Health and Social Care Bill

Public Bill Committee, 24 January 2008.

Further written evidence to be reported to the House

Clause 121

Greg Mulholland (Liberal Democrat, Leeds North West)

I beg to move amendment No. 124, in clause 121, page 77, line 14, at end insert—

‘(2A) Payments shall be made under subsection (1) to women from the sixteenth week of pregnancy.’.

I am sure that all of the Committee are pleased that this is our last day of deliberations. I am not sure how far we have persuaded the Minister, but we shall see how we get on today.

The effects of diet on pregnancy is a concern to all of the Committee. Everyone is aware of the evidence, particularly of effects such as low birth rates, and the impact on health chances later in life. We are all fully committed to the aim of improving diet in pregnancy to address those health concerns, which the Department of Health has acknowledged are there when they should not be. The fundamental question that has not been answered is whether the new health in pregnancy grant is the best way to tackle the problem. Furthermore, is the payment actually a way of improving health in pregnancy at all? The evidence and the arguments are not clear.

The main Government arguments for bringing in the payment are, first, that health in pregnancy is a key issue that must be addressed, which is a view that we all share and the Government’s rhetoric on that point has been strong; and secondly, that the people who have the poorest diets in pregnancy are the most disadvantaged. The evidence from the nutrition panel has laid that out clearly. However, the simple reality is that the new payment is focused on neither of those arguments. There is no evidence, either from trials or from other countries, that that kind of payment will actually improve health in pregnancy. It is a universal payment and is therefore not targeted at those who need it most. The key question that the Government have not answered so far, which is my concern and what I want to press the Minister on today, is whether this is the best way to spend that large amount of taxpayers’ money and to achieve what the measure is trying to achieve. What are the concrete aims of the payment? The aims are confused, a point that is backed up by the National Childbirth Trust in its written memorandum:

“The NCT recommends that the Government should be explicit about what it intends to achieve through the health in pregnancy grant, that this objective should be realistic on the basis of existing evidence and knowledge about physiological and social processes and that the process and outcome effects of the new grant are evaluated in independent research studies.”

I am afraid that we are simply not in that position, in terms of the measure being explicit in its aims or based on a body of evidence.

All the rhetoric around that significant new payment has been about it improving diet and nutrition, without taking account of evidence or the views of the organisations that clearly have a direct interest. Only some—the Minister would not disagree with this—of the £120 million will be spent on measures to improve diet and nutrition. Due to the timing of the payment, as we heard during the oral evidence sessions, at 28 weeks people will be spending the money on prams, cots, clothes or, potentially, to pay off debts in preparation for birth. No one is suggesting that that is a bad thing, but it does not match with the claims made by the Minister, the Secretary of State for Health and the Prime Minister about how the new payment will improve nutrition and diet. The Government appear to have a policy solution to a problem, but the two do not match.

Kelvin Hopkins (Labour, Luton North)

I have some sympathy with what the hon. Gentleman is saying. Is it not the case that if income is increased the potential mother will spend it on whatever is necessary at the time? If she does not have that money, she will have less to spend on food, prams and all the other things as well. If she has to buy the pram anyway, it means that she will have less to spend on food. The income will be increased, which will make it possible for her to have a better diet. I cannot understand the logic of the hon. Gentleman’s argument.

Greg Mulholland (Liberal Democrat, Leeds North West)

I do not disagree with what the hon. Gentleman has said, but the logic is clear. No one is saying that the money is a bad thing, but it simply does not match the rhetoric. In fact, is the proposal a health measure at all? The reality—this directly answers the hon. Gentleman’s question—is that this is a universal pre-birth child benefit payment, which is paid to all pregnant women two months before birth. Although that is not a bad thing, it simply does not match the justifications given for it. Should the measure be in its current form in the Bill, should it be amended or should it even come under this Department? [Interruption.]

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I have to ask hon. Members to be a wee bit quiet. If there is a rabble and hon. Members are out of order, I cannot hear the hon. Gentleman who is moving the amendment.

Greg Mulholland (Liberal Democrat, Leeds North West)

Thank you, Mr. Hood. It is interesting to see that hon. Members are very keen on a universal child benefit payment two months before birth, but why are the Government not being honest about what it is?

Angela Browning (Conservative, Tiverton and Honiton)

It seems important that the nutrition to the mother, and subsequently through the mother to the foetus, is delivered as early as possible. We must guarantee as much as possible that women will take something that will benefit both their own health and that of her child. Does the hon. Gentleman not think that properly balanced vitamin and mineral tablets provided at the point at which pregnancy is agreed, regardless of whether there are abortions down the track, give a much better delivery at the appropriate time than going through the rigmarole that the Government are suggesting now?

Greg Mulholland (Liberal Democrat, Leeds North West)

I thank the hon. Lady for her intervention. There are many ways in which to address the real issues of nutrition in pregnancy, but this measure is not one of them. There are many different ways to look at the matter. To paraphrase the famous advertising slogan, the new payment simply does not do what it says on the tin. It is not a health in pregnancy grant. It is a universal pre-birth child benefit payment. There will be better ways of spending money directly to address diet and nutrition.

Brian Jenkins (Labour, Tamworth)

Let me get to the hon. Gentleman’s argument. Is he saying that the universal benefit is wrong?

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I think the hon. Gentleman is going broad of the amendment.

Greg Mulholland (Liberal Democrat, Leeds North West)

Thank you, Mr. Hood. This is fundamental in showing that the payment will not deliver the claims made for it. Clearly, universal child benefit payments are a good thing. However, this measure is not a health in pregnancy grant. The National Childbirth Trust has suggested extending the healthy start programme. It stated:

“This would be a way to reach disadvantaged women at an earlier stage in their pregnancy.”

That is clearly the point of the amendment. The Government have not justified why the universal payment is being made. The arguments that they have given do not reflect what the payment is for.

I will turn now to timing, which the hon. Member for Tiverton and Honiton mentioned is clearly the main purpose of the amendment. On 7 January, the Department of Health issued the following statement, which is typical Government-speak. It stated:

“It is widely acknowledged that the health and general well-being of pregnant women in the last months is important for the health and development of a child later in life.”

That supposedly showed why the payment was to be made at a later stage, but what does “widely acknowledged” mean? Is there a body of evidence for the suggestion? The statement was also rather misleading, because it said that the matter “is important”. Of course it is important, but the implication is that it is somehow more important to pay the money at that late stage.

The Prime Minister, then the Chancellor of the Exchequer, said in the 2006 pre-Budget report that he had received “powerful representations” about the need better to recognise the extra costs faced by pregnant women in the last months of pregnancy and the few first few weeks after birth, but he gave no further evidence of what they were. We are still none the wiser. I ask the Minister whether we can finally see the body of evidence suggesting that the health in pregnancy grant should be paid so late in the pregnancy.

Steve McCabe (Labour, Birmingham, Hall Green)

On a point of order, Mr. Hood, is it in order for the hon. Gentleman to question whether there is an entitlement to the benefit, when the amendment mentions solely the time when it should be paid?

Jimmy Hood (Labour, Lanark and Hamilton East)

The hon. Gentleman will know that I am the person who is chairing the Committee, not him, and I shall make those judgments.

Greg Mulholland (Liberal Democrat, Leeds North West)

It is interesting to see how rattled Labour Members are, because they know that their Government have been guilty of mis-selling on the health in pregnancy grant. That is the simple reality.

We have seen no evidence that the payment should be made two months before birth, as is currently proposed. There is plenty of expert opinion that suggests that it should be paid earlier, as the amendment suggests. The NCT has stated:

“In order to make a difference to women’s diets during pregnancy, and to the health of babies, this grant should be part of a wider, co-ordinated strategy to improve awareness on the importance of nutrition around the time of conception and during early pregnancy—when it would be more likely to have an impact.”

The Child Growth Foundation director Tam Fry has said:

“By the time a woman falls pregnant, she already needs to be eating well to give her baby the best chance. Tackling it halfway through the pregnancy is really a bit late”.

A spokesman for the Royal College of Obstetricians and Gynaecologists, Daghni Rajasingam, has said:

“If a woman is not already eating a healthy diet by that stage, then encouraging them to eat more fruit and vegetables from 29 weeks is too little too late. Even for small babies it is too late, there is very little you can do to increase growth at that stage.”

Niall Dickinson, the chief executive of the King’s Fund, has said:

“Quite how a limited cash payment seven months into a pregnancy will have any impact on the health of the child or the mother is hard to see.”

The arguments are clear and run against what the Government have been saying.

Richard Burden (Labour, Birmingham, Northfield)

I wish to be clear about what the hon. Gentleman is suggesting. Is he suggesting to the Government that they should pay the money earlier in pregnancy, without any commitment from the Liberal Democrats that they would do so in the unlikely event that they were part of a Government, or is he actually committing them to spending for the earlier payment in that unlikely event? Which is it?

Greg Mulholland (Liberal Democrat, Leeds North West)

With the continuing fiascos in the Government, who knows what will happen at the next election? I am certainly not going to predict it. The reaction on the Government Benches is revealing.

Steve McCabe (Labour, Birmingham, Hall Green)

Answer the question.

Greg Mulholland (Liberal Democrat, Leeds North West)

I have not had a chance to answer the question yet, because of your chattering.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. The hon. Gentleman should address me.

Greg Mulholland (Liberal Democrat, Leeds North West)

Apologies, Mr. Hood.

The purpose of the amendment is blatant: to bring forward the payment. We are here to amend the Bill. [Interruption.] Address the Chair, please. I have just been told off for that. Clearly the purpose is to make the payment at 16 weeks, when it would, without a shadow of a doubt, according to all the evidence and expert opinion, make more of a difference to health, which would better justify Ministers’ claims.

Judy Mallaber (Labour, Amber Valley)

Will the hon. Gentleman help the Committee by letting us know whether the Liberal Democrats would provide such a grant in the 16th week of pregnancy to all pregnant women? Would they make that commitment?

Greg Mulholland (Liberal Democrat, Leeds North West)

As I have made clear, there are much better ways to achieve better health in pregnancy, an obvious one being to extend the healthy start programme. However, making the payment two months before birth will not deliver on the Government’s claims.

The NCT flagged up the explicit public service agreement target for all women to have started their antenatal care by the 12th week of pregnancy. Its memorandum states:

“Consideration should be given to starting the Health in Pregnancy payment once a woman has started her antenatal care, which should be by 12 completed weeks of pregnancy.”

The aim of all of us is to address health in pregnancy. However, if we are to do that through a universal payment, it must start earlier, otherwise we must consider different methods.

Whether Labour Members like it or not, the Government have provided no evidence to suggest that the new payment, paid two months before birth and costing £120 million, will deliver on their rhetoric. On the other hand, there is much evidence to suggest that, paid earlier in pregnancy, it would have a significantly greater impact on health. The Minister and his team need to justify the payment, make clear what it is trying to achieve and be honest about whether it is simply a child benefit payment two months before birth. If that is what it is, which would not be a bad thing, they should stop dressing it up as something that it is not. Having said that, I do not expect to hear any of those things in the Minister’s response.

Stephen O'Brien (Conservative, Eddisbury)

In the light of that discussion, it is clear that the appropriate time to discuss the evidence base is in a stand part debate, so I shall reserve my comments until then if I can catch your eye, Mr. Hood. In the meantime, this important debate is not dignified by a Liberal Democrat-Labour party scrap over a spending commitment that will let Labour Members supply a nice juicy nugget to their Prime Minister to help them in their little battle with the Liberals. I shall, therefore, let the matter rest.

Kelvin Hopkins (Labour, Luton North)

I strongly support the payments and am happy with their timing. However, during an evidence session, we were told that early pregnancy and conception are important times too—the hon. Member for Tiverton and Honiton made a point about vitamins during early pregnancy. Another important point relates to alcohol consumption around the time of conception and during early pregnancy; abstinence is very important, and I hope that my hon. Friend the Minister will use his good offices to ensure that the message gets across.

Ben Bradshaw (Labour, Exeter)

I am surprised and disappointed by the Liberal Democrats’ approach to the health in pregnancy grant. I am sorry that the hon. Member for Romsey is not present—she is the usual Liberal Democrat Front Bench spokesperson on such matters—because I wanted to remind her that she described the grant as a gimmick. Instead, I shall remind her colleague, the hon. Member for Leeds, North-West. For many women, particularly the less well-off, the grant will provide an extremely welcome addition to their income, at what is often a very difficult and stressful time.

Greg Mulholland (Liberal Democrat, Leeds North West)

Will the Minister give way?

Ben Bradshaw (Labour, Exeter)

I want to make some progress first. I was unclear, from the hon. Gentleman’s remarks, whether the Liberal Democrats oppose the grant on principle, whether they oppose the name, the fact that it is universal—a strange approach for the Liberal Democrats to take, given that they are constantly criticising the Government over means-testing—or whether they simply object to its timing. Perhaps he would enlighten us.

Greg Mulholland (Liberal Democrat, Leeds North West)

First, I point out to the Minister that the person who called the grant a gimmick was the consultant obstetrician, Darjney Rarjarsingham, who said, “It is gimmicky” and added that pre-pregnancy education would be more effective. The Minister, once again, is being overly defensive. He has not justified the arguments. To clarify his point, it is not a question of our opposing universal payment; I want the Government to be honest, and so far—

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. An intervention cannot be too long.

Ben Bradshaw (Labour, Exeter)

The hon. Member for Leeds, North-West has not cleared matters up at all. We still do not know where the Liberal Democrats stand. In response to the questions put by my hon. Friend the Member for Luton, North, I appreciate that if the grant was designed solely to improve the nutrition of pregnant women and through that, the health of the unborn child, there would be arguments for it to be paid earlier in the pregnancy. However, it is not only about that, it is much broader and comes on top of a number of other financial assistance measures that the Government have introduced to help pregnant women, including assistance earlier in pregnancy. The professional organisations involved have recognised that. The Royal College of Midwives said it was

“pleased that the financial costs of pregnancy for women and their families has been recognised. This will help women to make essential purchases before the baby’s arrival. Crucially it will also encourage pregnant women to live a healthier life, which is vital for them and the long term development of their babies.”

Dr. Peter Carter, the general secretary of the Royal College of Nursing, also welcomed the measure and said the college was

“particularly supportive of any policy measures to ensure that expectant mothers have improved access to advice on living a healthy lifestyle from healthcare professionals.”

That advice will, of course, be linked to the measure. Dr. Carter continued:

“It is also important for the grant to be non-means tested and available to all pregnant women, as their continued health during pregnancy is important for themselves, their baby and their family.”

Other countries, including Finland, France and Belgium, have introduced similar grants. Those grants are universal and are paid at the same time as we propose, with payment ranging between the 22nd week of pregnancy and the end.

We are aware of research by St. Thomas’ hospital that relates to a point made by the witness from the National Childbirth Trust during our evidence-taking session. She said that if we are talking only about nutrition, earlier payment would be better. However, she recognised that the measure would still benefit women, pointing out that particularly later on in pregnancy, women suffer more challenges and more stress. The Tommy’s research shows that women suffer more stress over money worries in the later stages of pregnancy, and specialists say that it is important to reduce stress to avoid risking complications in pregnancy. There is also evidence that low income can affect birth weight through psychosomatic means due to stress throughout the period of pregnancy.

I will go on to the reasons why, on balance, we have decided to pay the grant at 25 weeks, not 29 weeks as the Opposition keep claiming.

Kelvin Hopkins (Labour, Luton North)

It is very likely indeed that many women in later pregnancy will have to take time off work or even give it up entirely. Extra income at that time would be extremely helpful.

Ben Bradshaw (Labour, Exeter)

My hon. Friend makes a very important point, which is another strong argument for making the payment when most women will give up work and experience a drop in income. He is right.

There are other reasons why we have chosen 25 weeks rather than an earlier time. It is partly because it coincides with the advice given to women by their midwives and doctors at that point in their pregnancy. We also know that only a relatively small proportion of women seek professional advice earlier in pregnancy—at the time the Liberal Democrats would like the grant to be paid—so we expect take-up of the grant to be lower earlier in pregnancy than it would be later. We can tie it to specific health advice and reduce the administrative burden for the midwives involved, because they will not have to secure two levels of certification for it, only one. On that basis, I urge the Liberal Democrats to withdraw the amendment.

Greg Mulholland (Liberal Democrat, Leeds North West)

At least we are now getting somewhere in terms of some more honest justification for the payment, which is really—

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I ask the hon. Gentleman not to use words that imply dishonesty. I let it go once or twice, but I ask him not to do it at all.

Greg Mulholland (Liberal Democrat, Leeds North West)

Okay, Mr. Hood. We are now getting some justification that fits the reality of what the payment can achieve—if that wording suits you.

The Government have backed themselves into a corner, although the contribution from the hon. Member for Luton, North was reasonable. Yes, people take time off work—absolutely; so the payment will be a child benefit payment. On that basis, it may be justifiable regarding the purchases that I mentioned, but it will not deliver the results set out in the Government’s rhetoric. Certainly, making the payment at the stage they propose will not deliver anything like the same health benefits, as the Minister just about acknowledged. He mentioned some of the organisations that say the grant is a good idea, but if we read the quotations more carefully, we see that any policy measures would be welcome. Of course, all those organisations welcome any attempt to tackle nutrition in pregnancy, but surely £120 million of taxpayers’ money that is spent, purportedly, to improve the health and nutrition of women in pregnancy should deliver a large chunk of that improvement. The amendment would enable the payment to do so. If the payment is really for other things, as was suggested, that is fine, but if that is what it is for, can we at least be honest about it?

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. The hon. Gentleman has done it again.

Greg Mulholland (Liberal Democrat, Leeds North West)

Mr. Hood, I said “we”, including myself, so I hope that is acceptable.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I assure the hon. Gentleman that saying “we” is not acceptable.

Greg Mulholland (Liberal Democrat, Leeds North West)

In that case I apologise, Mr. Hood.

We are about to move on to the amendments tabled by the hon. Member for Eddisbury. I was disappointed by his rather tetchy and unhelpful contribution earlier, so I hope that he will have something constructive to contribute to the debate. I shall withdraw my amendment, because the point has been made that the Government have still not justified the measure. I ask the Minister to do so. He has started the process so I hope we will get a clearer picture of what the payment is really for, and I look forward to hearing the comments on further amendments. I beg to ask leave to withdraw the amendment.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. Before I call amendment No. 58, I remind hon. Members that chattering to themselves in wee groups is not acceptable; when the Chair can hear them they are out of order. That goes for Members on both sides of the Committee, so I hope that we can get back to the discussion and give due regard to the person who is moving the amendment or speaking to it.

Stephen O'Brien (Conservative, Eddisbury)

I beg to move amendment No. 58, in clause 121, page 77, line 17, after ‘a’, insert ‘maternity’.

Jimmy Hood (Labour, Lanark and Hamilton East)

With this it will be convenient to discuss amendment No. 59, in clause 121, page 77, line 24, at beginning insert ‘maternity’.

Stephen O'Brien (Conservative, Eddisbury)

The amendments would ensure that advice relating to maternal health came from a maternity health professional rather than someone who was qualified as only a health professional. As I shall outline in the clause stand part debate, although we think that there is little evidence of the nutritional benefit of the health in pregnancy grant to pregnant women and their babies, the grant has none the less been proposed, so we must plan on the basis that it will be introduced, and make it as worth while as we can.

The amendments, in conjunction with amendment No. 60, would establish that advice on maternal health was not just a tick-box exercise with a non-maternity health professional. I direct the Committee to the oral evidence of Jonathan Athow, the official who spoke about the topic at the oral evidence session. He is the head of the work incentives and poverty agency team at the Treasury. That title in itself shows how far the measure is, in reality, separated from health. He said:

“The intention with the grant is that the pregnant woman will need to have seen a health professional and to have got advice on all aspects of health, including nutrition, in order to receive the payment. We are trying very much to work with health professionals. We have had some very constructive conversations.”

I would be interested to know what those constructive conversations were. I would also be interested to know how the Department of Health has been involved in them and through which teams. It transpired from the subsequent questions of the hon. Member for Romsey that those discussions were with the Royal College of Midwives. Jonathan Athow also said:

“Midwives are a group we are talking with, trying to use them as a primary way of delivering the grant...We have been looking at how we can help them and use them as a way of helping to promote awareness of the grant, but also we want to minimise the burdens on health professionals. We do not want them to see this as an extra bit of form-filling that they have to do.”

