Debate on the Address
Debate resumed on the Motion moved on
"Most Gracious Sovereign—We, Your Majesty's most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament".
Lord Warner (Minister of State (NHS Reform), Department of Health; Labour)
My Lords, let me begin by restating the Government's commitment through a strategy of investment and reform to improving and protecting the health of the whole population, with special attention to the needs of the poorest and those with long-term conditions. We have seen the health budget treble between 1996-97 and 2007-08, when it will reach £92 billion. This has enabled us to expand the workforce by more than 300,000, including over 85,000 more nurses and more than 32,000 doctors.
We are treating more patients faster and better than ever before. Today, 95 per cent of people referred by their GP with suspected cancer are diagnosed and start their treatment within 62 days. Between 1996 and 2004, death from cancer in people under 75 fell by nearly 16 per cent, saving an estimated 50,000 lives. The total waiting list has fallen by a quarter in the past six years—a reduction of 260,000. From the end of 2008, patients will wait no longer than 18 weeks from GP referral to the start of treatment. A&E departments now consistently treat over 98 per cent of patients within a maximum wait of four hours.
Ten years ago, half the NHS estate was built before the NHS itself. That is now down to a quarter. There are now 157 new hospitals open, under construction or in procurement—the largest sustained hospital-building programme since the NHS was founded. More than 2,800 GP premises have been improved or refurbished. More than 75 NHS walk-in centres are open, including four commuter walk-in centres.
We have introduced treatment centres so that planned surgery can be just that. There are 44 NHS treatment centres, which have treated more than 300,000 people since 2003, and 21 independent sector schemes, which have delivered more than 300,000 treatments and diagnostic tests—all under the NHS, free at the point of need. No wonder 92 per cent of adult patients rated their care as good or better, as do 94 per cent of adult out-patients and 88 per cent of those who use accident and emergency departments. It is the same picture in primary care, where 97 per cent of patients say that their main reason for visiting their practice was dealt with to their satisfaction.
We are giving more choice for people about the services that they use and more autonomy to local hospitals through foundation trust status. We have more diverse providers, with more freedom to innovate and improve in response to what patients and commissioners want. The White Paper that we published in January will bring more care closer to home, as people want, and give a stronger emphasis to health promotion and public health, along with greater integration of health and social care.
The improvements across the NHS have encompassed mental health services, which remain a key priority for the Government. Since the publication of the national service framework in 1999, planned spending on mental health has gone up by more than 25 per cent in real terms—nearly £1 billion. There has been a huge shift in services from in-patient services to the community, with new roles for staff and new, more individual services for service users. In 2005-06, almost 84,000 home treatment episodes took place for people who would otherwise have required in-patient admission. At the end of June 2006, almost 19,000 people were receiving assertive outreach services.
Mental health services have become increasingly responsive to the needs and wishes of the people who use them. The new Mental Health Bill, introduced on
On behalf of the Government, I thank all those who have helped in the development of the Government's proposals for reforming this legislation, from Members of this House who contributed through the pre-legislative scrutiny committee, to the 1,000 or so organisations and individuals who commented on the earlier Green Paper, and the 2,000 or so organisations and individuals who commented on the 2002 draft Bill. We are very grateful for the enormous amount of time and effort that has gone into reshaping and improving this legislation.
Although one in six of us may experience some sort of mental health problem in the course of a year, most people never need to be detained in hospital and treated under this legislation. Mental health legislation affects only a very small minority but, crucially, it helps to ensure that people with serious mental disorders can be required, where necessary, to receive the treatment that they need to protect them and the public from harm. The new Bill will modernise the legislation in line with developments in the NHS, and strengthen patient safeguards. In addition, it is being used as the vehicle for introducing the so-called Bournewood safeguards, through amending the Mental Capacity Act 2005. These safeguards are for people who lack capacity to decide about their care, are deprived of their liberty to protect them from harm, but are not covered by the Mental Health Act safeguards.
Early in 2007, we will also publish a draft Bill, for pre-legislative scrutiny, to update the law on assisted reproduction and embryo research, following the department's review of the law in this area. The United Kingdom is at the forefront of developments in human reproductive technologies. This country has pioneered new techniques for alleviating infertility and for conducting research into serious diseases. We also pioneered a system of effective regulatory oversight. We are committed to ensuring that the law is up to date and continues to promote public confidence in human reproductive technologies. The law and the regulator—the HFEA—have performed well to date, but it is time to update the legislation, given new technology and attitudes. We will shortly publish the policy proposals related to the Bill.
