majority are already covered by the affirmative resolution. I am glad that the significant new step in regulatory policy—the creation of responsible officers—will have proper parliamentary scrutiny at its outset, at the very least.

In Committee, we tried to pin down some of the policy on responsible officers. The discussion was framed by the concerns expressed by Lady Justice Smith during her oral evidence. She told us:

“I really find it difficult to know how responsible officers are going to work and what role they will play in revalidation. I do not get that from this Bill.”

She went on:

“I cannot tell from the Bill how it will work, which bothers me. I am worried about responsible officers”.––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 42-43, Q83.]

One suggestion is that PCT medical directors will be the responsible officers. Indeed, the Minister told the Committee that while the Government

“do not seek to be prescriptive, we think that a medical director would be perfectly appropriately for this role”

and that

“it would not require a full-time post.”––[Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 431-33.]

PCT medical directors are already busy and have many priorities. In her oral evidence, Lady Justice Smith noted that, saying:

“I am really unhappy about that for several reasons…I do not like the idea of a medical director, who already has a lot of jobs, having to take on responsibility for revalidation as well as all his other jobs. I think that that is too much.”

Part of her desire to have the responsible officer as a separate role arises from her concern that

“the revalidation process should be clear and understood, that it should be summative and a proper test, and that it should not just involve shuffling pieces of paper around and rubber-stamping them”.

Perhaps my hon. Friend can help me. An allegation is an allegation. What in the Bill will protect members of the clinical professions from having allegations made against them? Surely the person making the allegation must be made aware that if the allegation is malicious, they will face legal action.

I am most grateful to my hon. Friend, who makes a powerful point. We in this House must be supremely conscious to ensure that justice can be done, and can be seen to be done. We are talking about a quasi-judicial area, and it is of course important not to discourage whistleblowing, which is one of the best sources of information. The Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), and I have been asked the question: what does one do to guard against those who might be minded to make a malicious allegation? There are people who might be keen to do so, because of career jealousy or personal angst. What would be the threat against those who knew that they had done something wrong? The answer is not in the Bill. The Bill rightly ensures that information can be provided, and it could be malicious or non-malicious. If it is non-malicious, that is fine, and the allegation will be examined.

Of course, as with laying information before the police, there is information that it is important to provide. If it is of the most catastrophic kind, we need to know it as soon as possible, so that the police or, in this case, the professions, can investigate. My hon. Friend’s point is about the middle ground—an issue that is not specified in the Bill. That could be improved.

rose—

Perhaps I could just finish the point. There ought perhaps to be a safeguard. Somebody who makes a complaint needs to know that they can opt for an alert system. They can put the matter to an official body, which can then be on watch, or on alert, without launching a formal investigation. By that means, responsibility is offloaded from the individual. If the complaint is non-malicious, that is likely to give the person confidence that they have at least done the right thing. They will know that the official bodies are in possession of information that gives them the chance to be on watch, or to put in place an appropriate alert system. That happens in other areas, and quite properly so.

The problem is that at the moment we do not have that necessary halfway house, which would at least in part provide the safeguard that my hon. Friend seeks in order to deter malicious tittle-tattle and worse. That is not in the Bill, but now that we have had this exchange, I hope that the matter will at the very least be picked up in the training and guidelines for all those involved officially in encouraging whistleblowing more widely, through marketing. We see advertisements encouraging whistleblowing in various parts of our community from time to time, so that we can get genuine information and so forth. That information will then be given, and the subject of the complaint can be officially put on watch; that way, allegations are not simply a way of passing on tittle-tattle. I hope that that addresses my hon. Friend’s valid and important point to some degree, and I am deeply grateful to him for raising it.

When the Minister addresses the points raised in discussion on this group of amendments, it would be helpful if he amplified his views on whether there will be official processes—perhaps a formal alert system of the kind that I described—to avoid tittle-tattle and unfair stigmatisation. That would give whistleblowers clarity and peace of mind about the fact that their concerns are being dealt with professionally. It would also give professionals the confidence that they need in the system, and I hope that the Minister listened carefully to our exchange.

Amendment No. 52 is coupled with amendment No. 56. They would ensure that the rules concerning the running of a pilot scheme for legally qualified chairs of panels were subject to the affirmative procedure. As I am sure the Minister remembers well, we have already had extensive debate about legally qualified chairs. The amendments were tabled in response to points made by my noble Friend Earl Howe in Grand Committee, and by others, about the fairness of the scheme. The Government amendments on legally qualified chairs that were brought forward on Report in the Commons did not go as far as they might have done, but they were an important concession by the Government, and they recognised the strength of the arguments—not least our own—on legally qualified chairs.