Revealingly, he also said that only

“a very small proportion of women... do not seek regular contact with the health professionals”. [Official Report, Health and Social Care Public Bill Committee, 10 Jan 2008; c. 106.]

The nutrition argument has been debunked by answers to parliamentary questions, and it seems that the health benefit argument has to some degree been debunked by Treasury officials. In passing and as a result of Mr. Athow’s responsibility for the poverty agency, I ask the Minister whether the measure is a sideways attempt to throw more money at the Government’s failing child poverty targets. As he knows, the Chancellor of the Duchy of Lancaster recently confessed that

“The fall in child poverty is short of the target we set ourselves”.

Last year, the Joseph Rowntree Foundation and the Fiscal Policy Institute argued that a minimum of £3.8 billion needs to be invested over the next two years to achieve the Government’s own target of cutting child poverty in half by 2010. Even if the health in pregnancy grant was directed solely at child poverty, it does not even come close to denting that figure.

The statutory instrument, which I am grateful that the Minister has made available in response to my request, defines a health professional for the purposes of subsection (3) as:

“a registered medical practitioner, a registered nurse or a registered midwife”.

Can the Minister clarify whether it is expected that the registered medical practitioner and the registered nurse will have particular skills in antenatal care? If not, surely it would be better to use midwives alone, and just to refer to midwives in the Bill. That would save paper, legislative time and the worry that the appropriate advice is not just a tick-box exercise. The only difficulty that I can see in just prescribing midwives in the Bill is that, under this Government, relative numbers of midwives are plummeting as the birth rate is rising. A shake of the head by the Minister does not recognise that situation. The Royal College of Midwives estimates that we need an extra 5,000 midwives by 2012 to support maternal choice and to offset the demands of a rising birth rate. According to Government figures—not mine—the number of midwives has increased by only 4.5 per cent. since 1997. I direct the Committee to Hansard column 176W on 16 July 2007. However, the number of births in England has risen by 12.5 per cent. since 2001.

Sandra Gidley (Liberal Democrat, Romsey)

Does the hon. Gentleman share my concern that not only has the number of midwives not increased, but the demographic of midwives is such that many will retire within the next 10 years, which will leave us with even bigger problems?

Stephen O'Brien (Conservative, Eddisbury)

I am grateful to the hon. Lady; she is spot on. We are really facing a clove hitch.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. Before the hon. Gentleman responds, the hon. Lady’s intervention is a bit wide of the amendment so he should try not to be tempted to follow her down that road.

Stephen O'Brien (Conservative, Eddisbury)

I am grateful for that guidance. I had just finished the sentence in which I had dealt with the intervention and confirmed that she had put her finger on a serious problem and that she is right.

The latest figures available show that numbers of obstetricians—obstetrics and gynaecology—have risen by 30 per cent. since 1997. However, because of pressure from the European working time directive, the number of hours each consultant works has been significantly reduced, which makes it necessary to increase further the number of consultants to maintain service levels—it is not rocket science. The Government’s commitment to offering women a choice over where to have their baby by 2009 has been derailed by woefully inaccurate estimates of the birth rate. The huge increase in the fertility rate in recent years vastly outstrips the Government’s estimates of the number of live births, and has placed intolerable pressure on midwives, the very maternity health care workers whom I am seeking, through the amendment, to say should be the ones who are used. Each midwife now delivers almost 25 per cent. more babies each year than the Royal College of Midwives believes is appropriate, helping to explain why there are so few home births and why so many midwife-led maternity units are threatened with closure.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I have to tell the hon. Gentleman that he is going a bit wide. The amendment does not deal with manpower planning in the national health service. Somebody may wish to address the subject on stand part, but not on this amendment.

Stephen O'Brien (Conservative, Eddisbury)

I am grateful for that, Mr. Hood. I hope that you recognise that my purpose was not to try your patience. The purpose of the amendment is to focus the advice.

Stephen Hesford (Labour, Wirral West)

Whinge.

Stephen O'Brien (Conservative, Eddisbury)

That comment is rather cheap.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. That is very much out of order. Members should not heckle from a sedentary position.

Stephen O'Brien (Conservative, Eddisbury)

I am grateful, Mr. Hood. I thought that I was being straight in introducing the amendment. We genuinely and sincerely wish to focus on the health professional who will have the job of advising and giving support to the pregnant mother. It should be somebody who is experienced and qualified in maternity and antenatal health care. The capacity to deliver such support, given the number of midwives relative to the rising birth rate, is vital. The hon. Member for Wirral, West, who sought to make such a cheap and completely demeaning little intervention, should hang his head in shame.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I am sure that the hon. Member for Eddisbury did not mean to commit an offence, and that he will withdraw his comment.

Stephen O'Brien (Conservative, Eddisbury)

I am not sure what I have done.

Jimmy Hood (Labour, Lanark and Hamilton East)

You cannot accuse an hon. Member of behaving badly and cheating.

Stephen O'Brien (Conservative, Eddisbury)

Obviously I was misheard. I said “cheap”, with a “p” on the end for “Peter”. I did not say “cheat”.

Jimmy Hood (Labour, Lanark and Hamilton East)

I have given my ruling. Carry on.

Stephen O'Brien (Conservative, Eddisbury)

Had I said “cheat”, of course I would have withdrawn it. I would not have said it.

The important point is that we want experienced maternity and antenatal health professionals to be the ones who are directed to give the advice. The clause is too wide. The fact that there are added pressures on the capacity of health professionals, particularly midwives, has been properly demonstrated. That, coupled with the various pressures coming from demographics and the European working time directive, means that we need clarification from the Minister that the provision will be directed by professionals skilled specifically in maternal health. Without the involvement of people experienced in maternity and antenatal care, there is a real risk that, for all the aspirations, we will not secure anything more than a tick-box exercise. Surely, that is not the Government’s purpose. It is certainly not something that we want.

Ben Bradshaw (Labour, Exeter)

Following your ruling, Mr. Hood, I do not intend to respond to the general remarks about midwife numbers, except to say that the figures given by the Liberal Democrats and the Conservatives were wrong. [ Interruption. ]

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. The Minister was absolutely correct to say that he is not allowed to refer to the figures, so he should not do so.

Angela Browning (Conservative, Tiverton and Honiton)

On a point of order, Mr. Hood, I wonder whether you could give me some guidance. It seems that if we are asking for a new and additional responsibility to be placed on a particular group of people, their numbers and existing responsibilities must be considered when deciding whether taking on yet another responsibility is doable. I would be grateful for your guidance on that.

Jimmy Hood (Labour, Lanark and Hamilton East)

The hon. Gentleman had gone too wide of the amendment. That is why I called him to order.

Ben Bradshaw (Labour, Exeter)

The hon. Lady’s comments are absolutely relevant, because her amendments would place even more burden on midwives by insisting that only they, and not GPs or nurses, could give advice. I shall address that shortly. [ Interruption. ]

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. I do not know whether hon. Members are a wee bit more excitable because this is the last day of the Committee, but I ask them to support the occupant of the Chair. It is usually easier and more productive without talking and muttering over other members of the Committee.

Ben Bradshaw (Labour, Exeter)

I had no intention to go on at length about midwife numbers, unlike Opposition Members. I simply refer them to yesterday’s Hansard report of Prime Minister’s questions, where the figures are on the record.

The Government do not think that the amendment is necessary. In fact, given those earlier comments, we think that it would be unhelpful. We intend in regulations to define the type of health professionals who can give advice on maternal health. The amendment would reduce that flexibility, and it could also have the unintended consequence of creating confusion about who delivers advice on maternal health and when it is delivered. Unlike the term “health professional”, the term “maternal health professional” is not defined in any other legislation. During their pregnancy, expectant mothers can expect to receive advice on maternal health issues from their family doctors, GPs, nurses, and midwives at antenatal appointments.

We are working towards developing procedures whereby certification for the health in pregnancy grant can also be accepted for the Sure Start maternity grant. By proposing draft regulations, we are proposing a more flexible approach by which to enable the double use of health certificates for the health in pregnancy grant and the Sure Start grant. We do not want to restrict the measure to midwives, because that would rule out allowing doctors and nurses to give the same advice and certification.

We do not agree with the hon. Gentleman’s approach, so I urge him not to press the amendment to a Division because, if he does, we will vote it down.

Stephen O'Brien (Conservative, Eddisbury)

In the light of the Minister telling us that there will be regulations, I dare say that we will pore over them when they are available. The regulations should be made available, so that we can have a sensible debate on the matter before the Bill becomes law. I urge him to publish the regulations before Report or at least before the Bill reaches another place.

Ben Bradshaw (Labour, Exeter)

We have already published them.

Stephen O'Brien (Conservative, Eddisbury)

The regulations to which the Minister referred in his reply are not complete, especially regarding the definition of “health professional”, to which he also referred. I am happy not to press the amendment to a Division, but better detail is required so that we can have a sensible debate on the matter. I beg to ask leave to withdraw the amendment.

Stephen O'Brien (Conservative, Eddisbury)

I beg to move amendment No. 60, in clause 121, page 77, line 19, at end insert—

‘(3A) “Advice” given under subsection (3) must include advice on—

(a) nutrition,

(b) immunodeficiency,

(c) lifestyle,

(d) pre- and post-natal care,

(e) post-natal depression,

(f) breastfeeding.’.

The amendment follows on from the previous group. It would ensure that a pregnant woman receives advice, even if it is not from a maternal health professional. Among other things, the advice would be on nutrition, immunodeficiency, lifestyle, pre-natal and post-natal care, post-natal depression and breastfeeding. The proposal gives the Minister an opportunity to clarify what advice will be provided under proposed new subsection 140A(3) of the Social Security Contributions and Benefits Act 1992.

In an oral evidence session, the hon. Member for Romsey made the point that antenatal appointments generally last 10 minutes and, as such, offer little opportunity or time for detailed advice. She also made the point that antenatal classes are being cut up and down the country, and we have already discussed the shortage of midwives and health visitors. NICE has advised that women expecting their first child keep antenatal appointments at 12, 16, 18 to 20, 25, 28, 31, 34, 36, 38 and 40 weeks; but presumably, midwives do not have a responsibility to organise those appointments.

The health in pregnancy grant is partly an inducement to encourage people to take up at least one appointment, but we are concerned that the ad hoc nature of the arrangements will lead to a short visit to rubber stamp a claim, rather than a fuller discussion of pregnancy issues. I am sure that the Minister and his officials have considered that. We do not want an appointment to receive advice to become simply a qualification to receive a payment, because that would defeat the purpose of ensuring that advice is offered and taken.

The issue of time is inescapably linked to personnel, but there is also the question of training—a theme that we have returned to relentlessly in considering the Bill. In fairness, the Minister has acknowledged that that is a fair area that we need to focus on and put a lot of effort into and that has support across the Committee.

The submissions of the Twin and Multiple Births Association—TAMBA—and BLISS are relevant examples. They have noted the illogicality of the health in pregnancy grant as regards twin and multiple births, and have called for the grant to be paid per expectant child, rather than per pregnancy. They go on to state:

“Although these pregnancies are high risk, the interim results of a recent survey of multiple birth mothers by TAMBA found that only 9 per cent. were given advice on nutrition in multiple birth pregnancies. Of the 103 mothers whose babies required ‘special care’, less than 5 per cent. were given this advice.

We would welcome further clarification from the Government on how they intend to use this opportunity to improve awareness of the added importance of nutrition in multiple birth pregnancies.”

In the UK, about one in every 67 pregnancies results in a multiple birth. This equates to just over 10,000 births a year (10,533 in 2005).

Twins are four times more likely to die during pregnancy when compared to single babies, seven times more likely to die shortly after pregnancy, ten times more likely to be admitted to a neonatal special care unit and have six times the risk of cerebral palsy. The best chance of survival for a premature baby is a healthy birth weight so unborn multiple babies need to be well and fully nourished pretty much from the moment of conception.”

I am sure that the Minister will be aware of the advice in the book, “Everything You Need to Know To Have a Healthy Twin Pregnancy”, by Gila Leiter MD, at Dell in 2000.

TAMBA cites Professor Simon Langley-Evans, chair in human nutrition in the school of biosciences at the university of Nottingham, who raised the concern that, to be effective, the grant needs to be spent on improving the quality of pregnant mothers’ diets and added that

“paying the money in the final trimester is too late—the optimal time for any intervention will be in early pregnancy.”

Again, I am sure that the Minister will be aware of the e-mail message that was sent on 3 December 2007. So what plans does the Minister have for training? How long will the consultations last, and if longer than 10 minutes, where is he going to recruit and pay the midwives from? The issues mentioned in the amendment are cited and supported in the evidence that I have adduced. Will they be covered? Where will he do so? If nothing else, I strongly commend the amendment as being the best way to ensure that these matters are dealt with in a manner that I believe he intends them to be.

Ben Bradshaw (Labour, Exeter)

Of course we agree that it is sensible that mothers receive advice on certain matters, but we are not convinced that it is sensible to prescribe in the Bill exactly what they should be. We would rather leave that to the good sense, experience and judgment of the professionals concerned.

Stephen O'Brien (Conservative, Eddisbury)

Well, there we have it. I am sorry that the Minister has not taken the amendment more seriously. I dare say that it will get pursued elsewhere, and I beg to ask leave to withdraw the amendment.

Stephen O'Brien (Conservative, Eddisbury)

I beg to move amendment No. 61, in clause 121, page 77, line 31, leave out ‘Treasury’ and insert ‘Secretary of State’.

Jimmy Hood (Labour, Lanark and Hamilton East)

With this it will be convenient to discuss the following amendments: No. 62, in clause 122, page 78, line 2, leave out from ‘the’ to end of line 3 and insert ‘Secretary of State’.

No. 63, in clause 122, page 78, line 23, leave out from beginning to ‘may’ and insert ‘The Secretary of State’.

No. 65, in clause 128, page 84, line 36, leave out from ‘The’ to ‘responsible’ and insert ‘Secretary of State is’.

Stephen O'Brien (Conservative, Eddisbury)

These amendments seek to make the Secretary of State for Health, rather than the Chancellor and the commissioners of Her Majesty’s Revenue and Customs, responsible for the regulations. I dare say that all members of the Committee will realise the import of what the amendments intend to achieve. If the Bill is a health measure—after all, that is why we are here—surely the Health Secretary should make the regulations on both the reasons for and the amount of the grant, although some hon. Members may feel that the Treasury should be in charge of absolutely everything.

Amendment No. 61 would ensure that the amount of the health in pregnancy grant is prescribed by the Secretary of State for Health rather than the Chancellor of the Exchequer. In addition, we will seek to amend proposed new section 140A(6) to the Social Security Contributions and Benefits Act 1992, which gives the Treasury

“the power to make regulations”

regarding

“the prescribed conditions in relation to a pregnancy”

and the circumstances in which a woman is to be treated

“as being, or not being, in Great Britain”

in proposed new section 140A(4).

Amendment No. 62 would give to the Secretary of State the power to make regulations in relation to the health in pregnancy grant under section 5 of the Social Security Administration Act 1992. I hope that everyone is able to follow me so far. As the Minister will no doubt point out, the inclusion of the commissioners of Her Majesty’s Revenue and Customs in clause 122(2) merely notes that the power to make regulations under section 5 of the 1992 Act lies with those commissioners, rather than granting them that power. I will not, therefore, press amendment No. 62 to a vote.

None the less, I hope that the Minister, if he smiles on the point that I am making, will propose legislation to amend section 5 of the Social Security Administration Act 1992, to grant the power of regulation in relation to the health in pregnancy grant only to the Secretary of State for Health. I hope that that is a very straightforward way of wresting the power away from the Treasury and giving it to the Department of Health. If Ministers cannot sort it out, we can enjoy the spectacle of a battle between officials behind closed doors.

Amendment No. 63 would achieve that change by amending proposed new section 12A of the Social Security Administration Act 1992, which sets out the necessity of application for the health in pregnancy grant and opens the way for relevant regulations about time, manner and so on. Given that the section is concerned with process, rather than the substance, amount and circumstances of the grant itself, it could be argued that it would be better in the hands of the commissioners of the HMRC. However, if the paramount concern is the health of pregnant mothers—something that the Minister and even the Prime Minister have been at pains to impress upon us all—the primary conditions surrounding the grant should take precedence over the process by which it is awarded. Frankly, it is almost inconceivable that anyone could possibly object to that.

Under such a measure, the powers awarded under proposed new clause 140A would go to the Secretary of State for Health. Decisions about where other powers in respect of the health in pregnancy grant go should be made in relation to that. It is legislatively and practically tortuous to have, on the one hand, the Department of Health in control of regulations on the amount and prescribed conditions of the grant and, on the other hand, the commissioners of HMRC in control of regulations as regards process. Given that the health aspects of the grant should take precedence over the benefit aspects of the grant, the power in proposed new clause 12A should lie with the Secretary of State for Health, which is what amendment No. 63 seeks.

Amendment No. 65 would amend clause 128, which will make the commissioners for HMRC responsible

“for the payment and management of health in pregnancy grant.”

I will not strain your patience, Mr. Hood, by suggesting that we should not put HMRC in charge of anything that relates to most of the nation’s children at the moment, while it seems to be losing all sorts of data. The arguments for this amendment are similar to those for amendment No. 63. Although there may be an argument for HMRC to have powers that relate to the payment and management of such a grant, that should not be used as an excuse not to bestow on the Secretary of State for Health powers over the substance of the grant. I will be very surprised if the Minister does not agree with that in relation to his immediate superior.

These amendments also give me the opportunity to discuss the proposals that draw out the discrepancy of Treasury Ministers making regulations about a health matter. I thank the Minister for showing me the regulations in advance of these Committee proceedings. I hope that he will convey those thanks to his relevant Treasury colleagues. I am interested that the claim and payment dates are left blank under section 1. When does the Minister expect those dates to be announced and does he expect them to be different? I note in passing that any date in 2009 is about a year before the next general election, which has a strong bearing on how the purpose of the measure might be construed.

I am interested that the 25-week stipulation, about which there was such discussion on an earlier amendment, is left to regulations. Why is that? Under what circumstances does the Minister envisage that that would change? We have already discussed section 3 in relation to health professionals. I hope to have some discussion on section 4 in the stand part debate, as I have indicated.

Section 10 establishes the amount at £190. I flag up the National Childbirth Trust’s concerns, which were expressed in their written evidence, about the payment being a lump sum rather than a weekly benefit. The NCT contends that because child benefit is paid weekly or monthly directly to the mother,

“women can rely on it as a regular supplement to the household income for the payment of day-to-day expenses such as food and fuel costs. A lump sum would appear less likely to be used for weekly or daily costs, including food, and more likely to be spent on one-off payments for larger items. Following a recent visit to Australia, Professor Debra Bick of Thames Valley University informed the NCT that in Australia single payments to parents in pregnancy”—

the Committee has already heard this evidence—

“have been coined ‘plasma payments’ as they are typically used to purchase flat-screen TVs... The NCT believes that the Health in Pregnancy payments should be paid on a weekly or monthly basis as an extension of Child Benefit so that they are most likely to be used to increase the budget for regular household expenses, increasing the likelihood of there being more income available for a nutritious diet during pregnancy.”

That point was emphasised by the hon. Member for Luton, North when he intervened. Could the Minister tell the Committee why the Government moved away from their original plan of bringing child benefit forward into pregnancy?

I have some concerns about section 12. It is worryingly reminiscent of mobile phone salesmanship, where one has to claim cash back in a prescribed month so many months after signing up. Why has the Minister opted for a calendar month, which is quite a short period, particularly given the stresses of pregnancy? Surely, if the grant is to benefit the first weeks after birth as well, it should be claimable into the first few months of the baby’s life.

Of course the elephant in the room is the question of how long the process will take and whether families will get the right amount of money before their baby is a teenager. If there is any doubt about Government incompetence, the Department for Work and Pensions overpayment of £2.6 billion in benefits in 2005-06 is surely testimony to it.

Why is the power to make regulations with the Treasury? Does it not further undermine any claim that the grant is a health benefit? Will the Minister reverse that on Report? Under what circumstances would the 25 weeks or the £190 figure change? Why is there such a small window in which to make a claim? What evidence does the Minister have that the most disadvantaged people whom he hopes to target through the grant—those on whom we have all been trying to focus—will be able to claim it within the time constraints? How long will the period be between the initial claim and the grant payment arriving in a bank account?