The Bill also provides an opportunity to establish a single regulator responsible for the whole range of human tissue and cells: the Regulatory Authority for Tissue and Embryos or, in short, RATE. RATE will replace the Human Fertilisation and Embryology Authority and the Human Tissue Authority and will take on important regulatory functions in relation to blood. The intention to create RATE was announced in the department's review of arm's-length bodies in 2004.
The Government will continue the programme of education reform to improve equality of opportunity and the skills base that our economy needs if it is to remain competitive. The Further Education and Training Bill is a key next step in the Government's programme to reform further education. It implements key aspects of the Government's White Paper published in March 2006. It will restructure and streamline the Learning and Skills Council. It will change the way the council is able to work with partners to make it more responsive to local needs and the needs of learners and employers. It will enable new forms of delivery and will encourage diversity and choice in further education provision.
We announced in the White Paper our intention to introduce a more robust intervention strategy to address provision that is inadequate, barely satisfactory or coasting. The Further Education and Training Bill includes the legislative changes needed for that. It will also strengthen the leadership of further education by requiring principals to have relevant qualifications. The Bill also simplifies the operation of industrial training levies and includes relevant measure-making powers for the Welsh Assembly.
The Government wish to extend opportunities for people to study for higher education qualifications. The Bill will enable that by allowing colleges to award foundation degrees. The key measures in the Bill will help to equip the further education sector so that it can respond effectively to the skills challenge articulated by the noble Lord, Lord Leitch, in his report to the Government on the UK's future skills needs. It will support employers and individuals in developing the skills that Britain needs to ensure our future prosperity.
The gracious Speech included three pieces of welfare reform legislation that reflect our vision of the state supporting people to achieve their aspirations and potential: a Bill on child maintenance to end the legacy of failure; a Welfare Reform Bill that will support those who face the most difficult journey back into work; and a Pensions Bill that will cement the broad consensus to support savings and pensions in an enduring pensions settlement for the long term.
Since 1998, 700,000 children have been taken out of poverty, reversing a trend from the 1980s that condemned children by stalling opportunity and mobility. Last month, we had the highest rate of employment on record. More than 29 million people were in employment, and that figure had risen by 120,000 in the past three months. The UK continues to have the best-performing labour market among the major world economies.
Since 1997, our measures have taken 2 million pensioners out of absolute poverty and 1 million pensioners out of relative poverty. When my right honourable friend the Prime Minister announced that this Labour Government would seek to end child poverty in a generation, he set an objective that reflected the scale of our ambition by seeking to eradicate child poverty by 2020 and so secure equal life chances for all. The system of child maintenance embraces the principle of caring for the welfare of children and requires parents to fulfil their financial responsibilities, particularly in the difficult transition of family break-up.
However, the Government recognise that the current system is not working; it works against parents rather than working with them to deliver the best outcomes for their children. There is a backlog of 225,000 cases awaiting assessment or calculation and there is an accumulated debt of £3.5 billion. That is why we commissioned the comprehensive redesign from Sir David Henshaw and have accepted the vast majority of his recommendations.
In broad terms, the new Bill will promote parental responsibility by encouraging and empowering parents. It will lift more children out of poverty by increasing the amount of maintenance that parents on benefit can keep; it will ensure that more parents take responsibility for paying for their children and that more, especially the poorest, benefit from this; and it will create a new organisation to replace the Child Support Agency and to deliver a more focused and cost-effective child support system. Importantly, the new system will crack down harder on the non-payers. We will create more enforcement powers to deal with parents who repeatedly fail to pay maintenance by suspending passports and imposing curfews.
Our Welfare Reform Bill, introduced in another place in June, puts forward a comprehensive package of reform to support our aspiration of an 80 per cent employment rate for people of working age. With record rates of employment, we can focus even more of our efforts on those who need particular support back into work to raise people out of poverty. The Bill replaces incapacity benefits with a new employment and support allowance for those whose health affects their capacity for work. This focuses on capability and continuing support to manage a condition and return to work. Further support is extended to individuals through the national implementation of the successful Pathways to Work pilots, delivered through the private and voluntary sectors to secure maximum innovation and flexibility in addressing complex individual needs.