The provision of legally qualified chairs arises from recommendation 79 of the Shipman inquiry’s fifth report, by Lady Justice Smith, then Dame Janet Smith. She reinforced her position during an oral evidence session in the Public Bill Committee, on 8 January, at column 37 of Hansard. Her grounds relate to effective chairmanship, the speed of proceedings, a higher standard of reasoned decision, and an ability to deal with the complexities of the civil standard of proof. It will be remembered that the Bill uses the civil, as opposed to the criminal, standard of proof for the processes in question. I am glad that both Houses will have the opportunity to scrutinise the final proposals when they come before us; that will be absolutely vital.

Amendment No. 62 prevents schedule 8 from coming into force on the day the Act is passed. Will the Minister clarify why he has had to take that step? I am grateful that the Government have conceded that the commission should be able to conduct special reviews from the outset. The Government spokesman in another place noted:

“The commission will decide for itself what reviews are necessary from the outset, taking account of the resources available to it and the need to fulfil all its statutory functions.”—[Official Report, House of Lords, 12 May 2008; Vol. 701, GC253.]

Both the Commission for Social Care Inspection and the Healthcare Commission have produced valuable special reports that are able to assess the national picture of a specific issue. There was some concern about the Government’s desire to delay granting that power to the regulators—not least that the delay would have conveniently tied the hands of the regulator until after the next general election. The Minister opposed the move in Committee and we pushed it to a Division. Why did the Government not change their mind at that point rather than now, welcome though it is that we have now reached agreement?

Amendments Nos. 73 and 74 make what the explanatory notes call “minor drafting changes” to schedule 7. Amendment No. 73 excises the phrase “member State” and replaces it with “relevant European State”. Often, these things can be absolutely fundamental, given how European legislation tends to work, but as far as I am aware, the relevant sections of the Medical Act 1983 have not been amended to read “relevant European State” instead of “member State”. Will the Minister explain the substance behind the amendment and why it is being made? Surely “member States” are easily definable and “relevant European States” less so.

The amendment may not be so much a “minor drafting change”, although it must be thought to be that, given that the phrase is in the explanatory notes. It just worries me that it could be a definitional read-across that it is important to recognise, given that at the moment there is the introduction under European legislation of the 48-hour week. That is having a major effect on how health services can be provided in our country, let alone in other member states. We should have uniformity of definition.

In answer to a written parliamentary question of mine, a Health Minister recently accepted that there was a great raft of member states that had not agreed to impose the 48-hour limit on the working week of those in the medical professions. We wonder whether a sleight of hand may be behind the issue. As I say, I have no reason to believe anything other than what is in the explanatory notes, but it is extraordinary that we should be asked to replace “member State” with “relevant European State” without an explanation, given that these things often carry such important cross-referencing in legislation.

Amendment No. 82 ensures that the Council for Healthcare Regulatory Excellence would not be able to take action on the case of any individual in respect of whom there were or had been proceedings before the Office of the Health Professions Adjudicator. We raised the issue in Committee. The Minister contended that he had already achieved that through what was then Government new clause 6. He said the new clause meant that possible disputes about whether the council had the power to consider individual cases would be avoided. Why, then, were the Government unable to get the issue right in the first place? That question is left hanging in the air. The other matters in this group of amendments need not detain us any longer.

On the removal of the Secretary of State’s power of direction over the Council for Healthcare Regulatory Excellence, I should say that we did listen to the debate, both in Committee and the other place. We also spoke to the chairman of the CHRE, and we changed our minds. I ended up agreeing with the hon. Member for Eddisbury (Mr. O'Brien) on that matter.

I think that amendment No. 35 was originally tabled by the hon. Member for Romsey (Sandra Gidley) in Committee; she raised concerns about the possibility of malicious complaints being made. The amendment is an attempt to address those concerns by ensuring that information must definitely reveal a threat to public safety if it is to be shared. We also made it clear in the amendment that the appropriate Minister, when making regulations under clause 116,

“must have regard to the importance of avoiding unfair prejudice to health care workers against whom unsubstantiated allegations are made.”