Ben Bradshaw (Labour, Exeter)

I shall just speak to the amendments, if that is all right. We think that there are good reasons why the Treasury and HMRC should be responsible for the health in pregnancy grant. All the main forms of financial support for families are administered by them in this manner, so it makes sense for the new payment to be brought alongside existing support for families, such as child benefit and child tax credit. That will bring the potential to simplify applications and administration, and it will build on the experience of those Departments that already make cash payments to a similar group of people. Asking my Department to manage a cash payment to pregnant women on this scale would be a major change in role and would bring none of the benefits that the existing links that HMRC has to the child tax credit and child benefit could bring.

Stephen O'Brien (Conservative, Eddisbury)

The Minister says that all such payments originate with the Treasury and HMRC. He might be able to correct me if I am wrong, but I believe that the carer’s allowance is handled differently, and it is much more equivalent. Therefore, my point is valid. I am a little baffled by the Minister’s assertion. Whether he wishes to correct me now is a matter for him.

Mr. Bradshaw indicated dissent.

Stephen O'Brien (Conservative, Eddisbury)

No. In that case, the situation causes us some problems. The matters are now set out on the record, and there are still the debates on Report and consideration in another place. If the Minister has not been able to secure sufficient advice and he has found that the question that I ask is worthy of consideration, let us try to get the matter under the control of the Department of Health—after all, it is proclaimed to be a health matter. However, if it is a benefit matter and therefore a financial matter that belongs to the Treasury, let us have Treasury rather than Health Ministers answer for it, and let us be straightforward about the Government’s proposals and their provenance. I leave the matter on the record, and I beg to ask leave to withdraw the amendment.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order. Although we have had a fairly thorough debate about the main proposition in the clause, I shall resist the temptation to deny the Committee a clause stand part debate, but I encourage hon. Members to be concise and not to repeat the debates that we have already had.

Stephen O'Brien (Conservative, Eddisbury)

I shall do my best to heed your advice, Mr. Hood, but we should not be in any doubt that the appropriate place to discuss the evidential basis for the clause and how it tries to deliver what the Government have proclaimed—from the Prime Minister’s first utterances to today—is here. You noted that it was difficult to bring the issue into the debate on the first amendment, Mr. Hood, which I hope is an answer to the scratchy but perhaps early morning tetchiness of the Liberal Democrat spokesman, the hon. Member for Leeds, North-West.

The Liberal Democrat amendment was not about timing, which the Minister highlighted, but about the evidence base for the proposal. The Minister was focused on making the grant available from 25 weeks, so the Liberal Democrat proposal of 16 weeks did not get to the heart of the evidence-base matter. It was a testing approach, rather than a proposal for a scientific basis of 16 weeks. The Government’s lack of evidence, either underpinning the measure or put before ourselves as parliamentarians to aid the debate about the proposal, is a genuine indictment of the way in which they claim that they follow evidence-based policy making. The Committee will recall that the measure was first announced on 6 December 2006 by the then Chancellor of the Exchequer, now the Prime Minister, who said that he had

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

I emphasise those last five words—

“and in the first weeks after birth, the extra costs borne by parents could be better recognised if we did more to help through the universal benefit—child benefit—which is paid to all.”

That is not a point with which I contend, but he continued:

“Maternity grants are available to low-income mothers from the 29th week of pregnancy.”

He said the 29th week at that point, and went on:

“Help should be available to all mothers expecting a child, so child benefit will be paid on that basis to every mother”—

it was all expressed as child benefit—

“additional child benefit that now recognises the important role, at this critical moment, that child benefit can play.”—[Official Report, 6 December 2006; Vol. 454, c. 308.]

The announcement was supported by notes, which said that the pre-Budget report

“provides further help for families and children, including from April 2009 every mother-to-be will be eligible for Child Benefit from week 29 of their pregnancy...so that women will be up to £200 better off.”

That policy was mentioned on pages 1, 6 and 101 of the pre-Budget report 2006. The report also said:

“The Government recognises the importance of a healthy diet in the final weeks of pregnancy and the additional costs faced by parents when their children are born.”

In the interim, the payment through child benefit has morphed into a one-off payment and, although in proposed secondary legislation only, been pushed back to the 25th week of pregnancy—something that the Committee might wish to discuss in our continuing debates. Initially, the benefit was to be £200 for the first child and £130 for subsequent children; now, it is £190 for all births but not necessarily for all children. As we have already discussed, the £190 payment applies only to the birth—even if the mother has twins or more.

I have sought indefatigably the evidence on which the Prime Minister’s assertion was made, but neither the Department of Health nor the Treasury has seen fit to provide it. One must question what they have to hide. Or, perhaps there is no evidence, so they actually have nothing to hide except the Prime Minister’s embarrassment, and the fact that he has been found yet again to be the emperor without his clothes—not a pretty sight.

Jimmy Hood (Labour, Lanark and Hamilton East)

Order.

Stephen O'Brien (Conservative, Eddisbury)

I agree that to go any further would be grossly out of order.

The move from a child benefit extension to a one-off grant was first made public when the Secretary of State for Health re-announced the measure in a speech at Toynbee hall—

Steve McCabe (Labour, Birmingham, Hall Green)

On a point of order, Mr. Hood, I am mindful of the the former profession of the hon. Member for Eddisbury, but is it possible to indicate that he is not being paid by the word in this Committee?

Jimmy Hood (Labour, Lanark and Hamilton East)

That is not a point of order, as the hon. Gentleman should know.

Stephen O'Brien (Conservative, Eddisbury)

The clause represents a Government promise to use many hundreds of millions of pounds of taxpayers money for something that they proclaim as a health benefit, but they have produced no evidence, so the Government Whip, the hon. Member for Birmingham, Hall Green, should not only withdraw the smirk on his face, but hang his head in shame. Arrogance is not appropriate in this Committee. We are seeking to scrutinise a Government measure—[ Interruption. ] I am sorry if he finds words difficult to tolerate, but we are parliamentarians—it is our trade. By April 2009—[ Interruption. ] One day, he may stop chuntering as well. It would be amazing if he ever learned manners.

The Secretary of State for Health re-announced the measure in a speech at Toynbee hall on 12 September 2007. He said:

“By April 2009, we will introduce a new Health in Pregnancy Grant, making a payment to each expectant mother. This will be in addition to Healthy Start vouchers... This substantial payment will be directly linked to improving nutrition — so it will be paid alongside nutritional advice, and the sum of money will be sufficient to help every mother eat healthily during her pregnancy.”

It is worth noting that, during the announcement, the Secretary of State focused solely on the nutrition arguments for the grant, in sharp contrast to the Minister’s contention in the oral evidence session that the Government

“want to tie this to specific health advice from the 25th week of pregnancy; the general pressures that women, particularly less well-off pregnant women are under; and the pressures immediately before and after birth”.——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 105, Q257.]

That was the first indication of the Government shifting their position—they were beginning to find themselves all over the place on the measure. The measure was re-re-announced by the Financial Secretary to the Treasury on 14 November 2007. There is a telling discrepancy between the two press releases posted on wired-gov.net. In the first, the Financial Secretary to the Treasury said:

“We know that a healthy lifestyle, including a healthy diet, is important for all women in the later stages of pregnancy”.

That quotation was removed from the press release in a later, corrected copy. Again, in the first press release, the Financial Secretary said:

“The Health in Pregnancy Grant is designed to provide pregnant women with financial support, alongside important advice from a health professional to help them invest in their individual needs during pregnancy, whilst giving them the flexibility to choose how they budget and where they spend this money”.

However, that ministerial statement was later excised from the body of the press release. I contend that that shows that the Government were in a terrible mix-up about both the provenance and future shape of the policy.

Having failed to glean evidence from Government announcements, I pursued the matter through parliamentary questions, as the Minister knows. On 28 November last year, I tabled two named day parliamentary questions. The first asked for the evidence underpinning the initial announcement. The second asked for the evidence and what consultations were held between the first announcement and the final health in pregnancy grant proposal. The latter was answered on the named day. On the former, I received a holding answer on 18 December from the Financial Secretary, who told me that she would respond as soon as possible—no change there then. The answer arrived on the letter board yesterday, and appears in Hansard today. To delay publication until the eve of our debate on the topic is symptomatic—it is a hallmark—of the contempt in which the Government hold Parliament. Doubtless the Financial Secretary hoped that I would not be nimble enough to spot that I had received the answer for today’s debate.

I shall deal with the questions as I now find them. On my question seeking information on the representations received and meetings held since the announcement, I was told that

“it is not the Government’s practice to provide details of...meetings”

between

“Treasury Ministers and officials”

and

“a wide variety of organisations”—[Official Report, 4 December 2007; Vol. 468, c. 1197W.]

The answer also stated that representations on the grant received after the initial announcement were contained in the Treasury’s 14 November 2007 press notice on the grant. That referred to the second re-announcement of the measure on 14 November 2007. The press release quoted only the Royal College of Midwives and the Royal College of Nursing, and while I have the greatest respect for both of them as professional bodies, I would remind that Committee that they are also representative bodies for those professions. As such, their motives, quite rightly, are mixed and regard their members’ interests as much as the needs of pregnant mothers, which almost invariably coincide. None the less, there are those mixed agendas.

It is strange that the Treasury had not sought to liaise with NICE, the Scientific Advisory Committee on Nutrition, academia or pregnancy-related charities in seeking the best way to achieve healthy outcomes for mothers. I was disappointed to be given a press release, rather than a substantive response in answer to the question. Having had that unenlightening answer on 4 December and leaving aside, for now, the unanswered question of the evidence for the claims of the Prime Minister and the Secretary of State for Health about nutrition in pregnancy, I tabled another tranche of questions on 11 December, which were answered on 17 December.

I asked the Secretary of State for Health

“what assessment he has made of the economic implications of the Health in Pregnancy Grant; if he will publish research (a) commissioned and (b) evaluated by his Department on the grant.”

The answer came back from the Treasury:

“HM Treasury received a wide number of representations before the 2006 pre-Budget report on tax and benefits issues, which formed part of the process of policy development for the 2006 pre-Budget report. The decision to make a payment to all women during pregnancy was announced in the 2006 pre-Budget report

It also said:

“The grant will help women meet the additional costs involved in pregnancy and in the run up to birth” —[Official Report, 17 December 2007; Vol. 469, c.1223-1224W.]

during the important last weeks of pregnancy. Once again, the Treasury refuses to provide any evidence. I also asked the Chancellor on 5 December

“what representations he received in favour of the introduction of child benefits in pregnancy before his 2006 pre-Budget speech; and if he will place copies in the Library.”

The answer came back:

“HM Treasury received a wide number of representations before the 2006 pre-Budget report on tax and benefits issues...”—[Official Report, 10 December 2007; Vol. 469, c. 283W.]

—blah blah, the same sort of stuff. [Interruption.] I am sorry, that was not very clear. I asked the Chancellor for what reasons benefits in pregnancy are to be provided through the health in pregnancy grant. This would have been a useful opportunity for the Treasury to explain to parliamentarians the reasons behind the shift to a one-off payment, rather than an extension of child benefit. The answer came back:

“The Government are introducing the Health in Pregnancy Grant from April 2009 as a one-off payment to expectant mothers to help them during the important last weeks of pregnancy. It will provide flexible financial support as a one-off payment, and will be payable per pregnancy. This recognizes the additional costs involved during pregnancy and in the run up to birth.”—[Official Report, 17 December 2007; Vol. 469, c. 1124W.]

Anne Milton (Conservative, Guildford)

Does my hon. Friend agree that the important weeks in pregnancy and nutrition are at the start of pregnancy and ideally, pre-conception?

Stephen O'Brien (Conservative, Eddisbury)

That is what, I think, we understand from the evidence. I shall come on to that in a moment to ensure that it is on the record. What I am trying to understand is that this did not come from nowhere—the Prime Minister, then the Chancellor, announced it as being the answer to a recognised need. He framed it in the last weeks of pregnancy, and we have done no more than ask for the evidence. I am only asking where it is, and why we do not have it.

Hon. Members from both sides might be lulled into believing that this measure is somehow magically supported. I hope that the Minister has got the answer in his notes. It would be wonderful, at last, to get there. Having comprehensively failed with the Treasury—the Department which, as we have already discussed, seeks to administer the grants right down to regulations on a health provision—I turned to the Department of Health for answers. It was more forthcoming with substantive answers, for which I thank the Minister, although the evidence that it cited pointed away from the health in pregnancy grant as an effective public policy intervention. I asked the Secretary of State for Health if he would publish the information that his Department holds on the effect of diet before and during pregnancy, for the birth rate of babies. The answer that I was given by the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), stated:

“In 2000, the Committee on Medical Aspects of Food and Nutrition Policy in their report ‘Scientific Review of the Welfare Food Scheme’ recommended that improving the dietary intake of women of childbearing age has the potential to ensure that nutritional status at conception is adequate to support optimum fetal development.

Under the Healthy Start scheme, the Department currently provides nutritional support to low income and disadvantaged pregnant women and families with young children by offering vouchers to put towards the cost of buying milk, fresh fruit, fresh vegetables or infant formula at a participating retailer. Currently the Scientific Advisory Committee on Nutrition—Subgroup on Maternal and Child Nutrition is reviewing the effect of early maternal, fetal and child nutrition on the development of disease in later life. The report is due to be published by end of next year.”—[Official Report, 18 December 2007; Vol. 469, c. 1375W.]

I shall come to the scientific review of the welfare food scheme, but as to rest of the answer, although I accept the existence of the healthy start scheme, I do not see what relevance the information had to the question. It did not provide any conclusions on my question about the impact of diet on birth rates. I take no issue with the fact that the Under-Secretary seemed to use a strange spelling of the word “foetal”.

It was brave of the Department to flag up the review currently being undertaken by the Scientific Advisory Committee on Nutrition’s sub-group on maternal and child nutrition. Any evidence-based policy should surely be built on the conclusions of that review, not pre-empt them. Furthermore, the Minister or his officials should have taken the time to examine the committee’s submission, as recent as last summer, to the NICE review of maternal and child nutrition—another review that the health in pregnancy grant has pre-empted. We could not find agreement to call the committee’ representatives before us as witnesses. Had the Minister examined that submission, he would have seen that the committee stated that

“it is too strong to state in a NICE guidance document that early nutrition ‘may also reduce the risk in adult life of conditions such as coronary heart disease and obesity.’ It ‘may’ but there is very little hard evidence in humans that changing diet in pregnancy can reduce the incidence of chronic disease in later life.”

That somewhat undermines the impact of the last paragraph of the answer given to me by the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth.

I turn to the scientific review of the welfare food scheme by the Committee on Medical Aspects of Food and Nutrition Policy. Helpfully, the Library was able to provide me with a copy so that I could ascertain for myself whether, as the Under-Secretary had suggested in her answer to me, it had

“recommended that improving the dietary intake of women of childbearing age has the potential to ensure that nutritional status at conception is adequate to support optimum fetal development.”—[Official Report, 18 December 2007; Vol. 469, c. 1375W.]

The review, published in 2002, notes on page 14 that

“there are no national data on the dietary intakes of pregnant women”

and that the national dietary and nutritional survey of British adults

“specifically excluded pregnant women and only 10 lactating women were included”.

The report also notes:

“The only nutrient which has a specific Dietary Reference Value at the time of conception is folic acid...For most nutrients, no increment for pregnancy is given. This does not necessarily imply no increase in metabolic demand during pregnancy but rather that such extra demands should be met by normal adaption or increased efficiency of utilisation, or from stores of the nutrient”.

As the parliamentary answer noted, it states that

“the special nutrient demands and critical growth periods experienced by children and women of childbearing age de facto makes them nutritionally vulnerable”.

At first glance that supports the health in pregnancy grant, but women of childbearing age are a much larger constituency than pregnant women, and very different. If the Government were basing policy on that evidence, would they not be intervening in the diet of all women of childbearing age?

The Committee might be interested to know that the review states on page 34 that in 1999 in England and Wales,

“7.1% of live births were low birthweight”.

That is the proportion that we are dealing with. Paragraph 5.4.1.ii of the review examines in depth the role of nutrition. The hon. Member for Luton, North might be particularly interested in it, considering his line of questioning at the oral evidence sessions. He was pursuing with clear determination the point about foetal alcohol damage. That paragraph states:

“Although it has been argued that maternal nutrition during pregnancy has an important effect on fetal growth (Barker 1992) evidence of a relationship in generally well nourished populations like that of the UK is inconclusive (Haste 1991, Godfrey et al 1996; Matthews et al 1999). Smoking and high alcohol intake are probably more important environmental causes of fetal growth constraint in such circumstances...the relationship between dietary factors during pregnancy, outcome and birth weight are not strong.”

It goes on to note that

“improving the dietary intake of women of childbearing age has the potential to ensure that the nutritional status at conception is adequate to support optimum foetal development. Currently welfare foods are provided only after pregnancy is established though there is clear evidence that women are nutritionally vulnerable before conception.”

The review, which the Department prayed in aid as evidence for this measure, to all intents and purposes would see the health in pregnancy grant as at best, of little value, and at worst, counterproductive.

As I mentioned earlier, I only yesterday received the answer to my question, tabled on 28 November last year—plenty of time before this Committee—about the evidence for the basis of the original announcement by the Prime Minister in the pre-Budget report of 2006, and we are only here because he made that statement. That answer is in Hansard today. Specifically, I asked him to place in the Library evidence that nutrition for pregnant mothers is most important in the last months of pregnancy. The answer states that:

“There is a wide range of evidence that nutrition for pregnant mothers is important throughout pregnancy...The importance of maternal health during pregnancy was recognised by the Royal College of Midwives and Royal College of Nursing in HM Treasury’s 14th November 2007 press notice on the health in pregnancy grant, on the HM Treasury website.”

If that is the evidence that the Prime Minister backs, to refer to a Treasury press release that he was authorising, circularity is the nicest word that I can possibly think of for that.

It seems that Ministers and Treasury officials are going out of their way to stop the Prime Minister from being embarrassed and squirming; it is worrying, to say the very least. Not only has that answer failed to answer my specific question about the evidence that informed the budgetary statement, it gives no examples of the evidence that it claims exists on nutrition and it prays in aid a press release delivered a year after the initial announcement as evidence for it. Does any member of the Committee think that that is an adequate response? I hope that the Minister will speak to his colleagues in the Treasury and perhaps to the Treasury officials, whom I know will be in this room as we are talking, because after all they are in charge of this payment unless the amendment is accepted, which is another point. I hope that they will take this message back and answer the question properly, not in the obfuscatory manner that is patently ridiculous and demeaning for this process, particularly given that the response took two months to write. I shall also be pursuing the matter.

In their unwillingness to provide answers and in providing evidence that directly contradicts the measure, the Government have shown how lacking the evidence is for the health in pregnancy grant, as designed by the Prime Minister and his Government. This criticism has been endorsed by the evidence of third-party organisations. During her helpful and balanced oral evidence, Rosemary Dodds of the National Childbirth Trust stated that

“the intention of the payment has not been made clear.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 85, Q197.]

She continued:

“There is good reason to think that improving women’s diet at the pre-conception stage may have that impact but improving diet later in pregnancy is likely to have much less impact.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 86, Q198.]

She also said:

“I think it is important to be clear about the intent in order to evaluate the impact, because I think that the Government want to be evidence-based and you cannot be evidence-based unless you have a reason for doing things.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 87, Q202.]

We agree with that. The Kings Fund has called the measure “silly” and the written evidence from Bliss and the Twins and Multiple Births Association, which we have already discussed in some depth shows how ill-thought-through this measure is, as regards nutrition for women pregnant with multiple babies.

The Minister may stand up and argue that this is post-hoc, given his admission during his oral evidence, in direct contradiction to his own Prime Minister that

“the evidence suggests that the nutritional benefits, specifically to the unborn child, are better earlier on in pregnancy.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104, Q257.]