Housing benefit reforms will make it easier for people to move into work by helping to speed up local authority administration, promoting greater choice and responsibility for tenants, promoting financial inclusion and helping the fight against benefit fraud. Powers to sanction housing benefit to people evicted for anti-social behaviour and refusing to engage with rehabilitation provision strengthen the rights and responsibilities contract that we expect between individuals and the state.
The third of our welfare measures is the Pensions Bill, which will reform the UK pension system for generations to come. The work of the noble Lord, Lord Turner, and his commission has led a process that has brought broad consensus. The measure outlined in the gracious Speech provides a clear way forward to tackle demographic challenges and support savings and retirement in the future. We will link the uprating of pensions to earnings—restoring the link broken in 1980—to provide a solid foundation on which to save for retirement. We will make entitlement to basic state pension fairer for women and carers by reducing the number of qualifying years.
The Bill will simplify the state pension and streamline the private pension regulatory environment, making it easier for people to plan and save. We will secure the long-term financial stability of the pension system by gradually raising the state pension age to 68 by 2046 to keep the proportion of life spent receiving the state pension stable for each generation. Finally, the Bill establishes a delivery authority to prepare for the infrastructure of personal accounts that will provide a low-cost savings vehicle.
The measures on child support, on welfare reform and on pensions reform provide a step forward in our support for people throughout their lives. Together they seek to improve children's start in life and support people of working age facing difficult circumstances to get back into employment, and they provide a lasting and comprehensive package of support for savings and pensions that help to give comfort and independence in old age when, as a society, we are living longer. Taken with our measures on further education, mental health and regulating human fertility assistance, and with our broader programme of NHS improvement, these welfare changes represent a vibrant programme for strengthening our social programmes that support people through their lives.
Lord Skelmersdale (Shadow Minister, Work & Pensions; Conservative)
My Lords, I suppose that I should not be surprised that the noble Lord, Lord Warner, spent half his time talking about health—after all, the Department of Health is his ministry—but I intend to take a more general approach and leave most of the health issues to my noble friend Lord Howe.
We look forward to not one but six maiden speakers—a quick look at Dod's shows that their interests comprise almost all of social affairs. We await their remarks with interest. Like them, I think the words "social affairs" cover a very broad spectrum: education, work and pensions, health and, in part at least, culture, media and sport. I say in part because at the top end, that last subject is in my book an industry. Take for instance Premier League football or ITV, where vast sums of money are involved. However, at the other end it provides social integration, education and improves mental and physical health. I cannot help but wonder whether the massive increase in childhood obesity, which appears to have taken the Government by surprise, is due to the fact that for decades competitive sport was discouraged in our maintained schools up and down the country.
We have had Questions and debates about selling off school playing fields. Still we are told that that does not matter because they are replaced by gyms and indoor sports facilities. There is not much fresh air there. Or are we to be told that fresh air does not matter any more? There is not much fresh air for youngsters either. The BBC told us recently that, on average, children spend 25 hours a week in front of either a television or computer screen. It is political correctness that tells us that outside is a dangerous place. "Don't play conkers: they might split and go in your eye". Of course they will split, that is the object of the game.
All is not quite lost. Farley Nursery School in Salisbury, Britain's only outdoor nursery, where children are taught outside for most of the time, is a real breath of fresh air in a system led by damage limitation and fear of risk. It champions the long-forgotten principle that children and young adults in education should be allowed to take responsibility for themselves in all aspects of their lives.
It was therefore with great disappointment that I discovered some of the intentions of the forthcoming education Bill, which had its First Reading yesterday. Although there are problems with the current system—for example, the worrying number of 16 to 18 year-olds out of education has risen by 40 per cent since 1997—the Bill promises no real change. Instead, it will merely reshuffle Learning and Skills Council officials from local to regional offices, where bureaucracy will be even further from the reality. We need training funds to follow student and employer choices, rather than bureaucrats second-guessing provision. The approach is not more responsive, as the Minister said, but a wasted opportunity.