We have been seeking advice from an expert group whose conclusions will be published in the autumn. We will then consult on the principles that will underlie the regulations and guidance and, in due course, on the draft regulations themselves.

I appreciate that this is a technical matter, but the Minister will understand that there are commencement dates and people need to make their plans. I may have misheard him, but I think he said that schedule 8 will need to be implemented before the main part of the Bill. That is the first time I have come across that in this House. I assume that a schedule can come into force before the main body of the Bill to which it relates.

I do not think that that is the case, but I undertake to write to the hon. Gentleman with clarification.

The hon. Gentleman asked about amendment No. 73. The European Qualifications (Health and Social Care Professions) Regulations 2007 amend the heading of section 44 of the Medical Act 1983. We have changed the reference in the Bill to reflect that. It has no effect on the meaning of the provision. The difference that he highlights is that between a European member state and a relevant European state. A “relevant European state” means a member state of the European economic area or Switzerland. The Swiss have certain treaty rights despite not being members of the EAA, including free movement of Swiss professionals and the recognition of their qualifications by member states.

Lords amendment agreed to.

Lords amendments Nos. 33 to 36 agreed to.

Clause 123

Public health protection

Lords amendment: No. 37.

I beg to move, That this House agrees with the Lords in the said amendment.

With this it will be convenient to deal with Lords amendments Nos. 38 to 47.

Amendments Nos. 38, 40 and 41 strengthen the safeguards available for those subject to orders by justices of the peace by placing additional maximum time limits on detention, isolation or quarantine. Amendment No. 38 provides for an automatic review every 28 days where an individual is quarantined, isolated or detained under regulations made using section 45C of the Public Health (Control of Disease) Act 1984. Amendments Nos. 40 and 41 provide for the period of any extension of a measure for detention, isolation or quarantine imposed under an order not to exceed 28 days. There were concerns in the other place that the wording of the legislation could lead to disposal of dead bodies in a less than respectful manner. Amendments Nos. 37 and 39 clarify that where disposal of an infected or contaminated dead body is required, it is by way of cremation or burial. It was also felt that clarification was needed as regards who should be notified when an application for a justice of the peace order is made regarding a dead body. Amendments Nos. 42 and 43 deal with that issue.

Amendment No. 47 ensures that regulations made using the emergency procedure in new section 45R are not subject to the process for making hybrid regulations. That is because the hybrid instrument procedure is a rather lengthy process and would not be appropriate where there is an imminent public health threat. Finally, amendments Nos. 44, 45 and 46 ensure that the first draft of the regulations under sections 45N and 45L(4), which provide for the making of additional provisions in relation to a justice of the peace’s order, are subject to the affirmative procedure.

I shall start with amendments Nos. 37 and 39, which ensure that dead bodies are disposed of respectfully. The former wording of the clause did not really protect the humane treatment of dead bodies, and I am sure that many in this Chamber would like to think that they will be buried or cremated, rather than disposed of. I would particularly like to thank those in the other place for picking up on this point. Conservatives in the Grand Committee commented that the insensitivity should be addressed, and I welcome those amendments.

Amendment No. 38 makes available a right of review for special restrictions or requirements

“imposed by virtue of a decision taken under the regulations”.

Proposed new subsection (6B) would provide that where the restriction or requirement imposed was isolation, detention or quarantine of a person, the maximum period prior to review, and the maximum interval between reviews, would be 28 days. In addition, the review would be automatic for such measures. I fully support that amendment. In Committee, we had considerable discussion about issues relating to detention. I am pleased to see that the Minister has recognised some of the concerns about safeguards on the power to detain, isolate and quarantine people. The measures will restrict periods of detention, isolation or quarantine under the domestic regulation-making power to a maximum period of 28 days before a review must take place. We do not want a situation where people are held in isolation or quarantine indefinitely at the mercy of a periodic review. I therefore welcome the extra safeguards that the amendment will give to the liberties of those detained.

The automatic review is most welcome, and it will not depend on an application. As I said, considerable concern was raised in Committee about the powers, and I know that organisations such as the National AIDS Trust have particular concerns on the matter. I am pleased that the Minister heeded some of the concerns raised in Committee. There has been a lot of discussion in the House on detention recently, and it is curious in some ways that the measures in this Bill received almost no attention. The powers are quite draconian; they may be necessary in certain circumstances, but we need to ensure that the public are protected.