However, the fact remains that this intervention is based upon an announcement made by the now Prime Minister about which no Minister can supply any substantial evidence. One wonders what limits, if any, Ministers and Treasury officials will go to, to cover the embarrassment of the Prime Minister. Instead of bringing forward measures that address the issues of the real world, Ministers have chosen to bulldoze on, in the face of the evidence on which they say they are drawing, and in the face of the evidence that is brought out in a close reading of third-party comment on this measure, and which I have taken the trouble to ensure is on the record through the Committee’s proceedings. They have chosen to change their language, not the substance of the policy, which is spin at its worst. They have chosen not to be free and frank with their parliamentary answers, which is unfortunate. The House deserves an apology.

Further written evidence to be reported to the House

Clause 121

Stephen O'Brien (Conservative, Eddisbury)

We were galloping through clause 121 stand part, but over lunch we have had the opportunity to reflect a bit more. I shall not rehearse what I briefly alluded to before the break, although I recognise that over lunch we had the slight distraction of the demise of the Secretary of State for Work and Pensions. I draw the Committee’s attention to “Healthy Weight, Healthy Lives A Cross Government Strategy for England”, which was the obesity strategy launched only yesterday—I appreciate that is not as fresh as today’s lunch time news. If the Government seriously consider the health in pregnancy grant a proper nutrition and health-based initiative, surely it should be included in that document? It is not. Although on page 3 the document claims:

“A baby’s growth rate is in part determined by parental factors, with the period immediately after birth of particular importance”.

The Government’s obesity strategy makes no mention of that grant.

In conclusion, both the Prime Minister on 6 December 2006 and the Health Secretary on 12 September 2007 claimed that the grant is for maternal nutrition in the last weeks of pregnancy, alongside the unsubstantiated claim that in that period nutrition is most important. By the time the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) gave his oral evidence, that claim had become diluted to the grant supporting other things, namely:

“specific health advice from the 25th week of pregnancy”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104.]

A claim that is questionable given the oral evidence of the treasury official, Jonathan Athow, who on the same day said:

“a very small proportion of women...do not seek regular contact with the health professionals”. ——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 106]

The Minister referred to:

“the general pressures that women, particularly less well-off pregnant women, are under”.—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104.]

If that is the case, a more focused intervention on less well-off women would make more sense. The Minister also referred to

“The pressures immediately before and after birth”.—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 105]

We have had no evidence from the Minster underpinning the choice of an otherwise apparently arbitrary figure of £190. Clearly that is a contribution rather than the full cost associated with the joyful event of having a baby. The Minister also referred to

“The serious problems of underweight babies in this country”

That is a serious problem affecting 7.3 per cent. of live births in 1999. The “Scientific Review Of The Welfare Food Scheme”, which I mentioned earlier, states that that problem is combated by impact pre-conception nutrition. It is also important to mention what the Minister referred to as

“the still very stark inequalities in health of both women and children”. —[ Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 103.]

I am absolutely sure that each one of those items will be recognised by the Minister because each one was a direct quote from his oral evidence.

Given the £3.8 billion that it is claimed is needed to achieve the Government’s target of cutting child poverty by half by 2010, the figure of £145 million does not even make a dent. In case hon. Members misunderstand me, particularly Government Back Benchers, I am not questioning the need to support pregnant mothers or the need to make a payment. We want to give the money; never let it be said that we do not. I am simply seeking to call the Government to account for the evidence for the health in pregnancy grant being the best way to spend £145 million per annum and whether that is the best way to achieve the best outcome for vulnerable pregnant mothers.

I believe that I have made my case, but I fear that I will be unable to persuade the Minister. I hope that Government Back Benchers will seek to call Labour party policy to account for the effective use of taxpayers’ money. Otherwise, there is a real danger that they will find themselves joining a bandwagon that an ill-advised Chancellor set rolling before he became Prime Minister. Officials and Ministers are now trying to cover up the Prime Minister’s considerable embarrassment at being seen to be a headline-grabber rather than someone who introduced a workable and effective policy based on hard-headed evidence. It is a policy that Ministers and officials are now desperately scrabbling around to post-rationalise, change by stealth, refuse to provide the evidence for and ram through. On that basis, we are looking genuinely and seriously for answers, and above all, at last, please, the evidence to substantiate what the Prime Minister said when he started the ball rolling. We are looking for the reason why we now find ourselves engaged in parliamentary scrutiny of the Bill.

Greg Mulholland (Liberal Democrat, Leeds North West)

I thank the hon. Gentleman for reiterating and reinforcing many of the points that I made at the beginning of the morning sitting, particularly the stark reality that there is no evidence to support this significant new policy. It is abundantly clear, and will plainly remain the case, that the very pertinent and important questions that have been asked, both today and previously, about the new payment and its aims, have not been answered at any stage. It is regrettable that that is still the case in Committee.

The reality—something that no one, including the Minister, would disagree with—is that a considerable proportion of the large sum of taxpayers’ money represented by the payment will probably be spent on things that have nothing to do with diet and nutrition. A proportion, again, probably considerable, will be spent on things that have no direct effect on health in pregnancy. It remains unclear what the health in pregnancy grant actually aims to do, and we have got no further down that road during our discussions.

In reality, this is a pre-birth child benefit one-off payment, and if that is what the Government want to do, they should say so and be clear about what they hope to achieve. One specific point that I wish to pick up is the issue of multiple births. If this is, as it seems to be, a child-benefit payment, it should reflect the reality of multiple births. Not to recognise that at seven months into pregnancy seems absurd.

There should have been more consultation. The expert advice and views of the involved organisations should have been listened to, to see whether there was a better way of achieving this or whether the Government need to change their rationale. Either way there is still a lot of work to do, and that should not be the case at this stage of the legislation. The measure will undoubtedly go through, despite the fact that the arguments and the purpose are not clear. When the payment starts, there must be a lot of analysis to see if it delivers. I hope that the Minister will acknowledge that and tell us that that will happen and that we will have a sense of what the payment achieves once it is introduced.

Angela Browning (Conservative, Tiverton and Honiton)

I want to pick up on one or two issues that have been raised. I feel confused about the Government’s intention for the grant. It is over 40 years since I studied nutrition to an advanced level as a home economist. In the oral evidence-taking session I mentioned that as a former president of the then Institute of Home Economics, issues of nutrition and care of family welfare, food and budgeting and so on made up an important part of our deliberations. I agree, if it is a question of putting extra money into the family income at a time when a child is expected and there are additional expenses. The case has been made that the money might be used not just for buying more nutritious food and having more information about it, but also for other things such as paying off debts, or helping to relieve stress in pregnancy, and we can all understand that. However, I wish to focus on how the measure will help women who are pregnant to be healthier and to produce children whose health can be measurably defined as improved at birth. I assume that the Government would want to monitor that. We have heard a lot about birth weights, so one must assume that, however the money is used, it will have a direct effect, statistically, over a period, on the health of the child at birth and on birth weight.

I do not claim to be as up to date on such matters as I was 40 years ago. I am aware of the importance of folic acid in pregnant women’s diets, which I was not aware of some years ago. Equally, some things are still relevant today. For example, as I said in an oral evidence session, calcium and vitamin D in particular, as well as phosphorous, are important in the foetal development of teeth and bones. We know how the generation who lived through the second world war and did not receive adequate supplies of calcium were affected.

Those things are important, but I am not clear on who will deliver the information and advice, or whether that will mean that mothers take heed of the advice. I remember watching with horror the Jamie Oliver series in which he tried to improve school meals. I was not shocked that school children did not want to eat their greens—all parents have been through the battle of trying to get their children to eat cabbage and things like that. I was shocked, however, that the mothers not only did not buy fresh fruit and vegetables, but would not know how to cook them if they did. There is a large body of people out there, and among those people, particularly mums, it is probably the poorest who most need the information about introducing those things into their diet. They need to undergo the education process by which they will come to recognise the importance of nutrition as well as in what foodstuffs the essential vitamins and minerals that are important during pregnancy are to be found. It will be fine if we are talking about middle-class mums who will read magazines on such matters and attend antenatal classes frequently. However, I suspect that the Minister has in the back of his mind that large group of people, who are among the poorest, for whom it is not only a question of introducing money or information, but who have a mountain to climb because of what they regard as a normal, healthy diet.

Earlier in the debate we discussed who will offer the advice. The Minister said that that would be dealt with in regulations. I made a quick note of the options available for offering the advice. It included GPs, practice nurses, and midwives who are involved in antenatal care. However, I suspect that once the forms are filled in to trigger the grant, it will be a matter of pressing a leaflet into someone’s hand and saying, “There you are, that is what you need to know”. If that happens, we will not be able to say in five years time that there has been a demonstrable improvement in birth weights and the ongoing health of children who benefited from the grant in the womb.

We should remember that recently, for the first time in 100 years, we identified rickets in children. Rickets can be avoided if people have proper nutrition, particularly those things that lay down calcium, such as vitamin D and phosphorous. The debate has gone round and round on what the measure is for, but we have not talked about outcomes. If we went out on to Westminster bridge, we could do a little survey by asking people, “Do you think it is a good thing that the Government are going to give this grant to pregnant women?”, and perhaps everybody would say “Yes”. The reality is, however, that if public money is going to used to deliver an outcome, the Minister must focus much more on what the money is intended for and how he will deliver it, bearing in mind some of my points about the lack of knowledge and understanding and the somewhat limited time scale that will be available to the professionals who are going to be charged with delivering the information.

I am going to congratulate the Government, something that I am always happy to do when they get it right. The Minister need not look surprised, he knows that I am a fair-minded person, he is my next-door neighbour. It is absolutely first class that the Government are going to introduce cookery classes into schools. I have lobbied for that for a long time; it was wrong to get rid of them in the first place. I hope that it will make a difference, but it will take some years to filter through, so let us start at the beginning, which is what the clause seeks to do, and ensure that the Minister gets it right. We are actually willing him to get this right, but at the moment I am not convinced from what I have heard that it will deliver what he intends.

Anne Milton (Conservative, Guildford)

I do not want to rehearse the arguments that have already been made, but there are a few issues that I want to raise. On the number of midwives, the Minister might have been under a misapprehension—he needs to look at the full-time equivalents. The figures for full-time equivalents demonstrate that the number of midwives is not keeping pace with the number of live births.

The other matter I would like to raise about the grant is inequalities in health. Under part 5 I have tabled an amendment that touches on some of the issues surrounding public health. The problem with the grant, to repeat what my hon. Friends have already said, is not whether it is spent, but how it is spent. As a poverty alleviation method, it is absolutely fine. As the National Childbirth Trust pointed out, it gives mothers some extra cash in the home at a difficult time in their pregnancies and one would hope that they would spend it on their own and their baby’s health. However, the grant does nothing to address the inequalities that exist in health, which are getting worse, not better. The distance between the health outcomes of poorer people and richer people is greater than it has ever been. I do not doubt the Government’s commitment to reducing those inequalities and the fact that they have been unable to reduce them demonstrates that it is extremely difficult to do so. The sad thing is that this is a substantial amount of money that is not being directed to closing that gap because we will be stuck with a group of people that are hard to reach. The trouble with antenatal care in particular is that the good old middle classes, the ones that actually think about what they eat and how they spend money, trot along, listen to the midwife, pick up leaflets and go home and do all the things that they are meant to. The ones that we really need to reach will not do that.

Sandra Gidley (Liberal Democrat, Romsey)

I am a little alarmed at the assumption that the middle classes will read magazines and do things well, and the working classes will not. I think there is probably a spread in any socio-economic group.

Anne Milton (Conservative, Guildford)

I thank the hon. Lady for her intervention. She used the words “working classes”, I did not. I am saying that there is no denying the fact that there is a hard-to-reach group. They might be in the middle classes; they might be those members of the middle classes who are alcoholics sitting at home drinking themselves stupid, and whose babies will be born with foetal alcohol syndrome. We have to use generalities; there is a hard-to-reach group. They are not necessarily working-class, but the hon. Lady might pay more attention to inequalities in health than making comments about language. It is absolutely vital that we reach those women. [Interruption.] If the hon. Lady would like to make another intervention, I am happy to give way to her again.

My hon. Friend the Member for Tiverton and Honiton commented that the problem with introducing vegetables into diets is that some families—some mothers, some fathers—do not even know how to cook them. That is what we are up against. Recently somebody who works on a labour ward in south London told me that a substantial number of women are asking to stay in for the night after their baby is born because they want to go out clubbing on that first night. Talking from personal experience, when I had a baby, I was locked in a room with the curtains closed. I would never have been able to go to a club, probably even within four weeks of the birth of my children. However, a different sort of women is having babies nowadays, and they are extremely difficult to reach. I do not think that the Minister has listened to all that has been said in this debate, but I urge him to be non-party political about this. We are making genuine attempts, as are the Liberal Democrats—despite their comments—to ensure that the money is well spent and directed at the people who need it most.

Ben Bradshaw (Labour, Exeter)

Mr. Conway, I am cognisant of the stricture of your co-Chairman this morning that contributions in the stand part debate should be brief. Given that we have spent about 50 minutes on it, and the hon. Member for Eddisbury spoke for more than 30 minutes, and that we had a good and comprehensive debate on the evidence base for the measure in response to the Liberal Democrat amendment this morning, I do not intend to repeat everything I said then in support of the evidence base. My comments will be in the record for Members to read tomorrow.

The hon. Member for Tiverton and Honiton raised a new issue about evaluation. I can assure her that we are developing an evaluation plan.

Clause 122

Stephen O'Brien (Conservative, Eddisbury)

I beg to move amendment No. 64, in clause 122, page 78, line 25, at end insert—

‘(6) The Secretary of State may by regulations indicate the payments to be made in the event of a pregnancy that is carried beyond the twenty-ninth week, but is not carried to term or live birth.’.

The Minister owes it to Parliament to take the Bill seriously; after all, he is proposing it—the rest of us are trying to scrutinise it. Following that gross disrespect, we move to amendment No. 64.

Amendment No. 64 seeks to probe Government thinking, but it sounds to me as if they cannot be bothered to think and, if necessary, amend the Bill on the issue of payments to mothers who, for whatever reason, at the later stages of pregnancy, when it is often at the most tragic, do not carry their babies to full term. I hope that, for once, the Minister will take the matter seriously, because outside this Room, people think it is extremely serious.

I note from the draft regulations that a woman who has given birth to a child, or a stillborn child, is entitled to payment of the health in pregnancy grant, if she was at least 25 weeks’ pregnant, and before that birth, had received advice on matters relating to maternal health from a health professional. Of course, I should be more than willing to withdraw the amendment if I received adequate assurance that the regulations touch on it. My anxiety is that the need to have received health advice will become the trigger, rather than the needs of the mother, who will no doubt be going through extraordinarily difficult times, when anything that would help her health, not least through diet and nutrition, so that she can overcome desperate stress and grief must be our primary focus.

Ben Bradshaw (Labour, Exeter)

The draft regulations published by the Medical Research Council, which I circulated to the Committee some time ago and which, incidentally, included the list of professions that would be involved in the work, set out the detail about the entitlement conditions. In particular, regulation 2 of the draft sets out the conditions in relation to pregnancy, and refers specifically to women who have a stillbirth after the 25th week of pregnancy. That would include the exceptional cases where a pregnancy has to be terminated on medical grounds after the normal 24-week limit for legal abortion. I assure hon. Members that we have carefully considered this most sensitive matter. When a woman loses her baby, we do not want to add to the distress that she and her family will be facing, by placing additional requirements on her. Accordingly, where a woman meets the specified conditions of entitlement, as set out in clause 121, and claims within the time specified in regulations set out under clause 122, she will continue to be entitled to the grant, regardless of the outcome of her pregnancy.

Stephen O'Brien (Conservative, Eddisbury)

As I said, I am happy to withdraw the amendment and I am glad that we have been able to ensure that all those points were properly aired on the record. I beg to ask leave to withdraw the amendment.

Stephen O'Brien (Conservative, Eddisbury)

The Patients’ Association supports Tamba—the Twins and Multiple Births Association—and Bliss on multiple births. Although we have raised these points already during our proceedings, the Minister was rather short on his answers, so we did not get the reassurance we sought and I shall have to detain the Committee for a short while. The Patients’ Association is

“concerned to learn that the Health in Pregnancy Grant proposed in the Bill will penalise mothers giving birth to twins and multiple births.”

The Minister will recall that there were a series of reasons for that concern, which it was important to consider. Indeed, they were reprised by my hon. Friend the Member for Tiverton and Honiton in her contribution. There was concern about the focus on the birth, which is what the Government pray in aid, as compared with the health of the baby and the mother, who is under much greater demand when it is a multiple birth. One must think carefully about making these grants available to individual human beings, be they boy or girl, on the basis of health rather than simply as an event of birth. I wonder whether the Minister would like to amplify his comments on that point, given that he chose to keep his remarks rather short during our previous attempt at the subject.

Ben Bradshaw (Labour, Exeter)

The way the grant will be administered is the same as for other pre-pregnancy grants such as the healthy start voucher, which is administered regardless of the number of babies that a pregnant woman is expecting. The evidence suggests that women with twins do not have additional nutritional requirements to those with single births.

Clause 127

Stephen O'Brien (Conservative, Eddisbury)

The clause makes the health and pregnancy grant an excepted matter, and therefore outside the competence of the Northern Ireland Assembly. As we are discussing a matter that is applicable to England and, through the auspices of Welsh Ministers, in Wales, with a reference to Scotland from time to time, will the Minister tell us when pregnant mothers in Northern Ireland might expect to have the same opportunities and be under the same protection, in terms of their health and that of their unborn babies?

Ben Bradshaw (Labour, Exeter)

This is the same system as applies to child benefit in Northern Ireland. The Northern Ireland Assembly has approved the legislative motion for the Bill, including the health and pregnancy grant.

Clause 128

Stephen O'Brien (Conservative, Eddisbury)

I wonder whether the Minister would give some explanation about subsection (2), given that it relates to the Immigration and Asylum Act 1999. I assume that it disallows illegal immigrants from claiming the health in pregnancy grant. Does that stand also for those who have claimed asylum but not yet heard the outcome of their application? This is an important issue because so many of those women who come in either as illegal immigrants or as asylum seekers are of child-bearing age.

In a connected issue, on 26 November last year, my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) asked the Chancellor whether A8 nationals resident in the UK will be eligible for the proposed health in pregnancy grant. As the Committee will know, the A8 countries are the new EU entrants: the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia. The ministerial response was, as I have come to expect from the Treasury, somewhat equivocal:

“The Government are introducing from April 2009 a one-off payment to expectant mothers, known as the Health in Pregnancy Grant, to help them during the important last weeks of pregnancy. Only women ordinarily resident in the UK will be able to claim the payment”.—[Official Report, 26 November 2007; Vol. 468, c. 51W.]

Could the Minister tell the Committee what “ordinarily resident” means, in practical rather than legislative terms, and under what circumstances nationals of the A8 countries will be classed as being “ordinarily resident”? Consequently, is the answer to the question yes, or no?

Ben Bradshaw (Labour, Exeter)

Under subsection (2), the health in pregnancy grant will follow the long-standing Government policy that those who have not established their right to remain permanently in the UK, should not have welfare provision on the same basis as those whose citizenship or status here entitles them to benefits and assistance when in need. To ensure that people who are subject to immigration control and who are in the UK illegally are not entitled to the health in pregnancy grant, subsections (2) and (3) apply section 115 of the Immigration and Asylum Act 1999 to the health in pregnancy grant. Section 115(9) of that Act defines

“a person subject to immigration control”

as

“someone who is in the United Kingdom unlawfully (either an illegal entrant, or someone who has overstayed his leave); someone who is here on limited leave with a condition that he will have no recourse to public funds (e.g. a visitor or a student); someone who is here under a maintenance undertaking; or someone whose leave has been extended to allow him to pursue an appeal. These classes embrace asylum seekers if they are subject to immigration control in this sense (an application for asylum does not itself confer an entry status or leave to remain), and a number of other persons subject to immigration control.”

Clause 129

Anne Milton (Conservative, Guildford)

I beg to move amendment No. 67, in clause 129, page 85, leave out lines 20 and 21 and insert—

‘(a) have regard to the standards set out in statements under section 41 of the Health and Social Care Act 2008, and

(b) produce an annual health improvement plan.’.