In preparing for this debate, a first for me—not, I hasten to add, the preparation but the debate on the gracious Speech—I chanced on something that the noble Lord, Lord Hunt, said in this debate in 2002. He said:
"There are strong links between ill health and the other problems that we face, such as unemployment, poor housing, poor educational achievement [and] the insecurity faced by so many young people. We will always have to work together throughout Whitehall to sort out such problems".—[Hansard, 19/11/02; col. 357.]
The noble Lord may remember saying that. "Aye", as Hamlet said, "there's the rub". The plethora of strategies, targets and curricula with which the Government are fixated have not proven to be the answer.
The Government do not have all the answers. That was proven when they asked the noble Lord, Lord Turner, to chair a pensions commission, which resulted in two valuable reports: the first analysing the problem, the second proposing solutions. That will result in not one but two Bills, one of which was forecast in the gracious Speech. Although this year's Pensions Bill is arguably the most sweeping state pension reform for a generation, it will only do half the job that the noble Lord recommended. Rather than deal with the most urgent problem of increasing people's savings for retirement which, for half the population, are non-existent and for most of the other half, negligible, it will comprise only a revamp of state pensions and the setting-up of yet another quango—except, of course, it will probably be called a commission—to administer a national supplementary pension into which employees will be expected to put 4 per cent of their earnings, the employer 3 per cent and the Treasury 1 per cent. Or will those figures change, and over what period will the scheme be introduced? We will have to wait for a White Paper to see the Government's intentions. This year's Bill, however, will steal one of my party's pledges at the last general election: to raise the level in line with incomes rather than prices. They will not do so, we are told, until 2012 at the earliest. Meanwhile, millions of pensioners should be claiming pension credits. Some are, but a worrying 1.6 million are not. They will also reduce the number of years needed for someone to acquire a full pension from 44 to 30, while still contributing throughout their working life—something of which the party on my right fundamentally disapproves.
As the Minister has just said, we will soon consider another work and pensions Bill, the Welfare Reform Bill, which has already started its passage in another place. In order to get 1 million people off invalidity benefit and into work by 2017, the Bill creates a single benefit with numerous sub-divisions and rates of payment for those with possibly temporary problems such as a bad back, for the long-term sick and disabled, and extra for those with children. Although I agree that it could reduce the number coming on to benefit, it does not seem to reduce the number currently on benefit, and it adds yet more complication to a social security system that, since its inception, has built one overlapping benefit on to another. It is time we considered the benefits regime as a whole. That would be a proper reform, like that of my noble friend Lord Fowler in the 1980s. That argument, however, is for another day.
In the summer, we were also promised a Bill—to be preceded by a White Paper—to sort out the mess of the Child Support Agency. I confess to a sneaking sympathy with the Government, who have taken steps to chase absentee parents who refuse to support their young. Perhaps the Minister will tell us what progress is being made by the outside agency that now conducts this work. As I understand it, however, the Bill will be about assessing what the absentee parent should be paying and about penalties for not paying. Yet again, the Government have a bad record in this respect. They introduced a new child support scheme in 2003, and, as of last October, had spent more than £530 million on it. Yet this June, the National Audit Office commented that,
"overall the new scheme has performed no better than its predecessor".
Some 250,000 child support cases remain to be processed, and it is hard to imagine that the Child Support Agency will reach its target to reduce the number of uncleared new scheme applications by 25 per cent between March 2006 and March 2007. As the Minister said, £3.5 billion of debt is uncollected. I failed to hear him say, however, that the department believes that £2 billion of this is uncollectable. The key issue here is the robustness of the original assessment, and if the Bill fails to crack this, it will be another wasted opportunity.
Naturally, much of the CSA's work is done by computers. There is no doubt that computers are marvellous things that can be programmed to make all sorts of calculations and communications. However, there seems to be a strand of thought in government that, just because something can be done, it should be done. As the song goes, however, it ain't necessarily so. Again and again, we see overcomplicated schemes running late, costing vast sums of unscheduled money and, when delivered, failing in their original conception.
That brings me on to statistics. No one who heard Her Majesty on Wednesday could have missed the laughter when she said:
"Legislation will be introduced to create an independent board to enhance confidence in Government statistics".—[Hansard, Commons, 15/11/06; col. 4.]