Amendments Nos. 40 and 41 will amend the Public Health (Control of Disease) Act 1984 to limit the period for which a part 2A order could impose detention, isolation or quarantine of a person to a maximum of 28 days. The amendments will also limit any extension of those measures to no more than 28 days, and provide a power to shorten the maximum periods further by regulation. I am pleased that the amendment will restrict the period of any extension of a justice of the peace order for detention, isolation or quarantine to no more than 28 days at a time. Once again, that will help to safeguard the human rights of those who have been detained, and it will protect the public from any miscarriages of justice. Consequently, I fully support that amendment. There is also a provision to shorten the maximum periods by regulation. If there is an opportunity to do so, and the 28 days is not found to be necessary in practice, I hope that the Minister will take up that option.

Lords amendments Nos. 42 to 47 are largely technical. As someone who has not been a Member of Parliament for very long, I find it disappointing that such technicalities are not ironed out earlier. My hon. Friend the Member for Eddisbury (Mr. O'Brien) said in his remarks on the first group of amendments that much parliamentary time could have been saved by introducing such measures when the detail had been properly worked out.

The group that we are considering is entitled, “Public health protection”, and public health staff will be greatly exercised by the implementation of some of the powers. The number of public health staff working in the NHS has more than halved in the past 10 years, since the Government came to power. In 1997, there were 3,000-odd key non-consultant public health staff, including nurses, nursing assistants and other key public health support workers. By 2006, that figure had fallen to 1,362—a 57 per cent. cut.

As the amendments point out, public health staff are crucial to implementing some of the powers and ensuring public safety, yet a 57 per cent. cut in staff means that they have less time to exercise those powers. Indeed, in 2002, Derek Wanless served a warning on the Prime Minister that a failure to tackle public health challenges would contribute to an extra cost of up to £30 billion a year by 2022. The Prime Minister’s failure to tackle them forced the Government’s chief medical officer Sir Liam Donaldson to raise the alarm last July that the country was following the Wanless report’s worst case scenario. He noted:

“There is strong anecdotal evidence from within the NHS which tells a consistent story for public health of poor morale, declining numbers and inadequate recruitment and budgets being raided so solve financial deficits in the acute sector.”

Obesity rates, sexually transmitted infections and substance misuse are all rising. Indeed, since 1997, the proportion of boys aged two to 15 who are either overweight or obese has increased by 33 per cent. I recognise that the Bill contains provisions to do something to address that problem through weighing and measuring children. However, the statistics are shocking. The position has been exacerbated by the Government’s abandonment in 1999 of the Conservative Government’s targets of reducing obesity rates in the general population to 6 per cent. among men and 8 per cent. among women.

Figures have recently been produced on sexually transmitted infections. Since 1997, cases of syphilis have increased by 1,654 per cent. Cases of gonorrhoea have increased by 44 per cent., of chlamydia by 148 per cent., of herpes by 17 per cent., of genital warts by 17 per cent. and of HIV by 11 per cent. The Minister may laugh, but I doubt whether it is a laughing matter for those suffering from a sexually transmitted disease or those involved in public health protection who are trying to deal with the problems, which are not only serious but increasing.

Surely the hon. Lady is stretching the facts to make a rather cheap partisan point. All the percentages that she cites are recorded increases, which have been recorded because of the massive extra resources that the Labour Government have put into the NHS, unlike the Tories, who systematically bled it dry and almost destroyed it.

I thank the hon. Gentleman for his intervention. It is interesting that he makes a party political point to knock me for making a party political point. I do not think that he will find that the increase in syphilis is down to extra recording. Syphilis has been recorded for quite some time. The issue is nothing to do with recording. To have sexually transmitted diseases at those levels in this day and age is very serious, and the issue is all about public health protection. On substance misuse, since 1997 the number of alcohol-related deaths has increased by 40 per cent. and the number of young people receiving treatment in hospital as a result of alcohol misuse has risen by 33 per cent. Smoking rates have fallen far more slowly since 1997 than in earlier years. In 2005, 24 per cent. of the adult population smoked, compared with 27 per cent. in 1998.

Will the hon. Lady give way?

I will give way one last time, but the hon. Gentleman failed to make an adequate point last time, so I hope that he will make one this time.

I am grateful to the hon. Lady for giving way again, but she failed adequately to respond to my point, so I will make it again, even more clearly. Is she seriously saying that if we greatly expand the number of health care professionals, as we have done, they will not inevitably produce, de facto, an increase in the number of recorded cases?