The amendment, crucially, would insert into the Act a duty on primary care trusts to produce an annual health improvement plan. All NHS bodies currently have a duty, under section 45 of the Health and Social Care (Community Health and Standards) Act 2003, to ensure that they have arrangements in place for the purpose of monitoring and improving the quality of care. Clause 129 would amend the National Health Service Act 2006 to insert a duty on primary care trusts to make arrangements to secure continuous improvement in the quality of care provided by or for them. This new version of the duty is intended to be more closely aligned with that imposed on local authorities by section 3 of the Local Government Act 1999. The existing duty in section 45 of the 2003 Act would cease to apply in relation to English NHS bodies. Responsibilities for the duty of care would thus be placed with commissioners of NHS services and primary care trusts.

The amendment would put a condition on PCTs to produce an annual health improvement plan. I believe it is still the case that primary care trusts produce an annual health report. That is important as it reports on what has happened within its area in the previous year. However, that focus on future improvement is crucial. Many parts of the Bill, in relation to maternity grants, the weighing and measuring of children and here under the clause, make reference to the public’s health. I would urge the Minister, as I said in my brief intervention on the discussion of the previous clause, that this is non-party-political issue. We will move on to obesity and I am restraining myself from talking about it now, but it is terribly important that we deliver better health for the public.

Public health is in many ways a dispiriting area to work in because, particularly with measures that have long-term outcomes, one is looking for improvements over the course of five years. The health improvement plan would help those working in the field to keep their focus and allow them to be measured against what they are delivering and indeed, measure themselves. It is disappointing that on the state of public health in July 2006, the chief medical officer warned that raiding public health budgets can kill. Although it is not so much the case this year, in previous years we have seen PCTs’ responses to budget deficits as raiding the public health budgets. Unfortunately, public health money is always seen as soft money, partly because of those long time frames for outcomes—there is no immediacy. I do not know that newspapers such as the Daily Mail report public health very much and it does not have the sexy image that many other parts of healthcare have, but it is equally if not more important.

If we look at the figures for the number of people employed in public health—I should reiterate my interest, which is that my husband is a public health physician—between 2005 and 2006, with no more recent figures available, the number of full-time equivalent public health staff in the NHS was cut by 4 per cent. It went down from 1,324 to 1,268. Of those, the number of public health consultants was cut by 6 per cent., going down to 687. PCTs are working with tight financial constraints these days and there is a feeling that they must deliver on those headline figures. It is absolutely crucial that we get PCTs to focus on public health improvement; to produce a plan would make a substantial difference.

Ben Bradshaw (Labour, Exeter)

I have a lot of sympathy with the sentiment that the hon. Lady has expressed, but as she may be aware, under section 24 of the National Health Act 2006, each primary care trust is already required to produce an operational plan, setting out its strategy for improving the health of the people for whom it is responsible, so the amendment is unnecessary.

Anne Milton (Conservative, Guildford)

I do not know whether that is producing quite what we want. I think that in considering the Bill, which addresses many public health issues, it is important to have reiterated just how important public health is, however, I beg to ask leave to withdraw the amendment.

Schedule 12

Sandra Gidley (Liberal Democrat, Romsey)

I beg to move amendment No. 229, in schedule 12, page 167, line 11, at end insert—

‘1A (1) Section 164 of the NHS Act (remuneration for persons providing pharmaceutical services) is amended as follows.

(2) In subsection (1), for “determining authorities” substitute “the Secretary of State”.

(3) Omit subsection (2).

(4) Omit subsection (3).’.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss the following amendments:

No. 230, in schedule 12, page 167, line 11, at end insert—

‘1B (1) Section 165 of the NHS Act (section 164: supplementary) is amended as follows.

(2) In subsection (3), omit paragraph (b).

(3) In paragraph (4)(b), for “determining authority” substitute “Secretary of State”.

(4) In paragraph (5)(a), for “determining authority” substitute “Secretary of State”.

(5) In subsection (9), for “determining authority” substitute “Secretary of State”.’.

No. 240, in schedule 12, page 167, line 22, at end insert—

‘( ) at the end of subsection (10) insert—

“but shall give directions to a Primary Care Trust with respect to remuneration determined by him in accordance with section 164(3).”’.

No. 241, in schedule 12, page 167, line 36, at end insert—

‘3A (1a) The Secretary of State shall designate any element of remuneration determined by him in accordance with section 164(3) which is not remuneration referable to the cost of drugs.’.

Sandra Gidley (Liberal Democrat, Romsey)

Clause 130 and schedule 12 deal with money for payment of pharmaceutical services, commonly known as the global sum. Currently the nationally agreed figure is administered nationally and everyone knows what the situation is. In its consultation, “Modernising Financial Allocations for NHS Pharmaceutical Services 2007”, the Department of Health proposed devolving the global sum to primary care trusts’ baseline allocation. In doing so, the Department stated that it would

“continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee and in discussions with the NHS”.

The Bill introduces the necessary amendments to the National Health Service Act 2006 to permit the global sum to be devolved, but does not include provisions to ensure that the Secretary of State will continue to set the levels of fees and allowances nationally, following consultation with the Pharmaceutical Services Negotiating Committee. Clearly there is concern that the longer term aim is perhaps to have different fees in different areas and fees set by primary care trusts.

Currently, section 228 of the National Health Service Act 2006 requires the Secretary of State to pay sums equal to pharmaceutical services expenditure to primary care trusts. Such sums are distinct from the main expenditure and require the Secretary of State to determine the remuneration of persons providing pharmaceutical services after consulting with the Pharmaceutical Services Negotiating Committee. The Bill removes the distinction between pharmaceutical services expenditure and a primary care trust’s main expenditure from section 228 and therefore removes any obligation to make a determination of the remuneration of persons providing pharmaceutical services. To give effect to the stated intention of the Department of Health to continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee, the Bill must retain an obligation on the Secretary of State to determine some elements of the remuneration of persons providing pharmaceutical services. In its current form the Bill does not do that.

The Bill amends schedule 14 of the National Health Service Act 2006 and adds a new paragraph 3A. That will authorise the Secretary of State to designate elements of remuneration payable by primary care trusts to persons providing pharmaceutical services, which is not remuneration referable to the cost of drugs. The designation has two effects; first, the Secretary of State will be obliged to apportion the total to primary care trusts—that will be accomplished by transferring the global sum—and secondly it will make primary care trusts accountable for those sums. Almost all fees and allowances paid to persons providing pharmaceutical services are not referable to the cost of the drugs being provided. However, the Secretary of State is under no obligation to designate any elements of the remuneration. To give effect to the Department of Health’s intention to continue to set the levels of fees and allowances for community pharmacies in negotiation with the Pharmaceutical Services Negotiating Committee the new paragraph 3A should oblige the Secretary of State to designate certain elements of remuneration. That is what the amendments would do.

Section 164 of the 2006 Act provides that the Secretary of State is a “determining authority” who determines the remuneration to be paid to persons who provide pharmaceutical services. However, he may also authorise any primary care trust to be a determining authority, which is particularly needed to allow primary care trusts to determine payment for locally commissioned enhanced services. Some fees and allowances apply to all persons providing pharmaceutical services, for example the dispensing fee. In its consultation, the Department emphasised the importance of continuing to set the level of those nationally.

Section 165 of the 2006 Act requires that before the Secretary of State makes a determination that relates to all persons who provide pharmaceutical services, such as a determination of dispensing fees, he should consult a body appearing to him to be representative of persons to whose remuneration the determination would relate, namely the Pharmaceutical Services Negotiating Committee.

Sections 164 and 165 do not place an obligation on the Secretary of State to determine the remuneration of persons who provide pharmaceutical services and the Secretary of State could, with no further legislative amendment, decide to authorise primary care trusts to determine remuneration for persons providing pharmaceutical services, including dispensing fees. The community pharmacies in England provide an accessible health care resource that is greatly valued by members of the public. In a recent Reader’s Digest survey only firefighters were more highly valued. It is a very useful health resource. Other health care professionals such as doctors and dentists have nationally agreed fee structures. 85 per cent. of a typical community pharmacy’s income comes from the NHS and certainty of income levels from this source is essential.

The payment by primary care trusts of remuneration to persons providing pharmaceutical services, which has been determined by the Secretary of State, must be mandatory. Unlike providers of general medical services, who have legally enforceable contracts, providers of pharmaceutical services do not operate under a contract that can be enforced by the provider. The Secretary of State may issue directions to PCTs with respect to the application of sums paid to them and to ensure that the fees and allowances determined by the Secretary of State, after consultation with the Pharmaceutical Services Negotiating Committee, are properly paid to persons providing pharmaceutical services. Direction must be issued to oblige PCTs to pay that remuneration.

There seems to be some uncertainty about the future of the payments. We are seeking to regularise a situation where the Government have made promises that do not appear to be incorporated in the Bill. I hope that the Minister will look kindly on the amendments. There is one small problem with the transfer of the global sum: because payments are made in arrears, the transition from one method of payment to another needs to be looked at carefully to ensure that PCTs have their act together and that there is no hiccup in the distribution of payments.

Kelvin Hopkins (Labour, Luton North)

I have had these problems explained carefully to me by a representative of pharmacists, and I ask my hon. Friend the Minister to ensure that whatever the Government do, they protect those local pharmacies who would find these problems difficult and might have their continued existence threatened. Local pharmacies are important for local communities, and I want to ensure that that is taken into account. I am not suggesting support for the amendment, but I hope that my hon. Friend will take into account what has been said.

Anne Milton (Conservative, Guildford)

I want to reiterate the point made by the hon. Member for Luton, North. Local pharmacies almost have an air similar to local post offices—a big topic at the moment. Local pharmacies are increasingly important in the delivery of some preventive matters, such as screening, and in respect of issues such as chlamydia, pregnancies and all the rest. It is important that any change does not undermine their business or make it more difficult for them to continue.

Ben Bradshaw (Labour, Exeter)

Hon. Members have raised some important points. These are matters of concern to pharmacists. I will spend a little time dealing with the concerns raised by the hon. Member for Romsey. Amendments Nos. 229 and 230 would remove the ability for anyone other than the Secretary of State to determine the remuneration paid for the provision of pharmaceutical services. Current legislation enables the Secretary of State to determine such remuneration himself or to authorise others, such as PCTs, to do so. Under these amendments, the Secretary of State would have to set the fees, allowances and payments for all categories of pharmaceutical services, whether those services were agreed nationally and provided by all pharmacy contractors, or commissioned locally by PCTs from certain pharmacies to meet local needs—for example, services for drug misusers. That would undermine the existing community pharmacy contractual framework, whereby PCTs determine the remuneration for the local enhanced services that they commission and fund from community pharmacies.

I share the hon. Lady’s desire for the NHS to commission a wider range of services from pharmacies. They are often in the most accessible location and can provide services tailored to meet local community needs. Having attended its annual conference last year, I know that that view is also held by the pharmacy profession, the all-party group on pharmacy and others. We believe that the amendments would undermine the ability of local PCTs to continue to commission existing local enhanced services from pharmacies, never mind extending the services that they fund through pharmacies.

Amendment No. 240 would require the Secretary of State, where he determines remuneration for pharmaceutical services, also to give directions to PCTs in respect of that determination of funding. That is unnecessary because, where the Secretary of State has made a determination of the fees and allowances to be paid to community pharmacy contractors, that determination has to be honoured by PCTs. So that amendment would add nothing.

Amendment No. 241 would require the Secretary of State to designate any element of remuneration determined by him for pharmaceutical services. Designation allows costs to be charged to a PCT other than the PCT where the pharmaceutical service was provided. That would enable certain elements of pharmaceutical services to be charged to the PCT where a prescription was issued, while other costs would be borne by the PCT where the pharmacy was based, thus avoiding a PCT with a pharmacy that provides services to a wide area—such as an internet pharmacy—inappropriately bearing the costs of pharmaceutical services for people resident elsewhere. Designation would not be appropriate for certain types of expenditure, which will be borne by a PCT where the pharmacy providing the service is based. That amendment would require the Secretary of State to make a designation in respect of all remuneration determined by him for pharmaceutical services, even where such a designation is inappropriate.

When the Department consulted on the proposals, we indicated our intention for the Secretary of State to continue to determine the fees and allowances for the national elements of the community pharmacy contractual framework, in negotiation with the Pharmaceutical Services Negotiating Committee and in discussion with the NHS. Those national elements are the essential services provided by all pharmacy contractors and advanced services, such as medicines use reviews, which pharmacies choose to provide.

Concerns have been raised, including by the hon. Lady today, that that might not continue to be the case. We recognise that pharmacy owners need to know the remuneration that they will receive for those substantive parts of the contractual framework, so that they have the confidence to continue to invest in their businesses. I should like therefore to take the opportunity strongly to reinforce our commitment that the Secretary of State will, indeed, continue to set the fees and allowances for the national elements of the community pharmacy contractual framework. In light of those reassurances, I hope that the hon. Lady will withdraw her amendment.

Sandra Gidley (Liberal Democrat, Romsey)

I thank the Minister for the explanation. Clearly, as he said, it is important that enhanced services continue to be commissioned locally. I fully support that. I do not want any unintended consequence for enhanced services, so the amendments may not be perfect. I was pleased to hear the Minister’s clarification that the intention is for the Secretary of State to continue determining national rates. Will he write to clarify where that is stated in the Bill? Also, where is the protection that I alluded to during my opening comments, so that payments cannot be determined by PCTs in the future? I beg to ask leave to withdraw the amendment.

Clause 131

Anne Milton (Conservative, Guildford)

I beg to move amendment No. 68, in clause 131, page 86, line 33, at end add—

‘(11) A scheme established under subsection (1) may only make provision to meet expenses or liability to bodies or other persons as specified in subsection (2) insofar as the expenses or liability arise from the provision of publicly funded healthcare.’.

The clinical negligence scheme for NHS trusts indemnifies members against losses and liabilities that arise out of negligence occurring in NHS care. It is currently only available to specific NHS bodies, under section 71 of the NHS Redress Act 2006. When the schemes were first established, most NHS care was provided directly by NHS bodies, but in recent years, non-NHS bodies have started to deliver a considerable amount of NHS care. The Secretary of State also procures some NHS services directly.

There has been considerable expansion in the use of private providers. We have seen them in the independent sector treatment centres, about which there has been some controversy, not only about the placing of the treatment centres and the possibility of them undermining the local NHS structures and trusts, but about them cherry-picking what are presumed to be the easier cases and leaving the NHS with a bill to pick up for the more complex ones.

There have also been issues about independent sector treatment centres, because when it all goes wrong, local NHS trusts pick up the bill. If ISTCs have been using, as many of them have, a lot of doctors from places such as South Africa, patients can be transferred in emergency circumstances into the care of perhaps the local orthopaedic surgeon who has not previously been involved with their care.

I am aware that the Government are keen to increase private provision. I gather that there has been some delay in the second wave of ISTCs, but the Government were aiming for a target of 9 per cent. of all NHS care delivered by private providers. We are now looking at an expanding mixed economy of provision in the NHS. We have talked about pharmacies delivering some care and undertaking some diagnostics. The amendment would cover the liabilities that relate to people who are treated in those private sector organisations.

Amendment No. 68 would prevent loopholes in the Bill, whereby expenses or liability might arise from the provision of non-publicly funded health care. I have been lobbied on the issue by, among others, Action against Medical Accidents. I quote from what I think was a submission by the organisation to the Minister that welcomes the move but believes

“that the provision of the Bill at the moment is seriously flawed in that it makes this arrangement voluntary on the part of the provider.”

The concern is that if the arrangement is not compulsory, private providers will not necessarily make it and that therefore leaves the

“NHS patient who suffers negligent harm from a private provider”

without access to

“the same system of redress as an NHS patient harmed in an NHS trust.”

That is becoming increasingly important.

I do not have a problem with who provides the health care—whether a voluntary, charitable, publicly funded or private body does so—but what matters to me is that patients get the best care that they need as and when they need it. However, we are still using public money, so we must ensure that if the state—the Government, the PCTs— commissions care from the private sector the same safeguards are in place to protect and indemnify patients when things go wrong.

Kelvin Hopkins (Labour, Luton North)

I do not expect a response from my hon. Friend the Minister, but some Labour Members do not want to see the private sector inside the public health service. I am sure that my hon. Friend is aware of my views, but I want to make sure that they are on record as not agreeing with private provision inside the national health service. The service should be publicly provided, and I shall continue to campaign on that basis.

Ben Bradshaw (Labour, Exeter)

I am sure that you would not welcome it, Mr. Conway, if the debate were widened into a general debate on the merits or otherwise of involving the voluntary and independent sectors in providing health care. I take the point that my hon. Friend made.

I have sympathy with the hon. Lady’s amendment, but I will explain why it is unnecessary. Subsection (1)(b) of section 71 of the 2006 Act limits schemes to covering liabilities that arise out of carrying out the functions of the member body. Under clause 131 (4) and (7), the liabilities of the Secretary of State and non-NHS members will be limited to those that relate specifically to their functions of providing health services under the 2006 Act. Under our proposal, schemes are limited to covering liabilities that relate to the provision of publicly funded NHS health care with regard to those members. However, the schemes cover not only such liabilities, but the functions of health service bodies and expenses that arise from the loss or damage to property that is not directly related to the provision of publicly funded health care. An example would be malicious damage to NHS property.

The amendment would prevent the existing schemes from providing cover to the NHS for such expenses and liabilities. I am sure that that is not the hon. Lady’s intention, but it would be an undesirable outcome. In response to her question about compulsory or voluntary participation, we cannot make participation compulsory, because we cannot compel foundation trusts, but in the contract with the independent provider, we can and will require liability—we cannot specify, but the scheme will be much cheaper for them.

Anne Milton (Conservative, Guildford)

That was very fast, and I did not entirely follow the Minister. Will he confirm that the same cover will be available for patients regardless of whether they are treated in NHS or in private provider settings?

Ben Bradshaw (Labour, Exeter)

There will still be liability, yes. We cannot force providers to take part in the scheme, but I suspect that they will, because it will be cheaper for them.

Anne Milton (Conservative, Guildford)

I shall withdraw the amendment, although I am slightly hesitant. The Minister presented some very technical details, which I am in no position to question, although I am sure that his advisers know exactly what they are talking about. I would not want to undermine any current situation, but I put on record a slight caution about such people being treated with public money, because of the concern about whether they will get the same cover. However, I beg to ask leave to withdraw the amendment.

Derek Conway (Conservative, Old Bexley and Sidcup)

I remind the Committee that, although we can consider the Bill until 7 o’clock tonight, the House may divide up to seven times at 5 pm, which will cut into a hour and 20 minutes of that time allocation. I am sure that hon. Members will bear that in mind when they seek to make their contributions.

Clause 132

Sandra Gidley (Liberal Democrat, Romsey)

I beg to move amendment No. 168, in clause 132, page 86, line 41, after ‘the’, insert ‘annual’.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss the following amendments: No. 169, in clause 132, page 86, line 41, leave out ‘junior’ and insert ‘primary’.

No. 170, in clause 132, page 87, line 3, after ‘the’, insert ‘annual’.

No. 171, in clause 132, page 87, line 3, leave out ‘junior’ and insert ‘primary’.

No. 176, in clause 132, page 87, line 32, at end insert—

‘(1A) Information authorised in accordance with sub-paragraph (1)(c) shall include information relating to a child’s body mass index.’.

No. 172, in clause 133, page 88, line 7, after ‘the’, insert ‘annual’.

No. 173, in clause 133, page 88, line 7, leave out ‘junior’ and insert ‘primary’.

No. 174, in clause 133, page 88, line 11, after ‘the’, insert ‘annual’.

No. 175, in clause 133, page 88, line 11, leave out ‘junior’ and insert ‘primary’.

No. 177, in clause 133, page 88, line 40, at end insert—

‘(1A) Information authorised in accordance with sub-paragraph (1)(c) shall include information relating to a child’s body mass index.’.

Sandra Gidley (Liberal Democrat, Romsey)

This is a timely debate, given that we had the paper on obesity yesterday. The obesity problem could be tackled in part by keeping a closer eye on schools, so that children who were developing patterns of obesity could be identified at an early stage and appropriate action could be taken, whether that involved educating the parents or whatever.

Currently, as a function of the national child measurement programme, children have their height and weight measured in reception and in year 6. The Bill appears to give the Secretary of State the power to increase the frequency of those measurements, but the Minister is not being bold enough, so these amendments are an attempt to provide something more meaningful.