Statistics are at the very heart of social security. Even if a Minister thinks that it would be a good idea to change something, such as creating a new benefit, they will get nowhere without discovering what is going on now and with how many people, and how many gainers and losers there will be as a result of the proposal. My honourable friends and I have recently been trying to get to the bottom of social exclusion—a very big subject. We recognise that we cannot do so until we know exactly how many adults and children are involved. The Social Exclusion Unit, which this Government set up, lists the main causes and consequences. Statistics exist for all of them, except family breakdown. Yet, recently, in a Written Answer, the noble Lord, Lord Adonis, told me:
"It is estimated that each year between 150,000 and 200,000 couples with children separate".
He will remember that, no doubt. He continued:
"This is made up of 100,000 divorces, and between 50,000 and 100,000 cohabiting relationships breaking down".—[Official Report, 18/10/06; col. WA 191.]
That is not very helpful. Both he and I would need much better figures than those to convince a Treasury colleague to spend money on even a part of the problem. I can only hope that the new board will sort this out and, most importantly, that members of the board, not Ministers, decide what is to be subject to the proposed code of conduct and Ministers do not have a veto on their publication. Is that a pipe dream? Maybe it is, but no more than many of the aspirations underlying the legislation proposed in the gracious Speech.
Baroness Barker (Spokesperson in the Lords, Health; Liberal Democrat)
My Lords, I very much look forward to the six maiden speeches which we will hear during this debate. Whatever the fate of this House, when people at both ends of the long corridor come to an eventual decision about reform it will be difficult to remove the expertise and range of experience which noble Lords bring to bear in debates on very complex matters. I am sure that the six noble Lords whom we will hear today will be part of that long, rich tradition. I welcome them very much.
It has been a year of huge change in the NHS. From these Benches, we pay tribute to NHS staff who have faced a year of great uncertainty, but who have nevertheless continued to display remarkable dedication to public service, which is the lifeblood of the NHS. On
I shall look at how those real difficulties are reflected in the gracious Speech, whose theme was security. When Ministers talk about Department of Health plans, they are quick to cite examples of local successes that would lead one to think that the populace of this country should believe that there is greater security in healthcare. They should, as the NHS has had an unprecedented increase in funding—a 51 per cent increase since 1999. People should feel more secure about the health service than they did at the end of the Conservatives' term but evidently they do not. Despite all that spending—in 2005-06 it was £80 billion—in the past few weeks we have seen unprecedented demonstrations on the withdrawal of maternity services, the threatened closures of A&E departments and the unavailability of drug treatments. I imagine that that included people who have never before taken to the streets. Those are hardly signs of a sense of security.
At around this time of year, it is traditional in the NHS that hard-faced trusts try to achieve a balance by reducing their variable costs, and some elective procedures are always delayed, with a disproportionate effect on patients. Behind the headlines, one sees that this year something deeper, and perhaps more worrying, is going on. Up and down the country, preventive and community-based services are being cut drastically. For example, in the London Borough of Hillingdon, the PCT has announced cuts of £500,000 to the voluntary sector, which includes the cutting of core funding for Crossroads, the carers' organisation, and the mental health advocacy services of Rethink, which supports people with severe mental illness. A further £0.3 million worth of cuts will be made unless the local authority can come up with funding. If it does not, services such as the Child Accident Prevention Trust programme will go. More than that, the organisations themselves will disappear. In practice, without the presence and services of those organisations, many more people will present with acute demands for healthcare, and the NHS will face an ever-increasing demand. We know that because in 2004 Sir Derek Wanless told us so in his report, Securing Good Health for the Whole Population.
The Government's reform programme has been focused on centralised targets set for short-term expediency at the expense of longer-term health improvement. The concern is that Sir Derek's own estimates for NHS demand were based on a scenario in which the population of this country would be fully engaged in its healthcare, fully informed and fully supported. He anticipated that if that were the case, the NHS would still require a 4.4 per cent growth funding in 2008, but we understand that the Treasury plans to provide only 1.5 per cent growth funding at that point. Therefore the NHS is not only experiencing cuts today but also storing up problems for the longer term. Over this period of investment the Government have constantly invested in short-term reforms and repeated reorganisations; as a result, there is not much to show for it.
Measures are set out in the gracious Speech, but there is also a huge gap. Nothing covers the implementation of the White Paper, Our Health, Our Care, Our Say; that is, there is nothing about social care. We know already that social care is severely underfunded. If it continues to be underfunded over the long term, that in turn will generate long-term demands on the NHS. The number of people set to live longer with high dependency needs continues to grow, but nowhere does the Queen's Speech address these matters.
