Address in Reply to Her Majesty's Most Gracious Speech
Baroness Ashton of Upholland (Labour)
My Lords, it is with a real sense of privilege that I make the first of what I hope will be many contributions in your Lordships' House. In preparing to enter your Lordships' House, I trawled the Internet--something I enjoy doing enormously--to look for other noble Lords' speeches on similar occasions. I was struck by the number of times that references were made to the kindness shown to newcomers in your Lordships' House. I confess that I thought perhaps that was merely good form. I will admit for the first and probably the final time in your Lordships' House to being completely wrong. I echo those sentiments and I add my heartfelt thanks for the kindness shown to me.
I am pleased that I have the opportunity to speak to your Lordships and the opportunity to be brief. Your Lordships afford me the right to stand here and speak to you without interruption. I will respect the traditions of the House and speak in an uncontroversial manner.
I have spent 20 years of my life in economic and community development, on the fringes of education policy, and advising the Home Office on the relationship between government and the voluntary sector. By any stretch of the imagination, I am an "implementer". Most recently, I have become chairman of a health authority. In that capacity, I shall have much to say in future debates with the noble Earl, Lord Howe, and the noble Baroness, Lady Young.
I bring experience rather than expertise to your Lordships' House. It has been my joy, and occasionally my lot, to try to turn the policies, plans and strategies that emanate primarily from another place into practical action on the ground. Those of your Lordships who have also been practitioners will recognise a sense of frustration sometimes in trying to do precisely that and a desire perhaps to see the plans and practices on the ground turned into policies.
I can put it no better than an American president, who said:
"We know what works in practice. The challenge is to make it work in theory".
I do not often have the chance to quote President Reagan in anything that I say but on this occasion I can wholeheartedly support him.
I wish to commend three particular words in the gracious Speech on the subject of the health service. Those words are "10-year programme". As a practitioner, it has been my lot to be blighted by short-termism. We have academic years, calendar years, two-year funding cycles, three-year cycles and four to five-year electoral cycles. All of these mitigate against solving some of the deepest problems that we have, some of which go back to the Industrial Revolution and beyond.
In health in particular we are now looking to tackle some of the preventive issues and at ways in which we can ensure that people do not need the health service in the way that they traditionally have. But as we look at the prevention of heart disease, at teenage pregnancies, at drug abuse and at ensuring there are fewer accidents in the home, we know that we have to take a long-term view. I hope that the House will welcome with me the prospect of thinking in 10-year terms.
As we look at solving some of the health issues and at prevention rather than cure, we are also mindful of health inequalities. I am of the view that health inequalities go hand in hand with social and economic inequalities. They are joined-up problems, and joined-up problems need joined-up solutions. But joined-up solutions also need joined-up money.
I have spent 20 years inventing public, private and voluntary sector partnerships. In doing so, we have taken the best from each of the different sectors in our society and put them to work to try to address some of the underlying economic and social issues that our country faces. I think all will agree that some of these partnerships have been hugely successful. I was working on them in the early 1980s, when they were deeply unfashionable.
But we can go further. On Monday, I spent my day with the three party political leaders in Hertfordshire, where I live and where I do my day job as a health authority chairman. We met with the chief executive of the county council, with the director of social services and with colleagues from the health authorities. Our purpose was to look at how we could more successfully integrate the budgets between education, health and social services; to look at things from the perspective of the clients, the people we were trying to serve. We have therefore come up with a solution which looks at the adult population as one group and brings together education, the family and the child into another, focusing on the people rather than on the structures.
In Hertfordshire we know a great deal about working in an integrated way. In the health service we have a nursing home-at-home scheme which allows patients--particularly elderly patients--who need some kind of continuing care to leave hospital when they are ready to do so. They might have gone into residential care for a short time or, worse, they might have stayed in hospital. Instead, they can now go home and be cared for by social care staff and healthcare staff working together. The benefits to the health service of that are obvious. We take people away from beds which we need for other treatments. But, most importantly, the patient is able to do the one thing that all patients want to do, which is to go home.
We also have an assertive outreach programme in Hertford which works for those in our society who suffer from mental illness and whom we need to keep safe and whose communities we need to keep safe. Again, that work is shared by mental health staff and social care staff--again, a good strategy. As my noble friend Lord Bassam said, throughout my county the crime and disorder partnerships bring together many different agencies which work with an integrated approach. I long for pooled budgets, not simply integrated approaches. I hope that your Lordships will support me in wanting that.
If we can take away the ownership of a pot of money and give it for the purpose for which it was created, I believe that we can do even more. My noble friend Lord Hunt of Kings Heath will hear for the first, and probably the last, time from a health authority chairman not a plea for more money but, indeed, a plea that we use the money differently in order to use it more creatively.
I stray on to dangerous ground because I wish also to use the word "modernise". But I wish to use it in the context of a practitioner in the voluntary and public sector where it is a word that we use continuously. It is defined by me as meaning that we make sure that the processes we have--the organisations and institutions which we create--are fit for the purpose for which they are created. In the private sector we commend the modernisation that goes on; we commend the way in which companies learn to compete in a global market, painful though that can be at times. I simply make a plea that in our voluntary organisations, in our schools and in all our institutions, however simple and however grand, we follow that same rule.
As we move through the 28 Bills that will come to this House, I hope above everything that we will make sure that the processes of which those Bills are merely part are always subordinate to the goals and values that we hold.