Amendment Nos. 168, 170, 172 and 174 would provide for annual measurements of weight, so that weight could be tracked. I have also tabled amendments that would change the designation of junior school to primary school, so that the clause covered all children between 4 and 11 years old.

We also tabled amendment Nos. 176 and 177, which would specify that the information that is provided to parents includes

“information relating to a child’s body mass index”.

That is important because height and weight in themselves are not accurate enough measurements. They give a picture, but some children have growth spurts, for example, and any problem would be less easy to identify. The American Academy of Pediatrics has placed frequent measurement as its first priority in the identification and management of obesity. The academy’s research stressed to every doctor the importance of a yearly assessment for children. If body mass index were tracked from year to year, it would be easier to identify any early deviation from the normal, expected growth curve.

Body mass index is not something that most people can calculate off the top of their heads, but there are easy sliding scales and mini calculators, so it can be done at the touch of a button or the turn of a dial. Once a school nurse, say, has the height and weight measurement, it would be easy for them to provide the extra information. People could plot the information on hand-held growth charts so that they had a history over time. A one off measurement of height, weight or BMI is, in fact, fairly useless—all one can do by measuring that trend is to get an overall picture of whether 11-year-olds are getting larger and fatter. That may help to provide national statistics, but we are trying to produce something that will help to identify children who are at risk so that appropriate action can be taken.

I hope that the Minister will look kindly on the amendments. He has not looked kindly on any amendment so far, but I live in hope—I am eternally optimistic. I do not think that we should get too bogged down in whether people understand the concept of BMI; it is a fairly simple idea and can be explained to people. They do not need to know the calculation or anything else, but it is important that they are able to track the trends. My children are too old to benefit from such a measure now, but perhaps I will be a grandmother one day, and I would like to think that someone would keep an eye on my grandchildren.

Anne Milton (Conservative, Guildford)

I congratulate the hon. Lady on finally using the word “fat”—it is not used very often these days. My issue with the word is that “fat” is something for which a person might feel that they have responsibility, whereas they might think that “obesity” simply happens to them. I feel like a victim because of the extra stone and a half that I carry, but if I thought about it as “fatness”, I might take more personal responsibility for getting rid of it.

I appreciate the hon. Lady’s sentiments. I do not know about the use of the words “junior” or “primary”, but I dare say that there is a legal definition. We could use numbers or simply a term such as 9 to 10-year-olds. I do not believe that inserting the word “annual” would be terribly useful because, in fact, it might be useful to weigh and measure people monthly. There needs to be quite a lot of leeway for those who would be involved in the programme.

Sandra Gidley (Liberal Democrat, Romsey)

I intervene to clarify the use of the word “annual”. It would ensure an annual weight check for everybody—for all children. I fully accept that there may be a need for more frequent measurements in some individual cases, but specifying a more frequent measurement would be over-prescriptive on the health service.

Anne Milton (Conservative, Guildford)

I thank the hon. Lady for her intervention. I will not prolong the discussion but I look forward to a stand part debate on the matter. There is much more to be said about the weighing and measuring of children.

Ben Bradshaw (Labour, Exeter)

Amendments Nos. 168, 170, 172 and 174 make explicit provision for weighing and measuring to be carried out annually. In England, the National Child Measurement Programme is currently run on an annual basis, with children in the reception year and year six being weighed and measured at any time during the school year. I am happy to confirm that we have every intention of continuing to collect that data annually. However, we do not think that the frequency of the programme needs to be specified in the Bill, indeed, that could cause potential confusion as existing guidance already asks primary care trusts to weigh and measure the children in reception and year six each year. PCTs are able to carry out that task over the course of the school year, which allows for the local health care professionals involved to be used most effectively, spreading their duties over the year and visiting schools at the time that best fits in with school activities and causes least disruption.

Sandra Gidley (Liberal Democrat, Romsey)

I am not sure why that would cause confusion. The Minister mentions a scheme in which, at some stage during the school year, children in reception and year six are measured. This measure is an entirely different proposition and suggests that each year all children will be measured. It is not so that they can be measured at any random time, the aim is to provide an annual health check for each child in Britain.

Ben Bradshaw (Labour, Exeter)

I beg the hon. Lady’s pardon, I misunderstood. I have explained why we believe the amendment to be flawed, but I misunderstood her reasons for tabling it. We do not take the view that it is justified or proportionate to measure every child every year. Measurements from these two different years will give us a pretty comprehensive database without imposing disproportionate burdens either on PCTs or schools.

Sandra Gidley (Liberal Democrat, Romsey)

It would be interesting to know if the Minister has any data so far. The scheme has only been going for four or five years, so he may not have any, but we do not yet know how far adrift children have been allowed to go in six years. It is a considerable period of time during which a child may have picked up bad eating habits. Yesterday we discussed how children do not always get the best food at home and how lunch boxes are not always healthy. Despite efforts being made with school meals and cooking, a lot of damage could have been done during that time. It is not about recording data, it is about identifying early problems.

Ben Bradshaw (Labour, Exeter)

That implies that the only way of identifying those problems is through weighing and measuring. As the hon. Lady knows, there are a range of measures taken by schools and by doctors and nurses so that they are able to intervene in this. Our advice suggests very strongly that, as things stand, annual weighing and measuring would not be justified in terms of the benefits compared to the costs.

Amendments Nos. 169, 173 and 175 would make the scope of the provisions in clauses 132 and 133 apply to primary pupils instead of junior pupils. There is a technical reason why we have used “junior”. It goes back to the Education Act 1996, where

“junior pupil” means a child who has not attained the age of 12”.

Primary pupil, however, is not defined, and unless accompanied by a suitable description, the amendment would use a term in statute without a clear definition. The main difficulty with that approach is that it risks excluding those children aged 10 or 11 who attend middle schools rather than primary schools.

On amendments Nos. 176 and 177 on the body mass index, as the hon. Lady will appreciate from the letter I sent her at the end of November last year, we have not ruled out providing parents with their child’s BMI but we believe that further work is required before we can be certain exactly what should be prescribed. That will be debated again when we come to discuss the regulations. An important reason why we may decide not to include BMI information is that recent research suggests a lack of understanding about it. We need to be sure that the information we provide is in a form that can be most readily understood and used by parents. Research commissioned as recently as 2007, from the British Market Research Bureau, on parental attitudes to the current weighing and measuring programme in England suggests that most parents do not understand BMI. Some parents said that they had never even heard the term used before and others, who had heard the term, said that they did not understand what it meant.

Angela Browning (Conservative, Tiverton and Honiton)

While the debate has focused on weight gain, in terms of a child’s health, I wonder what thought the Minister has given to girls approaching puberty. We know that increasingly, some of them suffer from anorexia and bulimia at quite a young age and the idea that suddenly their parents are going to start encouraging them, as a result of a statistic, to dramatically lose weight would give me some cause for concern. Although in terms of children’s health weight gain is a problem, so too is the increasing problem of how we handle young girls who become much more fashion conscious, even at primary school level, and for whom getting the balance right in how that information is given will need to be sensitively handled.

Ben Bradshaw (Labour, Exeter)

The hon. Lady is absolutely right. Sometimes we are better to talk about a healthy weight, because she is right to point to the problems of anorexia among teenage girls in particular, at a slightly later stage than the one we are discussing now. We agree that we need to move away, over time, from focusing solely on obesity to focusing on a healthy weight and healthy lives.

Angela Browning (Conservative, Tiverton and Honiton)

May I say to the hon. Gentleman, I do not think that we must assume that this is a problem just in the teenage years? Increasingly, it is younger and I know of many nine, 10 and 11-year-olds who are fans of the Sugababes and others, who are now fashion conscious even at primary school level, and for whom the argument would apply.

Ben Bradshaw (Labour, Exeter)

Yes, indeed and as part of the national child measurement programme we will advise school nurses or other health professionals who are concerned about a child’s health or weight that whether the child is overweight or underweight, they should take action accordingly through the local care and support that is available.

As I was saying, one of the reasons why we think that BMI may not be the appropriate way to give information to parents is that they do not understand it. Another reason is that as a single measurement, it may not as accurate in young children as it is in adults and I am advised that there are a number of reasons for that. Unlike adults, children are still growing and therefore one single measurement may be skewed by a particular growth phase, in particular BMI may vary with puberty. Secondly, evidence linking children’s BMI to health outcomes is not as strong or well established as it is for adults. We will be consulting parents, professional groups and other relevant organisations over the next few months, to develop the best system and format for providing children’s results to their parents. That will include determining what level of detail parents would find most helpful. In due course, we will consult further on the regulations around this measure, so all who have a view will be able to contribute to that debate. I have already sent the draft of the regulations to the Committee. I hope that in the light of those assurances, the hon. Member for Romsey will feel able to withdraw her amendments.

Sandra Gidley (Liberal Democrat, Romsey)

I listened with interest and disappointment to the Minister’s remarks. To return to the point about BMI, it is slightly different in children but I think that the Minister was being uncharacteristically feeble when he said that parents do not understand it—whatever happened to education? We do not have to call it a body mass index, we can call it something else, such as a healthy weight index, but it is a cop out to say, “Oh, this looks a bit difficult, we won’t do it this way” if it does prove to be the most effective measurement.

Anne Milton (Conservative, Guildford)

Moving away from BMI, has the hon. Lady considered the use of centile charts, which can be terribly useful and slightly less complicated to use? What does she feel about those?

Sandra Gidley (Liberal Democrat, Romsey)

Yes, I have considered the use of centile charts and, having been reduced to a nervous wreck by a health visitor because my child was at the bottom of the curve, am not terribly enthusiastic about them. The BMI gets round some of those problems. I was interested to hear what the hon. Member for Tiverton and Honiton said because I have a naturally-skinny daughter who has always been slim, although she ate like a horse and has a healthy body image. She was constantly being asked by school nurses if she felt that she looked fat. Clearly, they thought that she was potentially underweight. If that had been tracked for a longer period, they would have realised that that was just her and that some people fall at the extremes of those measurements quite naturally.

An obsession with weight can be unhelpful for a fit and muscly child who will always be at the top of the scale, and it is a difficult one to judge. However, annual weighing would help to pick up early signs of decreasing BMI, which can also give cause for concern. Obviously, that would be treated in a different way. I shall turn my attention to the regulations and beg to ask leave to withdraw the amendment.

Anne Milton (Conservative, Guildford)

I could not help but notice the Minister’s eyes go up to heaven when I mentioned the possibility of a stand part debate. We started this morning’s sitting with everyone feeling a little tetchy, but I think that the mood of the Committee has improved. I would hate to see the Minister’s emotional state regress as a result of a stand part debate because this is important.

Obesity is probably one of the most important public health issues that we face. I understand that we are the first generation of adults whose children are likely to have a lower life expectancy than us. In this century, it is absolutely appalling to think that what we are doing will shorten our children’s lives.

I have a few issues that I would like to raise. I am not entirely sure why there has to be legislation on this matter. I saw the regulations and would like to thank the Minister because, although they are neither lengthy nor exhaustive, they give some idea of the thinking on that. They state:

“An important effect of the Regulations is to protect the position of the young children participating in the NCMP in compliance with the European Convention on Human Rights and data protection legislation.”

I assume, therefore, that that has to be placed in legislation simply to allow the PCTs to relay the information to the parents, but I would like the Minister’s clarification because at the moment that is already ongoing. I have had contact with all the strategic health authorities, which are all advancing well towards meeting their targets for that programme.

One of the issues that we should start with is just how fat we all are, and the figures are absolutely dreadful. The Department of Health’s website advises that the proportion of children in England aged two to 10 who were overweight or obese in 2005 was 31 per cent., compared to 22.7 per cent. in 1995. The proportion of children who are overweight increased from 12.8 per cent over that period to 14.2 per cent, while the proportion of obese children rose from 9.9 per cent. to 16.8 per cent. over the same period. In 2005, the prevalence of obesity for boys and girls aged two to 10 was similar: for boys, obesity rose from 9.6 per cent. in 1995 to 16.9 per cent. in 2005, while for girls, obesity rose from 10.3 per cent. to 16.8 per cent.

I also have some figures from Yorkshire and Humber. In fact, I congratulate the strategic health authority there on giving me such a detailed breakdown of what is going on. This will distress my hon. Friend the Member for Tiverton and Honiton, but it suggests that young people in the region eat only half the recommended portion of fruit and vegetables. It is projected that 33 per cent. of boys and 30 per cent. of girls will be overweight by 2010.

The figures for those aged 11 to 15 are even more stark. The projected level for boys is 33 per cent., and the projected level for girls is the highest in England. Some 28 per cent. of girls are projected to be obese, with a further 16 per cent. being overweight by 2010, which means that almost half the children in that region aged between 11 to 15 will be obese. That is truly shocking.

My hon. Friend raised the issue of anorexia. It is important to note that the flipside to obesity is anorexia. She is right to say that the issue affects younger and younger children. Sadly, though, that issue and the issue of obesity cannot be addressed simply by weighing and measuring them.

Stephen O'Brien (Conservative, Eddisbury)

I would like to reinforce the points made by my hon. Friends the Members for Guildford and for Tiverton and Honiton. Because of the increased evidence of obesity and anorexia appearing at a much younger age, the clues that one gets for the trend starting are that much smaller. The sooner that the trend lines can be picked up, the sooner one can get the evidence, which will lead to better health advice and hopefully to a better outcome. That is another reason for saying the younger the better when it comes to applying this measure.

Anne Milton (Conservative, Guildford)

My hon. Friend raises a crucial point. It is all about picking up the trend. Early intervention is important for children suffering from anorexia and bulimia. It is not nutritional advice that such children need but psychological help. Looking at the figures on what is being spent on obesity drugs, one can see that they are now the fastest growing item being prescribed. Prescriptions for obesity drugs increased 28 per cent. with a total cost of nearly £50 million. I know that the Government are keen to address the drugs budget. In some ways it is a shame that we are having to treat such conditions with drugs because we have not acted at an earlier stage and tried to treat the condition with a lifestyle change.

The burden of the proposed measure will largely fall on school nurses from primary care trusts. The nurses will oversee the weighing and measuring. Schools will be asked to provide the PCT staff with a list of children to be weighed and measured and to inform the PCT if the parents have chosen to opt out of the programme. Information about individual children’s weights or heights will not automatically be given to parents, although they may request the child’s information. The records of children’s heights and weights will be anonymised and the data used in the NHS for the analysis of trends in obesity and overweight and underweight children.

I have to flag up to the Minister the concern that exists in my own constituency and across the country as a whole about the need for security of this data. We had quite a lot of discussion yesterday about obesity following the Secretary of State’s statement. I appreciate that this measure is only one aspect of the Government’s programme to tackle obesity. Again, if anyone wants to get to sleep tonight and is failing to do so, the current arrangements are described at length on the Department of Health’s website. Such reading is a guaranteed cure for insomnia. The Department of Health has issued a leaflet for parents called “Why your child’s weight matters”. It is probably an indication of the state of affairs that we have got to, that we have to say that.

There is guidance for PCTs and arrangements for measuring. Some of the regulations are highly specific about what machines are used and so on, which is important. If we are going to lump the data together, we need to ensure that data sets mean something. As I said, the guidance also sets out the legal basis for the current programme, the responsibilities of PCTs, the role of schools and local authorities, the schools covered, and lists of data collected and how they are stored and used. Separate guidance will also be issued for schools. That is a considerable burden on schools and PCTs.

There is concern about school nurses. The Royal College of Nursing—I declare an interest in that I am a member—supports the proposals that help school nurses to share information with parents on the well-being of their children. It sees it as a positive step that PCTs and the Government will work together to ensure that every child has access to a school nurse by making the adequate resources available. However, it is concerned that progress to achieve the Government’s target of one qualified school nurse in every secondary school and its cluster primary schools is slow, with evidence indicating that many school nursing teams have been adversely affected by the impact of NHS deficits, which I mentioned earlier.

The 2006 joint report by the National Audit Office, the Healthcare Commission and the Audit Commission entitled “Tackling Child Obesity—First Steps” indicated that head teachers reported that their ability to tackle health issues, such as obesity, was seriously inhibited by the lack of access to health professionals within schools and other educational settings. I am sure that I am not alone in saying that schools are increasingly worried about the burdens and responsibilities place on them for looking after an aspect of a child’s growth and development that they do not feel is their responsibility and that, in many cases, they do not feel well equipped to deal with. The presence of school nurses, therefore, will be crucial to the success of the programme.

The other point I want to raise relates to what we do with the information. In the light of some of the responses from strategic health authorities around the country, my concern is that it will be yet another box-ticking exercise. Their letters had an air suggesting that what mattered was that they reach the target for weighing and measuring children, and that was it—their job was done. But, of course, that is only a way of benchmarking health improvements put in place afterwards. What is crucial is the follow-on that we are able to provide and the resources.

Stephen O'Brien (Conservative, Eddisbury)

I am sure that the Minister would be the first to accept that the weighing and measuring of children is important in public health. In any village in any developing country, the first thing that one sees is a sling on which babies are weighed. It is the first means of establishing, in those cases, the presence of malnutrition, and in general the state of young people’s health. That applies quite a long way up the age scale.

We ought to learn from the public health agendas of such developing countries, because we are in grave danger of losing out as a result of our more sophisticated approach to health care provision. We should issue the mother with a little booklet recalling over time all the weights and heights of her children—most of us of a slightly older generation will have experienced that. That would be a very powerful tool, because that information would be owned by the mother, which is more important than the broad statistical measurements in SHA or PCT measuring units. That is one way in which we could use such information. It would give the mother ownership of the health of her child.

Anne Milton (Conservative, Guildford)

My hon. Friend raises a very important point about ownership. I opened by talking about fatness and obesity, with one being something that happens to me and one being for which I am responsible. That endorses his point. The ownership by parents of their children’s health is extremely important. I must raise again the issue of hard-to-reach groups. Parents can withdraw their children from the programme, and I dare say that the child could withdraw themself. Even if a parent gives permission for their child to be weighed and measured, if the child on the day refuses, the school or school nurses could not insist otherwise. My concern is that the fat kids will withdraw.

Often, particularly with very obese children, there are huge issues about self-esteem. We have talked about anorexia and bulimia, and in relation to severe obesity there are many similar psychological overlays making children fat. This has a great deal to do with self-esteem. It is important that when we introduce the programme there is a safety net to pick up the children at that stage and to give them counselling, because there are other problems in their life. It gives us an opportunity to deal with those children and their psychological problems at a very early stage. Withdrawal from the programme is in itself an indicator that there are other problems.

Obviously, we would support anything that could be done to tackle the problems with obesity. If you will indulge me for a minute, Mr. Conway, I will return to the health in pregnancy grant and say that this issue starts with maternal health, foetal health and having enough midwives to support and encourage breastfeeding. In this day and age, women are not in hospital long enough to establish breastfeeding, and the problem starts from that point and goes right the way through. The work is quite resource-intensive; it costs quite a lot of money. However, if we really believe in joined-up government and want to make a difference, we have to see that investment up front in the areas that I have described will save—if we want to consider this purely in financial terms—a great deal of money in the long term, because we will prevent at an early stage all the diseases associated with being both underweight and overweight.

I think that the Minister finds these clause stand part debates slightly tedious, but the issue is important. He is shaking his head to show that he enjoys every minute of them, but he did not feel happy to respond to the points raised on the health in maternity grant. I hope that he will address some of these matters. The problem concerns us all, and the Government can make a difference if they apply themselves not to the headline figures or to the figures on children’s weight going down, but so that we see children at a more healthy weight, eating more healthily and living more healthy lifestyles to prevent the implications for the health service that we are storing up for the future.

Derek Conway (Conservative, Old Bexley and Sidcup)

I cannot imagine why Mr. Hood and I were appointed to chair this Committee.

Ben Bradshaw (Labour, Exeter)

May I put it on the record that there is nothing tedious at all about clause stand part debates? What I always try to avoid is repetition —particularly when I am given direction by the Chairman, who has asked specifically for brief contributions because many of the arguments have been explored and illustrated in debates on the amendments. I think that most members of the Committee find that tiresome and it is exactly what I was trying to avoid earlier. However, the hon. Lady has made some very important and new points and I will endeavour to respond to them to the best of my ability.