We also have a draft health Bill in the gracious Speech. It focuses to some extent on restructuring the regulation of human tissue and embryology; a Home Office Bill can be found masquerading as a health Bill—the Mental Health Bill—and reference is made to the possibility of legislation to replace patient forums with local authority-led local involvement networks. It pleases me to see that the noble Lord, Lord Hunt of Kings Heath, is to reply to the debate because he and I spent many happy hours discussing the formation of patient forums. I should like to ask him whether such a Bill will be forthcoming. If it is, I hope that those who are preparing it will look at a discussion paper produced by the Department of Management Studies at the University of York, entitled The Rise and Fall of the Patient Forum. It sets out succinctly what the demise of the CHCs and their replacement by patient forums at £10 million more per annum will mean and suggests why the current top-down performance management approach to running the NHS means that true patient involvement is highly unlikely ever to happen.
I should like to take this opportunity to agree with Mr. Andrew Lansley, who said in another place a few days ago that the Bill on human tissue and embryology should not be hijacked as a means to have a debate on abortion. The issues covered in the draft Bill are serious and need distinct and detailed consideration of the type best done in this House. I further agree with the health commentators who have said that we should have a debate about why different regulatory bodies should be merged before discussing how such a process will happen.
I turn briefly to mental health issues. After more than 20 years in which to evaluate the workings of the 1983 Act, two draft Bills, a Joint Scrutiny Committee report and other expert reviews such as that led by Genevra Richardson, this Government must find the time and the means to come up with considered legislation which will set the framework for the improvement of mental healthcare for a generation. Instead, we have this clunking fist of a Bill which, for the most part, was not wanted and which few believe will work in practice.
The Minister thanked profusely the many people and organisations involved in considering the legislation up to this point. He did not say that the Government took any notice whatever of what most of those organisations and people said. Perhaps if they had, we would have had a Bill about mental health and not the punitive Bill before us.
If there had been that listening process, the Government might have understood that, of the 2.6 million people in this country on incapacity benefit, 40 per cent have mental health problems. That means that £5.2 billion per annum is spent on incapacity benefit for people with mental health problems. There are more people with mental health problems claiming IB than the total number on jobseeker's allowance. Not only does unemployment adversely affect a person's mental health but, as the CBI indicated in the report produced by the noble Lord, Lord Layard, on
It would have been good to have before us a Mental Health Bill which really sought to address the causes, incidence and prevalence of mental illness and to introduce the new means at our disposal to manage and assist those who have mental health problems, the vast majority of whom, as the Minister said, pose no danger to themselves or anyone else; they simply need assistance to live their daily lives.
We could have talked about ways in which healthcare workers could play a part in multi-agency arrangements to enable people to get back to work. We could have discussed how supportive employers can play a role in ensuring that people get a job and regain their self-esteem, which could so change their lives that they no longer need medication. Most of all, we could have talked about the chronic lack of access to community-based services such as talking therapies—those early interventions which, we know, enable people to avoid acute, serious episodes of illness. It would have been good to have a mental health Bill.
The Queen's Speech has been delivered by a Government who seem to have focused on the short term and run out of strategic vision in their powers to tackle the underlying causes of ill health in this country. We will do our best to see that that is redressed and that the National Health Service is run with a strategic vision nationally and accountability locally.
The Bishop of Southwark (Bishop)
My Lords, we shall shortly hear the first of the maiden speeches, which we eagerly anticipate. In order not to delay the House for too long, I shall focus most of my remarks on the proposed Further Education and Training Bill.
The Church of England has a long history of engagement with skills education, dating back to the early days of apprentice education in the medieval period, when the chaplain was responsible for the teaching of literacy and numeracy skills to young people in the guilds, trades and chapels, as they are still called in the print trade in London. The first FE college was in London—the Working Men's College in Camden—which still dispenses an excellent range of skills courses to mainly adult students. It was founded in 1854 by Christian socialists F. D. Maurice and Charles Kingsley, and throughout the 19th century other educational initiatives for young people and adults were developed, usually with secular partners.