I am indeed going to suggest that. Perhaps the hon. Gentleman should have listened to my point that public health staff have been reduced—not increased—by 57 per cent. I suggest that he check those figures and write me an apology tomorrow, because I am right.

Furthermore, health inequalities are crucial. Public health staff are the key to doing something about the rising rates of sexually transmitted infections, substance misuse and obesity. Although the inequality gap in circulatory disease mortality has declined and is on track to meet the target, the latest health inequalities figures show that the inequality gap in the infant mortality rate has not reduced by a sufficient amount to meet—

Order. I am reluctant to stop the hon. Lady, but she must ensure that she relates her remarks specifically to the Lords amendments that we are discussing.

Thank you very much, Mr. Deputy Speaker. The Lords amendments before us are grouped under the heading “Public health protection”, and that is what we are talking about. We are talking about the duties placed on public health staff to detain and isolate people, and to protect the public.

Let me finish by saying that health inequalities can be changed by public health staff. The inequality gap in the infant mortality rate has not been reduced by a sufficient amount to meet the target. The inequality gaps in male and female life expectancy at birth have both increased since the baseline. If current trends continue, the target will not be met. The inequality gap in cancer mortality has declined since the baseline, despite a slight increase in the last period. The minimum requirements for the 2010 target have already been met. However, that is irrelevant, as the meaningful outcome measure is the five-year survival rate.

Although I welcome the Lords amendments, they place yet more duties on public health staff, who are struggling to meet the already onerous burden imposed by the rising rates of substance misuse and sexually transmitted infections, and, more worryingly than anything else, particularly from this Government, by the rising inequalities in health.

Lords amendment agreed to.

Lords amendments Nos. 38 to 47 agreed to.

Clause 126

Administration: Great Britain

Lords amendment: No. 48.

I beg to move, That this House agrees with the Lords in the said amendment.

With this it will be convenient to discuss Lords amendments Nos. 49, 50, 63 to 65, 90 and 91.

Lords amendment No. 50 introduces a new clause into the Bill to amend section 164 of the National Health Service Act 2006, which allows the Secretary of State to authorise any primary care trust or other person to exercise the functions of determining authorities in relation to the making or varying of a determination on the remuneration for those providing NHS pharmaceutical services. There is corresponding provision in the National Health Service (Wales) Act 2006.

The Government have repeatedly given a commitment, both in the public consultation and during the passage of the Bill, that the Secretary of State would continue to set the fees and allowances for the national elements of the community pharmacy contractual framework. However, we recognised the concerns raised during the passage of the Bill in this House and the other place that that might change in future. Amendment No. 50 addresses those concerns by ensuring that if, in future, a decision were made to appoint primary care trusts or other persons as determining authorities for the remuneration of those providing pharmaceutical services under section 126 of the National Health Service Act 2006, that may be done only through regulations. There are also a number of related consequential amendments as a result of amendment No. 50.

I welcome the opportunity to debate this group of amendments. I am sorry that we did not receive any clarification on the health in pregnancy grant in another place. I must express my concern about amendment No. 48, and by extension, amendment No. 49. On the previous group of amendments, the Minister chose not to make any response whatever to my hon. Friend the Member for Guildford (Anne Milton), who made an outstanding contribution. I am sorry if we are delaying his teatime, but we hope to get some responses on this matter, as this is our last opportunity to get the Bill right.

All the amendments now being proposed were initiated by the Opposition, supported by other Opposition parties, even as far back as the Committee stage in the House of Commons, but we are only now debating the proposals, to which the Government have at last acceded. The Government therefore have a serious duty not only to account for their conduct on the Bill but to ensure that the necessary clarifications are in place. They will have no further opportunity to do so, as no ping-pong is anticipated with this Bill.

Amendment Nos. 48 and 49 will, as the explanatory notes somewhat euphemistically put it, allow the Department for Work and Pensions and Her Majesty’s Revenue and Customs

“to share information to help develop and refine policies for pregnant women.”

Can the Minister clarify what kind of data he envisages being shared? This proposal seems to add further confusion to the health in pregnancy grant. I will not detain the House by rehearsing the important and extensive arguments that we had in Committee—columns 455 and following—or in the other place, which showed clearly how little thought the Government appeared to have put into this measure, how little evidence it was based on, and how desperately Ministers seemed to be covering up for the Prime Minister’s ignorance, after he told the House from the Dispatch Box that nutrition was most important in the last months of pregnancy—Government reports confirm that that is not the case—and that this measure would assist that, for which there is little evidence.