The hon. Lady asked first the most fundamental question: why is the legislation necessary? There are three reasons why we need to legislate. First, we need to give a legal basis to the existing programme. Secondly, we need to allow feedback to parents. She will be aware that at the moment people have to opt in to obtain the feedback, whereas this provision will mean that people have to opt out. We hope that it will mean that more parents receive the feedback. Thirdly, we need to legislate to allow the data to be used for performance management for local primary care trusts on their obesity strategies.

The hon. Lady has said, and I acknowledge, that this provision is a small part of our overall strategy against obesity, which was launched, and very well received, yesterday. I do not intend to broaden the debate out to that in general, because we are talking about a specific programme of weighing and measuring of children. She may not have mentioned it, but it is worth putting it on the record that another reason why we are legislating is that two Select Committees—the Health Committee and the Public Accounts Committee—specifically recommended that we did so.

As the hon. Lady will know, our target for 2006-07 is 80 per cent. coverage—that is the percentage of eligible children weighed and measured. We are confident that improvements to the programme will have resulted in much greater coverage and that there will be a vast improvement on the 48 per cent. participation that we achieved in the first year, 2005-06. We do not have those figures yet for 2006-07, but the hon. Lady might like to table a parliamentary question every few weeks and as soon as I can I will put them in the public domain. She is right to point out that the child would have the freedom to refuse. I do not think many people would suggest that we should force children, particularly given the self-esteem issues and the sensitivity that she rightly described, but we have developed a DVD and a flyer for children about the programme to help to reduce any concerns that they might have about participating.

PCTs will upload the data electronically to the national child management database, which will be developed and maintained by the Information Centre for Health and Social Care. The centre will not have access to child-identifiable data. When the data is uploaded to the database, it will be anonymised by removing or converting all identifiable data, including the name of the child; the postcode will be converted to lower super-output area, whatever that means; and the date of birth will be converted to age and month. Although the information centre will not have access to any patient-identifiable information, there are robust information security measures in place to ensure that the data is held and accessed securely.

Individual children’s results will not be shared with school staff or other pupils, and suppression and disclosure controls will be implemented when the data is set and publication released. That means that when the data is published, small numbers that could allow individual children to be identified will be suppressed. For example—someone must know what this means—at super-output area level, or even at PCT level, if numbers between one and five appears in any data cell, that number will be replaced by an X; so will any corresponding total relating to that number.

Clause 134

Greg Mulholland (Liberal Democrat, Leeds North West)

I beg to move amendment No. 125, in clause 134, page 89, line 32, leave out ‘consider’ and insert ‘have determined’.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss amendment No. 126, in clause 134, page 89, line 38, at end insert—

‘(1D) In determining the suitability of a person under subsection (1C) the responsible authority shall undertake such investigations into the making of direct payments as the Secretary of State shall by regulation define.’.

Greg Mulholland (Liberal Democrat, Leeds North West)

I warmly welcome clause 134 as a whole, as it extends direct payments to include people who lack capacity. We strongly agree with the choice and flexibility that it will give the system. It is an important and possibly overlooked part of the Bill. The Minister will also be aware that the provision has been welcomed by many of the relevant organisations, including Age Concern, Carers UK, the Parkinson’s Disease Society, the Local Government Association and the Commission for Social Care Inspection. However, some organisations have expressed the concern that although it is excellent in principle, and that it is right in practice, they want to be reassured that adequate support is offered for the service user and the carer—and the nominated representative or agent.

The amendments are about creating safeguards to ensure that there is sufficient protection for recipients of direct payments. Together, they would mean that a designated person must be determined by investigations to be undertaken by the responsible local authority. They would bring in arrangements that would allow direct payments to be made to the agents of someone lacking capacity, interlined with current good practice as established under the Mental Health Act 2007, in order to determine who is or is not suitable to act as agent.

The amendments would place a clear duty on local authorities to make such checks when agreeing to make payments to an agent or nominated person. The suggestion is simply that such checks would be prudent to ensure the safety of vulnerable people who lack capacity. The amendments would also ensure that public funds were appropriately spent and not passed on to anyone with an unsuitable financial background, which would make such payments a matter of concern. It might be that the Minister can assure the Committee that the amendments are not necessary, but I am sure that he agrees that the sentiment is a sensible one. I look forward to his comments.

Anne Milton (Conservative, Guildford)

I do not want to add much, except to welcome this move with direct payments. I would just like to caution the Minister again that I might want to say something briefly in the clause stand part debate—he did not raise his eyes, but he looked a bit tense for a second. I will be very brief.

The issue of the proper person can fall two ways. I was involved with a case in which an over-zealous social services department was utterly convinced that the guardian of an elderly lady was abusing his position. It took more than five years to resolve the matter. This issue is very difficult, and it arises in child protection and any case when responsibility has been given to a third party to look after somebody. We need to ensure that there are safeguards in place in both directions: to protect the vulnerable person; and to protect genuine carers from over-zealous social services departments.

Brian Jenkins (Labour, Tamworth)

I ask the Minister for clarification. If a person is regularly taken into day care on a regular basis, a local authority may provide direct payments. Some local authorities, I understand, will give a direct payment for the individual, but then refuse to allow them to go into public authority day care so that they must buy that provision in the public sector. Is the Minister’s intention to clarify that if a place is provided by a public authority, the people with the direct payments should have the opportunity to purchase that requirement from that authority?

Ben Bradshaw (Labour, Exeter)

I reassure the hon. Member for Leeds, North-West, who tabled the amendment, that we all agree that we should take steps to reduce the likelihood that a suitable person may mismanage a direct payment or abuse their position of trust. Anyone who cares for a person who lacks capacity under the Mental Capacity Act 2005 and wilfully neglects or ill-treats that person can be found guilty of a criminal offence that is punishable by up to five years in prison, a fine, or both.

I do not think that the amendments are necessary because the safeguards that they would introduce are already present under new subsection (1A) and amended subsection (3). Direct payments will be made under the new scheme through a multi-step process. If someone is considered to be a suitable person who could potentially manage a direct payment on behalf of somebody else, that does not automatically mean that the direct payment will be made to them.

We have taken the powers in new subsection (1A) and amended subsection (3) to enable regulations to be made that impose conditions that must be met before the responsible authority decides to make the payments. Only if certain steps have been taken, or conditions have been satisfied, can payments be made to a suitable person. An example of a condition that we envisage being in the regulations is the requirement that the local authority must, when appropriate, consult family members or friends already involved in the care of the person who lacks capacity before deciding to make a direct payment to a suitable person. Furthermore, regulations may specify that if the suitable person is not a family member or a friend of the person lacking capacity, local authorities may be required to carry out vetting and a barring check under the Safeguarding Vulnerable Groups Act 2006 before making the direct payment.

I should perhaps add that the draft regulations on these matters will be subject to full consultation with local authorities, the Office of the Public Guardian and other interested stakeholders. In the light of those comments, I hope that the hon. Gentleman will feel able to withdraw the amendment.

In response to the question from my hon. Friend the Member for Tamworth about whether direct payments can be received even though somebody has been assessed as eligible for continuing care funding, my understanding is that it is not currently possible for somebody in receipt of continuing care funding to receive a direct payment as well.

Greg Mulholland (Liberal Democrat, Leeds North West)

I appreciate the Minister’s full explanation of the regulations, and I beg to ask leave to withdraw the amendment.

Anne Milton (Conservative, Guildford)

I want to raise the question of what direct payments buy, and I have some figures from an article that appeared in one of the papers. We have already talked about our welcome for direct payments, and there is no doubt that empowering people and having them feel in control of the services that they receive is useful for not only the individual concerned, but service providers. However, the effect of individuals’ purchasing power can be quite profound, and the help that people will be buying will be in the form of a personal assistant or a home carer. It is very important that these changes do not have unintended consequences. The job of being a personal assistant or home carer must be kept viably attractive.

The danger is that cost cutting is turning the personal assistant or home carer role into that of a poorly paid dogsbody, and a job that not enough people are willing to do. We have seen this in the tourism industry. For some reason, we have a dislike of unskilled labour in service industries in this country. I do not remember the precise figures, but in central London there is unemployment of about 8 per cent. We are importing labour from eastern Europe and British people will not work in service industries here because it seems demeaning.

These direct payments must be sufficient to employ people of a sufficient calibre to give the care. The danger, particularly in any sort of work that involves going into people’s homes, is that if the status of that work is not high, not enough people are recruited and we get second-class care. While it is important that people are empowered and feel that they have ownership of the care that they receive, we do not want them to feel that they can receive only the very worst possible care that is available.

Clause 136

Anne Milton (Conservative, Guildford)

I beg to move amendment No. 73, in clause 136, page 92, line 30, leave out ‘or by the Welsh Ministers’.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss amendment No. 74, in clause 136, page 92, line31, leave out ‘and the Welsh Ministers’.

Anne Milton (Conservative, Guildford)

We rehearsed the Welsh issue earlier in our proceedings and I will be happy to withdraw this probing amendment. As a Surrey MP, I am not as familiar with the problems of cross-border and devolved issues as many hon. Members, including my hon. Friend the Member for Eddisbury. I do, however, think that we need absolute clarity about who is responsible for what and whom. We have had a heated exchange at times, but I hope that the Minister will take on board the comments that have been made by my Welsh colleague, my hon. Friend the Member for Preseli Pembrokeshire. Sometimes the lack of clarity in legislation and from Government—and the lack of clarity from Ministers and Welsh Ministers—leaves Members of Parliament and, more importantly, their constituents, in an awful vacuum between the two.

Ben Bradshaw (Labour, Exeter)

At present there is no one person with legal responsibility for determining cross-border disputes on ordinary residence between English and Welsh local authorities. Clause 136(2) remedies that defect and allows for a proper mechanism to be put in place for resolving such disputes. The amendment would remove entirely the Welsh Minister’s power to resolve disputes, thus creating a situation in which the Secretary of State for Health would be solely responsible for making ordinary residence determinations between English authorities, Welsh authorities and English-Welsh authorities. I hope that the hon. Lady will accept that that is not a workable option.

Stephen O'Brien (Conservative, Eddisbury)

I want to record how welcome that is to someone who contends almost weekly with contentious cross-border disputes in which people do not feel that they are getting a fair entitlement when they cannot get the same provision in England that is available 200 yards across the River Dee in Wales. People often cross the river to try to play the system. We need to avoid effectively gaming with our public services as a result of constitutional arrangements. Therefore, I welcome the amendment, which I think is important.

I make a general plea that perhaps could be transmitted up through the Government into policy making. If the system is to really work, my constituents, just as much as those of my next door neighbour, the hon. Member for Wrexham (Ian Lucas), for example, need to know that their Member has access to a Minister in this place who can be held to account through questioning, rather than simply having a mechanism to go through. Ultimately, my constituents’ power to make something happen lies in them coming to me so that I can rattle the cage and open the door, as we do for all our constituents.

Anne Milton (Conservative, Guildford)

I beg to ask leave to withdraw the amendment.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss the following new clause 18—Continuity of social care support

‘(1) This section applies where—

(a) an English or Welsh local authority (the original authority) has made a determination of need for care services in respect of a person ordinarily resident in its area under any of the social care enactments and—

(i) has arranged or is providing such services or

(ii) is making payments to such a person in lieu of care services under section 57 of the Health and Social Care Act 2001 (c. 15) or section 17A of the Children Act 1989 (c. 41); and

(b) the person concerned becomes or intends to become ordinarily resident in a different local authority (the new authority).

(2) It shall be the duty of the original authority to—

(a) give notice to the new authority if it becomes aware that a person to whom it provides care services or direct payments intends to become ordinarily resident in the new authority’s area; and

(b) co-operate with the new authority in making appropriate arrangements for such a person.

(3) It shall be the duty of the new authority to provide the person concerned with—

(a) services of an equivalent type and quantity to those provided by the original authority or

(b) direct payments enabling an equivalent type and quantity of support to that provided by the original authority,

for such transitional period as may be prescribed.

(4) All arrangements made under subsections (2) and (3) are to be made with the involvement and consent of the person concerned and must include effective arrangements to meet any new or different needs of the person concerned.

(5) For the purposes of this section “social care enactments” includes—

(i) Section 2 of the Chronically Sick and Disabled Persons Act 1970 (c. 44).

(ii) Section 4 of the Disabled Persons (Services, Consultation and Representation) Act 1986 (c. 33).

(iii) Section 17 of the Children Act 1989 (c. 41).

(iv) Section 47 of the National Health Service and Community Care Act 1990 (c. 19).

Greg Mulholland (Liberal Democrat, Leeds North West)

I do not want to delay the Committee, particularly for selfish reasons, as I wish to get back to put my two-year-old little girl, Isabel, to bed.

I would like to give a brief explanation of the new clause. It would address concern relating to people moving house or care home between local authority areas, and designate the responsibilities of both the original authority and the new one. The aim is to resolve any problems that might arise from the patient moving so that care may continue uninterrupted. The practical reasons are that local authorities might have different standards and practices of care. People are concerned that they might have to start the assessment process again, which could have cost implications. They are also, crucially, concerned that there could be a delay in receiving care in their new local authority, and, fundamentally, that the level and quality of care may fall. I hope that the Minister can assure the Committee that that is not the case and that the new clause is not necessary, and that he appreciates that this is a sensible, practical point.

Anne Milton (Conservative, Guildford)

The hon. Gentleman raises an important point.

I will go back to the subject of over-zealous social services departments and problems relating to where people reside. I will give as an example an adult, perhaps with learning difficulties, who has been looked after by his parents, but who moves to another area because it is thought that he is able to manage on his own. For argument’s sake, let us say that he builds up social networks and lives there happily for ten years, but his situation then deteriorates and he needs care. He could find himself wrenched away from the area that he knows, has social contacts in, and has become used to, and having to return to where his parents live, but where he has not lived for ten years. I do not know whether the new clause is necessary, but I would like the Minister to take on board the fact that the problem often arises because people get caught up in the crossfire of no one wanting to pay. That is what this comes down to.

Social services departments under pressure spend a huge amount of time and energy avoiding paying for things, but if they directed that attention and energy into just looking after people, they might save more than they are being required to spend on people’s care. It can be trying to watch, and extraordinarily stressful for the people involved.

Ben Bradshaw (Labour, Exeter)

The hon. Lady and the hon. Member for Leeds, North-West make some important points, but I hope to reassure them that the new clause is not necessary. Local authorities already have a duty to work together to make appropriate services available to people who move from one local authority to another and to co-operate with each other in the process. The statutory guidance that we issue also requires co-operation when people are placed by one authority into accommodation in another authority area.

New clause 18 seeks to impose a duty on the new local authority to provide

“services of an equivalent type and quantity to those provided by the original authority”.

Given the example that the hon. Lady just gave, it would remove any flexibility from the relevant authorities and would assume that the needs of the individual have not changed since the original authority’s assessment. In order to allocate funds appropriately, it is essential that local authorities have responsibility to decide their eligibility criteria and to carry out an assessment of individual needs, circumstances and preferences. In the light of those comments, I hope that the hon. Gentleman will not press the new clause, and will get home in time to put his two-year-old to bed.

Derek Conway (Conservative, Old Bexley and Sidcup)

To enable me to get my breath, Mrs. Milton will move amendment No. 75.

Clause 145

Anne Milton (Conservative, Guildford)

I beg to move amendment No. 75, in clause 145, page 96, line 23, leave out ‘seek to’ and insert ‘make efforts to’.

I am glad that I serve some purpose to the Chairman, if nothing more than to enable him to draw breath. We should all be disappointed if you did not have opportunities to do so, Mr. Conway.

This is a pedantic little amendment, but I make no apology for being a pedant. The Minister says that all will be well because local authorities have a duty to work together, but things are not always so simple; sometimes words matter. The amendment would replace “seek to improve” with “make efforts to”. I am not a lawyer, like my hon. Friend the Member for Eddisbury, and so am not so familiar with legislation, but I think that wording makes a difference. I should like there to be more emphasis on the board improving

“the practice followed by relevant bodies in relation to the processing of relevant information.”

If the Minister shares my pedantry, perhaps he will agree to the amendment. I do not think that he has agreed to any amendments during this Committee. The change we propose is a small one, and we certainly would not throw it in his face if he agreed to it. We would keep it a secret and not tell a soul.

Stephen O'Brien (Conservative, Eddisbury)

My hon. Friend’s amendment is more important than she thinks. Without being too legalistic, as opposed to pedantic, I think that the point of moving from “seek to” to “make efforts to” is that her form would have something against which one would hope to be able to show that efforts have been made and therefore possibly have something to hold to account.

Anne Milton (Conservative, Guildford)

I thank my hon. Friend, who reinforces my belief that it is important for this place to contain a variety of talents, such as his legal expertise. He is right; it is important that organisations created in legislation can be held to account for their actions. The words “make efforts to” would make a small difference to that.

Ben Bradshaw (Labour, Exeter)

Although we have not accepted any amendments, I have indicated in at least two cases that we intend to address the concerns raised at a later stage. I am not trying to be difficult, but we simply do not think that the amendment would add anything.

I am pleased that the Conservatives agree with our plans to establish a national information governance board for health and social care. We believe that the vigour with which the board will approach its functions will be down to the drive and enthusiasm of its chair, members and officers, rather than the nuance of the words in the Bill. Although I cannot accept the amendment, I reassure the hon. Lady that we shall do all we can to find a chair, members and officers who are passionate about information governance practice and capable of delivering the aims that we all share.

Anne Milton (Conservative, Guildford)

I thank the Minister. Of course I am disappointed that he did not feel our amendment would add anything to the Bill, but I thank him for considering some of the points that have been made previously in the Committee. I hope that he takes on board some of the comments made today—I am sure he will. I beg to ask leave to withdraw the amendment.

Clause 146

Anne Milton (Conservative, Guildford)

My only point on this clause—the same point has come up before—is that although abolishing existing bodies and establishing others often makes a great deal of sense, it is terribly important that absolute clarity of roles is established. That is particularly true in relation to matters addressed by the Health Protection Agency. I refer back to my comments about the Local Government Association not being clear about its functions in emergency situations. I reiterate that when there are measures to be used only in an emergency, such as those that the new body will deal with, it is even more important that guidance is clear and the bodies and boards involved are absolutely au fait with procedures.

Clause 150

Stephen O'Brien (Conservative, Eddisbury)

We have moved to the general part of the Bill, part 6. Our amendment No. 66 relates to this clause, and I believe that I said I may wish to press it to a Division. In my point of order in the Committee’s fourth sitting, I pointed out that we were made aware of the memorandum on delegated legislation only the day before our sittings began. The Minister kindly apologised, ascribing the error to a new Library rule. Officials have now succeeded in depositing the paper, and I am pleased to confirm that it is numbered DEP2008-0077. I am of course happy with that explanation, and I should be grateful if the Minister would continue to ensure that his Department and the Government give hon. Members plenty of time to study the Bills that they sponsor, particularly those involving complicated memoranda.

I am conscious that amendment No. 66 would mean that all regulations would need to be confirmed by the affirmative resolution. I am equally sure that I would press it to a Division only to hold the Government’s feet to the fire, as it were, as I have said on rare occasions before, so that they go away and think about the measure. Quite fairly, the Minister has just said that he promises to think about some of the issues that we have raised in amendments. Even if they were not made, they have spurred the possibility of some refinement of the Bill’s drafting, and we may well look forward to some changes on Report.

We will have to focus on that next week because, with the recess on the way, the timetable is such that we will have to table our amendments for Report in the next few days to ensure that we are ready to deal with that stage of the Bill on the first day following the recess. At least, that is what I have been informed. If that proves to be the case, we will have a busy time even in the recess.

I hope that the Minister will look carefully at our arguments. It is important, particularly with this Bill, given that we are dealing with so many entitlements and rights of people who are often in a vulnerable position, and because we are seeking positively to promote itemised and tailored individual public health issues, that we consider using the affirmative resolution procedure.

Amendment No. 260 is coming up on clause 158, so I am trying to work out in my own mind the best way to ensure that the earnestness of our intent is well recorded in the Committee proceedings.