Last July, the General Synod debated further education and produced its own report, Pushing Further. The opening sentence of that report states: "FE changes lives". Many will bear witness to the effect that FE can have in rescuing a young life going off the rails, encouraging young adults to develop the specialised skills to reach their full potential or enabling a single mother or a refugee to start on the road to fulfilment and employment.
FE is important but it is often undervalued, which is why we especially welcome the Bill and the Government's commitment to raising the profile of FE. We also salute the national skills strategy, so vital for the future of this country's economic interests but also for the benefit of each young person. We wholeheartedly support the Bill's main purpose, which we understand is to enable the provision of the full range of 14 to 19 education for young people—vocational and skills options as well as academic opportunities—through partnerships in every area between healthy, thriving FE colleges, excellent sixth forms and sixth-form colleges, and employers.
However, we have one or two other comments and one major concern. Our comments refer first to the consultation mechanisms. The Learning and Skills Council's strategy, Framework for Excellence, identifies three constituencies where consultation is vital—employers, learners and communities—but proposes consultation mechanisms for only two: employers and learners. The Bill repeats this limitation. Why cannot a mechanism be devised for consulting community interests, where the church and faith communities would be happy to play their part and would have much to contribute?
Secondly, we are disturbed by proposals announced earlier this month by the Learning and Skills Council that free further education and English language courses are to end for asylum seekers over the age of 18. These measures will also impact on those under 18 in asylum-seeking families. If parents are not entitled to language provision but their children are, the burden of translation and interpretation will fall more heavily on the children. Because of the disruption in their early education, many teenage asylum seekers start their further education late. To have their studies disrupted when they turn 19 seems a waste of talent and resource.
Our major concern is that we had hoped that the opportunity would be taken in the Bill to correct a historical anomaly. In schools, 16 to 19 year-olds have an entitlement to provision for their spiritual, moral, social and cultural development, while those in FE colleges do not. In its draft form, the Bill makes no reference to extending this entitlement to FE students. The implication, which is that the Government do not consider that young people in FE colleges have spiritual and moral needs and that colleges have no duty to meet those needs, does not bear thinking about.
We are sure that this anomaly is a historical accident, in that the Education Act 1944 and the Education Reform Act 1988 which underpin this entitlement did not cover FE colleges, and FE students were, in the past, mainly on a part-time or day-release course. This argument is not about chaplaincy. We welcomed the endorsement of multi-faith chaplaincy arrangements in the White Paper earlier this year, and we are working with many of the 50 per cent of colleges that have not had chaplaincies to bring this about.
This entitlement is about equality of esteem for vocational and academic students, something that the Bill is designed to achieve. Even more importantly, it is about supporting colleges in ensuring that students of all faith backgrounds and those of no religious faith are enabled to explore—and challenge where appropriate—their faith background. The exclusion of faith from college campuses makes students more vulnerable to outside influences, which can sometimes be extremist, with all the potential dangers that that has for social cohesion and even security. It is when educational institutions celebrate and validate faith—in festivals and chaplaincies, certainly, but also in their overall provision—that students are encouraged to reject extremism and develop a sense of real meaning and purpose in their lives, with values appropriate to our multi-faith society.
I turn briefly to the Mental Health Bill. There is undoubtedly a difficult balance to be struck between the rights and liberties of mentally ill people and the protection of the public. But the potential dangerousness of a relatively small number should not skew the conditions for the application of compulsory powers to a much larger group. To detain mentally ill people to impose treatment that does not have a therapeutic benefit in arresting or improving their condition risks turning psychiatrists into guardians of public safety, which is not their proper function. We should beware of using mental health legislation as a pretext for preventive detention.
Of course, we fully acknowledge that there is a strong case for some form of supervised treatment to deal with patients who relapse in the community, but the proposals in the Bill are too widely drawn. They need to be targeted on a smaller number of vulnerable and in some cases dangerous patients or they will be counterproductive in making it more difficult for community mental health services to engage with people who need care and treatment.
Finally, we regret that the Bill, in its predominant emphasis on public protection, fails to include earlier proposals for patients who are detained to have access to independent advocacy and that it fails to guarantee a right to assessment of mental health needs before a crisis is reached. Such provisions might have helped to avert some of the tragedies that have resulted from failure to heed the desperate warnings of patients and carers. In the end, we believe that public safety will be better served by effective and properly co-ordinated care than by unnecessary and damaging restrictions on liberty.