As a member of the Public Accounts Committee, I am trying to imagine what effect this measure will have on our proceedings. Representatives of Her Majesty’s Revenue and Customs appear regularly before the Committee, and I cannot imagine the kind of questions that I would put to the permanent secretary to find out how HMRC had aided the nutrition of pregnant women. Is that really HMRC’s responsibility?

I dare say that many of us would like to be a fly on the wall, if not in the Public Gallery, of the next PAC meeting when my hon. Friend will have a chance to put precisely that question. It will be interesting to hear what answer is given, in view of the expected responsibilities. It is extraordinary to find ourselves in this situation, not least when the health in pregnancy grant has been tested by having gone through such a lengthy process in both Houses. By his own admission, the Minister found much of the debate on that grant somewhat frustrating. We support it in principle, but we do so on the basis of evidence that it is indeed in the early weeks of pregnancy, and often the time before conception, that is most important for the health—in the broadest possible definition—and the health care of women either just pregnant or seeking to become pregnant. How that will be understood in the rather clinical world of the PAC, I do not know. Like my hon. Friend, I remain fascinated and I remain to be convinced.

Does my hon. Friend share my astonishment that although the Government conceded many points in Committee and have introduced many changes, this very issue—the pregnancy grant—was one of the core elements of the Bill, which was quite flawed, yet the Government appear not to have made any substantive changes to it? Does he share my concern that they have failed to address the problems in this crucial part of the Bill?

I really do, which is why amendments Nos. 48 and 49 rightly raise this issue at this stage of our proceedings. The Government have sought to skate over what they know to be a patent embarrassment, and a patent inability to produce evidence, because they know that the evidence is not there to back up the Prime Minister’s statement from the Dispatch Box to a full House that nutrition was most important in the “last months of pregnancy”. The Prime Minister cannot undo those words or, as Hillary Clinton would say, “unspeak” them, as they are there on the record. It is difficult to have an explicit debate on a subject which was kicked off on the wrong basis by the absence of evidence for a prime ministerial opinion.

We have not pinned down the function of the policy. On 6 December 2006, the then Chancellor of the Exchequer, now the Prime Minister, said:

“I have received powerful representations”—

his normal code for trying to dismiss things that have not come out of his own head—

“that in the last months of pregnancy, when nutrition is most important”—

I am quoting him—

“and in the first weeks after birth, the extra costs borne by parents could be better recognised if we did more to help through our universal benefit—child benefit”—[Official Report, 6 December 2006; Vol. 454, c. 308.]

The Treasury has repeatedly refused to make those “powerful representations” available; it has been asked, but repeatedly refuses to do so. I have asked, but I have had no response, despite a raft of parliamentary questions perfectly properly asking for the evidence that the Prime Minister has specifically and explicitly relied on. Both the Treasury and the Department of Health have failed to provide any evidence that nutrition is most important at those times.

During the oral evidence sitting, as I am sure the Minister and my hon. Friend the Member for Tiverton and Honiton (Angela Browning) will remember, the Minister admitted, in contradiction to what the Prime Minister said, that the evidence suggested that the nutritional benefits specifically to the unborn child were more important earlier in the pregnancy. We agree with the Minister about that.

Does my hon. Friend recall, as I do, that it was openly acknowledged in Committee that the money may not go on food and nutrition, even in the latter stages of pregnancy. It was suggested that the money could be used to pay off debts or buy other household items, so there is no guarantee at all that this money will benefit the unborn child.

I am again grateful to my hon. Friend, whose memory serves her well. I recognise, Mr. Deputy Speaker, that I must remain in order in speaking to amendments Nos. 48 and 49, but it is vital to try to find the basis on which this approach and the relevant amendments have been brought before the House, to explain where we are today. I recall what I thought was a rather inelegant parallel when it was said in Committee that Australia had had a similar scheme, which had perhaps rather unfairly been called the “plasma payment”. It was being paid in the later stages of pregnancy, and rather than being spent on food and nutrition or vitamin supplements, it was used to buy wide-screen TVs. That was a most inappropriate use of something which was introduced for the ends that the Prime Minister is seeking to achieve. It was referred to when we were trying to understand the purpose of the health in pregnancy grant.