Derek Conway (Conservative, Old Bexley and Sidcup)

Before the Minister responds, if he intends to do so, I can help the hon. Gentleman. Normally, when amendments are debated in a group, it is important that whoever moves the amendment indicates to the Chair or to the Clerks if they wish to press the amendments to a Division. Otherwise, the group is not specifically put at a later point in the proceedings. With that in mind, if the hon. Gentleman wanted to press to a Division, it would have to be on clause stand part, rather than on an amendment which the Committee has already considered. To avoid that happening with any future amendments that come up in future clauses, the hon. Gentleman or other hon. Member should indicate that they wish to press to a Division. I am sure that we could accommodate them.

Stephen O'Brien (Conservative, Eddisbury)

By way of reply, I shall be straight by saying that I cannot recall whether I flagged the fact that I wanted to reserve a position to press amendment No. 66 in clause 150 to a Division. My instinct tells me that I probably did not. However, I did reserve the right to press amendment No. 260 in clause 158 to a Division. I suspect that, for the purposes that I am driving at, I shall have to rely on that reservation.

Derek Conway (Conservative, Old Bexley and Sidcup)

The hon. Gentleman’s recollections are absolutely right, so we shall be able to accommodate him.

Clause 151

Stephen O'Brien (Conservative, Eddisbury)

The clause deals with the regulations relating to the National Assembly for Wales. I shall not press to a Division, but I wish to reinforce how important it is, when we consider how the powers are transmitted and utilised by Welsh Ministers, that the Government recognise that those of us who represent English constituencies in border areas have a grave difficulty in accessing accountability through Parliament for Welsh matters that affect our constituents. Notwithstanding the helpful discussion we had earlier, that has been a running theme and, at many times, a running sore in legislation since devolution. To a lesser degree, that applies to those who represent Welsh constituents in the Westminster Parliament in relation to English matters, such as when my neighbours are treated in a hospital in my constituency.

With those matters in mind, there is still this overhanging difficulty about the accountability through this place and giving our constituents the power to hold to account the actions of both the Executive and the Administration as laid out in the clause. It is an appropriate stand part point to make. I am sure that the Minister already has the point on board.

Clause 154

Stephen O'Brien (Conservative, Eddisbury)

Just in case anyone was getting excited about us galloping away, and if my hon. Friend the Member for Guildford thought she was being pedantic, well here we go. The important point to note is that the clause deals with repeals which are listed in schedule 15. Some 15 Acts passed by the Government over the last nine years will be repealed or amended. They include the Health Act 1999, the Care Standards Act 2000, the Health and Social Care Act 2001, the National Health Service Reform and Health Care Professions Act 2002, the Health and Social Care (Community Health and Standards) Act 2003, the National Health Service Act 2006, the National Health Service (Wales) Act 2006 and the Health Act 2006. So it is clear that the vast majority of those 15 Acts are from this Department’s watch.

Parliament is the place to both propose and pass laws, but it is always helpful if Governments can get it right first time. Most importantly there is a big question about the almost iterative method by which we are making law in this area. Our parliamentary predecessors recognised that ground-breaking law needed a lot of consideration. Of course that was in the days when Bills were not programmed, so they would get full and detailed consideration. I have never been in favour of the new hours of this House and I think we should work through the night when we need to. That would give us plenty of time to discuss everything in detail. This is a good example of where truncated parliamentary scrutiny and iterative law making have ended up with a rather shabby list of Acts that have to be repealed. I am sorry to see that, but it is worth placing on the record because it is a reflection of where we have got to in the legislative procedures, which the House has decided, in its wisdom, to sanction.

Schedule 15

Stephen O'Brien (Conservative, Eddisbury)

On a point of order, Mr. Conway. It may be completely my confusion, but I cannot find these amendments on the selection list.

Derek Conway (Conservative, Old Bexley and Sidcup)

If it would help the Committee, the Chair and the Clerks have to work from the amendment paper. I realise that this gets very confusing for people, including the Chair, but the other piece of paper lists the amendments that have been grouped for debate.

Stephen O'Brien (Conservative, Eddisbury)

So those amendments have been brought forward from the past? We have already debated them.

Derek Conway (Conservative, Old Bexley and Sidcup)

I shall take advice. From the Clerk’s paper I can see that those were debated with the groupings with amendments Nos. 153 and 95. The amendments have been debated, but not formally moved, which has to be in the order that they appear in the Bill.

Stephen O'Brien (Conservative, Eddisbury)

I am grateful. I thought we had dealt with them. I could not work out why I had not prepared myself. I did not know whether I should be standing or not.

Derek Conway (Conservative, Old Bexley and Sidcup)

It is not marked on my paper, but fortunately the Clerks have it on theirs. They have a firm grip on such matters.

Clause 155

Stephen O'Brien (Conservative, Eddisbury)

All I need to know from the Minister about the power to make transitional and consequential provisions is, on line 23, what is meant by “savings”?

Ben Bradshaw (Labour, Exeter)

I will have to write to the hon. Gentleman with the specific details.

Clause 157

Ben Bradshaw (Labour, Exeter)

I beg to move amendment No. 123, in clause 157, page 103, line 27, after ‘110,’ insert

‘(Fees payable by General Medical Council and General Optical Council),’.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss Government new clause 7—Fees payable by General Medical Council and General Optical Council.

Ben Bradshaw (Labour, Exeter)

Both provisions relate to the fee-charging regime of the Office of the Health Professions Adjudicator, which we debated at some length earlier in the Committee. I do not intend to add any more to the discussions that we had then.

Stephen O'Brien (Conservative, Eddisbury)

As the Minister said, this relates to matters that were brought forward on the Floor of the House in a separate ways and means debate. We had a long discussion around the fee-raising powers of the OHPA and the associated governance and value-for-money issues. That debate is recorded from column 357.

It is right to point out that we remain concerned that the OHPA is not totally independent of the Government. The Minister assured the Committee that departmental power lies only with payment and loans made to OHPA. He also assured us that an executive, non-departmental public body—if OHPA is eventually classified as one of those by the Office for National Statistics—does not have to refer any of its judgments back to the sponsoring Department. It does not have to explain to the Department why it has made any professional decision, nor does it have to give the Department details of its professional decisions. There is total independence in the panel’s professional decisions and Ministers will have no power to interfere in any of its adjudication decisions.

However, new clause 7 opens up the path for the OHPA to collect fees from the General Optical Council and the General Medical Council—fees that will be passed on to doctors, opticians and associated professions. Again it is right to place on record that we remain concerned that the Government have a power over the levy, particularly as they have not yet clarified the likely level of the fees and the running costs of the OHPA, although I readily acknowledge that the Minister will seek to give us further details, hopefully in the near future, so that we can bottom this one out. The Government have not given sufficient guarantees protecting doctors against massive year-on-year fee increases, in the event that the OHPA fails financially because of Government error. I was half-inclined, on a feet-to-the-fire basis, to propose that we should seek to divide the Committee on the issue, but assuming that the Government are happy to acknowledge that they are genuinely coming forward with more details for us to consider, I am happy to allow the amendment to go forward at this stage.

Clause 158

Clause 159

Stephen O'Brien (Conservative, Eddisbury)

Had the Secretary of State adopted the amendments that we proposed in relation to making the Secretary of State for Health and his Department responsible for the health in pregnancy grant, this is the point at which we would have had the need to delete the word “Treasury”. If, when reviewing all that we have discussed, he finds that we have made a sound point and would like to wrest this power from the Treasury as we have been urging him to do—frankly, all power to his elbow—this is where he would also need an amendment.

Clause 160

New Clause 6

New Clause 7

New Clause 13

New Clause 14

New Clause 8

Stephen O'Brien (Conservative, Eddisbury)

I beg to move, That the clause be read a Second time.

Derek Conway (Conservative, Old Bexley and Sidcup)

With this it will be convenient to discuss the following: New clause 9—General duty of HealthWatch

‘It shall be the duty of HealthWatch to further the interests of patients and the public in relation to the provision of health services in England.’.

New clause 10—Functions of HealthWatch

‘(1) HealthWatch shall make arrangements for ascertaining—

(a) the state of public opinion about the manner in which health services in England are provided,

(b) the views and experiences of patients in relation to the provision of health services in England; and

(c) the views and experiences of patients in relation to the handling, by commissioners and providers of healthcare services, of complaints made to them by such patients.’.

New clause 11—Local Involvement Networks.

‘(1) HealthWatch shall be regarded as an “English network” for the purposes of section 222 of the Local Government and Public Involvement in Health Act 2007 (c. 28).

(2) HealthWatch may make such arrangements as it thinks fit for consultation with Local Involvement Networks.’.

Stephen O'Brien (Conservative, Eddisbury)

It does not matter how many times one does it; returning to a discussion of many days or weeks ago is the most challenging part of the procedure. At least we have reporters if I have got any of that wrong.

We have had an important discussion on public and patient involvement. That is something that is of great concern across the House and I do not intend to seek to embarrass or press in a partisan way. As hon. Members are aware, there is a proposal, which happens to come from the Opposition, to establish an organisation called HealthWatch. I have urged the Minister to look seriously and carefully at what my party proposes. We have worked very hard on this matter: we have discussed it with a lot of people and we have made a commitment to establish HealthWatch, a national consumer voice for patients and service users. Having had many discussions about local involvement networks with patients and public involvement throughout the Committee stage, we are very grateful, and I genuinely mean that, that the Minister has undertaken to look at the matter again. His commitment is welcome.

I will not unduly delay the Committee although we are not particularly rushed. New clause 8 seeks to establish HealthWatch as a committee of the CQC and makes provision as to its constitution. New clause 9 is established to

“further the interests of patients and the public in relation to the provision of health services in England.”

New clause 10 would require HealthWatch to ascertain:

“the state of public opinion about the manner in which health services in England are provided...views and experiences of patients in relation to the provision of health services in England; and...the views and experiences of patients in relation to the handling, by commissioners and providers of healthcare services, of complaints made to them by such patients.’.”

New clause 11 would establish HealthWatch as an “English network” for the purposes of the Local Government and Public Involvement in Health Act 2007. I do not know whether any members of this Committee served on the Public Bill Committee for that legislation, but I should have checked, given that there has been genuine interest from many hon. Members present. HealthWatch would use existing legislation to achieve the aim of having a national representative body for local involvement networks.

Contrary to the Minister’s assertion that our proposal is opposed to the bottom-up, organic approach—he will recall that discussion—LINKs would be the drivers. HealthWatch would give them the power to engage with policy at national level, which they are denied by the Government. That is the essential part. I am sure that Committee members will recall the importance of the old community health councils and the bed watch publication. That had a major impact on the way in which Governments thought about the patient experience, what needed to happen and priorities. Indeed, in their early years in office, one of the Labour Government’s priorities was capacity issues.

With the new clauses, we aim to deliver on our commitment to establish a national consumer voice for patients—HealthWatch—to provide them with support at a national level, to provide leadership to LINKs at a local level and to incorporate the functions of the independent complaints advisory services. That is very important. We have had many discussions on concerns about the capacity to process complaints, assuming the Bill becomes an Act, and the capacity of the complaints handling system. Today’s memorandum helped to put a little more flesh on the bones regarding complaints issues. That welcome and important document has been placed on the record as a memorandum.

HealthWatch would also make representations on the closure of NHS services, for example. We would have it make representations to the NHS board, and we have published a draft Bill on that, which we hope to have the opportunity to introduce. Subject to consultation, HealthWatch would have statutory rights over nationally issued guidelines on the care that NHS patients should receive and on decisions that affect how NHS care is provided in an area. I urge the Minister to take our new clauses into account as he seeks a way forward for patient involvement in the CQC and our NHS.

My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has promised to bring our proposals forward as part of our announced NHS Autonomy and Accountability Bill. I hope that this debate has sufficiently whetted the Minister’s appetite for that discussion and that he has no concerns about pride of authorship or the fact that the measures happen to have been proposed by us rather than his Government. It is undoubtedly the right way forward for our NHS. On that basis, I commend the new clauses to the Committee and very much hope that the Minister will regard them as a useful addition that will improve the Bill as we speed its passage through Parliament.

Kelvin Hopkins (Labour, Luton North)

I reiterate my concern that the representation of patients should be sufficiently strong and robust both in representing patients as a group and providing access for individual patients with particular problems. I am also concerned about access to advocacy. Some Labour Members will be watching carefully to see how the new arrangements work in practice and to ensure that patients have proper representation in every way necessary and appropriate. I hope that my hon. Friend the Minister will take note of our concerns that the new machinery should work properly. If it does not work so well, we will look forward to more reforms in the future.

Ben Bradshaw (Labour, Exeter)

I am sorry to tell the hon. Member for Eddisbury that we think the HealthWatch idea is as flawed as other ideas in the Conservatives’ draft Bill, such as giving over the running of the health service to an independent, unaccountable national quango. The reasoning behind the new clauses appears to be that the committee will represent patient and public views to the commission more effectively than the local involvement networks—or the regional or national networks that they might choose to establish with the Care Quality Commission—might otherwise be able to achieve.

The re-establishment of a centralised body, especially one that sits within the Care Quality Commission would undermine our move towards more local determination, flexibility and responsiveness. It would also go against the conclusion of the arm’s length body review in 2004, which recommended the abolition of the Commission for Patient and Public Involvement in Health—a not dissimilar body to the one being proposed as part of the wider Government agenda to move resources from centralised bodies to the front line.

LINKs should be given time to determine their own way of being represented regionally and nationally if they wish. Together with other changes we are making such as the complaints reform to which the hon. Gentleman referred, that will more than cover the function set out in the Bill for HealthWatch and ensure the representation of the public and patient voice to the new regulator, as my hon. Friend the Member for Luton, North so eloquently advocated.

Stephen O'Brien (Conservative, Eddisbury)

I put it on the record that we do not accept the Minister’s analysis of the approach advocated by our NHS Autonomy and Accountability Bill but there may be a future opportunity to consider it in detail. I recognise that the soundbite used in relation to it has been repeated.

I pay tribute to the hon. Member for Luton, North, who did not necessarily support the new clause, for his consistent approach to patient involvement and the level of advocacy that needs to be established. He and I have shared a view on that issue over at least eight years since we looked very closely at what was happening when the community health councils were abolished, as it was one of their key roles. The independence and trust that they enjoyed led to advocacy that worked, which was especially helpful to those in a very vulnerable situation. Our HealthWatch proposal, which is contained in the new clauses, is intended to try to replicate that aspect of the CHCs.

I do not want to press the hon. Gentleman to make a decision and I recognise that the Government are taking a view on these matters. The point is well heard as well as well made and the best I can do is hope that if we continue to take opportunities to press these ideas, the Government will one day realise that they are not intended to be something that they should resist, but something that they should embrace. That would be one of the best ways of demonstrating that there is a unity in many of our objectives for making sure that the NHS is not only robust and well designed but that its priority is to serve patients from the very first to the very last and to improve their lives through better health.

I beg to ask leave to withdraw the motion.

New Clause 17

Sandra Gidley (Liberal Democrat, Romsey)

I beg to move, That the clause be read a Second time.

New clause 17 would end the post-code lottery in social care provision and ensure that every disabled person has a clear right to independent living support that meets basic human rights standards. The system we have now means that the entitlement of disabled people to support for independent living varies considerably depending on where they live and whether they meet increasingly high thresholds to qualify for support.

Increasing hardship and exclusion for disabled people and their families and carers is resulting from under-investment in social care. We accept that investment is being made in health but there seems to be a lack of will to reform an outdated and antiquated system. Although there are some good things in the Bill, for example, the extension of direct payments, more could be done. This year, many more disabled and older people will be turned away by social services. [Interruption.]

Derek Conway (Conservative, Old Bexley and Sidcup)

Order. I am sorry to interrupt the hon. Lady, but there are three or four different conversations going on in the room, and the Official Reporter is having difficulty hearing what she is saying. Perhaps it would help if she could speak up a bit, and if members of the Committee could converse outside.

Sandra Gidley (Liberal Democrat, Romsey)

I do not feel that I should have to speak up. It is polite to listen.

This year, many more disabled and older people will be turned away by social services because they do not meet the threshold for support. If they are lucky, family and unpaid carers may step into the breach, at great cost to their health, employment opportunities and well-being, as we all know. Instead of rationing according to severity of need, which deprives some disabled people with moderate or low support needs of any help whatsoever, and increases the likelihood of more costly acute health and social care intervention further down the line, the new clause proposes an alternative approach. It would require local authorities to meet minimum outcomes in respect of disabled people regardless of the level of presenting need. That would maximise the opportunities for disabled people and maintain and extend their independence and well-being.

The minimum outcomes would be prescribed in regulations, and, given the import, there would be virtue in making them subject to the positive resolution procedure. Parliament should get the chance to debate fully and decide what a minimum level of support should be.

Examples of minimum outcomes are given in the new clause. They are based on core human rights standards as set out in the European convention on human rights: freedom from physical risk is based on article 2, which deals with the right to life; freedom from inhumane or degrading treatment is based on article 3; and the right to privacy and family life is based on article 8, which encompasses a positive obligation on states to support people in developing their personality and social relationships, and in participating in social, economic, cultural and leisure activities.

Organisations such as the Royal Association for Disability and Rehabilitation hear from many disabled people for whom those basic human rights are denied. Unless and until those rights receive clear statutory underpinning, disabled people and their families will continue to experience daily hardship, exclusion and indignity.

We believe that local authorities are left to flout human rights standards because the Government have failed to spell out clearly what the positive obligations in the convention actually mean. They cannot simply be dismissed by reference to resource constraints, although I would point out that independent living support is frequently cheaper, better and more flexible than traditional support.

The new clause would underpin effective implementation of recommendation 4.4 of the Prime Minister’s strategy unit report, which is accepted as Government policy. That report on improving the life chances of disabled people said that there should be a new system in place by 2012 to deliver independent living. It should include provision for eligibility based on requirements arising from disabling barriers—for example, cash payments for taxis when public transport is inaccessible—and additional requirements associated with impairment. For example, voice-recognition software would enable someone to read text at home and work. Subsection (1)(a) is designed to implement that. The system should also include provision for security and certainty about what level of support is available. That would be implemented by subsection (1)(b).

The new clause would help to create a social care system geared towards prevention and the achievement of beneficial social and economic outcomes in place of the dependency-oriented, increasingly threadbare safety net that exists today. I will concede that the Government want a debate about the future funding of social care, but it must be informed by a clear position on what we want social care to achieve. The Wanless review noted that the impact of current social spending on achieving the Government’s desired outcomes of promoting choice, independence and prevention is unclear. In fact, the review said that the evidence that does exist suggests that the social care system is falling short of those aims.

The economic and social benefits, and cost-effectiveness of independent living support, including the low-level support mentioned earlier, have been well documented in reports published by the Office for Disability Issues. Wanless estimated that an additional £3 billion now needs to be pumped into social care. Even if that investment is not forthcoming, whole-system reform as outlined in the Disabled Persons (Independent Living) Bill currently before the Lords—which includes provision for seamless support and individual budgets—would release major savings which could fund the provisions in the new clause.

Stephen O'Brien (Conservative, Eddisbury)

I do not want to detain the Committee long. I have read the new clause very carefully. When something deals with guaranteed minimum outcomes for people with disability, I think that we are all genuinely very exercised as to whether it carries with it a thrust that we should follow.

The first issue I have is that it does not come with any costings. That has an effect. We have real issues about increasing the burden on local authorities at the very time when their finances are under increasing and continuing pressure, particularly in the area of social care. The hon. Lady and I have regularly had quite serious disputes, both in Westminster Hall and at other times because of her confession that the free personal care promise made by her party, first in Scotland and then as part of their last national election campaign, was a lie. That was something she agreed and confirmed on the Floor of the House, and I have been regularly reassured that it is in order to use the word.

Indeed, she said that that was the way her party’s manifesto writers like to approach their whole manifesto, something with which I could not possibly disagree, and which I dare say the Minister would also find it very tempting to endorse. [Interruption.] The hon. Member for Leeds, North-West says he wants to go home. It seems quite extraordinary that he does not wish to vote this afternoon.

Greg Mulholland (Liberal Democrat, Leeds North West)

Just to say—and it has nothing to do with this debate, nor with the nonsense he is talking—that the reason I am not voting is that I have chosen not to vote on my own pay or allowances, and that is a point of principle.

Derek Conway (Conservative, Old Bexley and Sidcup)

Order. I am sure that the hon. Gentleman would not be tempted down that path. What he does on the Floor of the House is a matter for him later.

The rest of the debate is in Hansard.