Lord Bradley (Labour)
My Lords, it gives me great pleasure to rise to speak for the first time in this House. I immediately thank noble Lords and those who serve your Lordships' House for their courtesy and warm welcome and the help and assistance that they have offered me and my family since I was introduced. I thank in particular my sponsors—the noble Lord, Lord Sheldon, of Ashton-under-Lyne, who I am pleased is in the Chamber, whose unstinting support for me as a resident in my former constituency will always be appreciated; and my noble friend Lady Taylor of Bolton, with whom I worked closely in the Government Whips' Office in the other place, where we had extremely happy times in spite of the idiosyncratic behaviour of some of our former colleagues. Her kindness to me during that period and since will always be hugely appreciated.
It is 19 years since I made my maiden speech in the other House as the first ever Labour Member of Parliament for the Manchester Withington constituency. I was proud of that achievement and now I am proud that Withington forms part of my title. This area of south Manchester has generally thrived over the past 10 years because of the stable economy, low interest rates and low mortgage rates, and because of the investment in public services—especially in new schools and new childcare facilities, in the educational field, and in many new health facilities, in particular the new Withington Community Hospital. Clearly there is much more to be done, with far too many parts of Manchester and other great cities like Manchester suffering from areas of poverty. I believe that this gracious Speech will build on the progress that has already been made in this respect as a result of excellent regeneration projects within the city, employment programmes and world-class events such as the Commonwealth Games, which are a tribute to Manchester City Council and the partners who have worked so hard to address those issues.
I wish to highlight a number of policy areas from the gracious Speech. But first I must point out that since the good people of Manchester Withington decided that I needed a long rest, I have been employed as a special adviser in government and public relations in the University of Manchester. It is a privilege to work directly for the president and vice-chancellor of the university, Professor Alan Gilbert, whose inspirational leadership has already made the new combined university a powerhouse within the city, within the region, nationally and, I believe, internationally. The mission to make the university one of the top universities in the world by 2015 drives all our efforts within the city. It also allows the university to contribute more and more to shaping and delivering public policy in this country.
The first commitment in the gracious Speech that I welcome is the aim to reduce poverty even further, both here and abroad. Significant progress has been made to reduce family and child poverty in this country, but, as I have mentioned, this work must go deeper and wider in our urban centres, such as the city of Manchester, if all sections of society are to benefit from relative economic prosperity. That prosperity must also extend abroad to places such as Africa, where abject poverty is an indictment on us all. I know that the recently established Brooks World Poverty Institute at the university, with the Nobel laureate Professor Joseph Stiglitz as its chair, will play a significant role in helping to shape this very important agenda.
Secondly, the continuing programme of educational reform is essential if the aspirations of our young people in Manchester are to be significantly raised. The continued rollout of the Building Schools for the Future programme, the proposals for academies, the 14-to-19 agenda and now, with the Bill already published, the reform of further education, crucially underpinned by high-quality pre-school and primary education, must be coherently organised and clearly accountable to parents with the needs of children at the forefront, if these aspirations are to be achieved.
I have some concerns in this respect, however, regarding the reorganisation of the Learning and Skills Councils at the regional level. In Manchester, in my view, there has been a failure: until recently the Learning and Skills Council has not properly been part of the planning process and the strategic direction of education within the city. I will look carefully at the Bill to ensure that the changes proposed do not undermine the council's renewed efforts to engage with the city and the other partners to bring about better educational standards there. Barely 15 per cent of 18 year-olds resident in Manchester achieve a place in higher education at any institution in this country. That is totally unacceptable. Again, the university will continue to play a key role in supporting all schools in the city by extending its excellent widening participation and leadership programmes.
Thirdly, as already mentioned, the emphasis in the gracious Speech on health is welcome. It was with great pleasure that I was recently appointed a non-executive director of the world-famous Christie Hospital, a specialist cancer hospital in Manchester. It has been, and will continue to be, at the forefront of delivering the Government's commitments on cancer services. We must ensure, however, that the 62-day target for treatment is met throughout the country. The Christie Hospital is at the hub of cancer care, particularly for Greater Manchester and the north-west. It is the centre of the cancer network for radiotherapy and chemotherapy. The latest plans for the Manchester Cancer Research Centre, a partnership between the hospital, the university and Cancer Research UK, will provide a world-class centre of excellence for basic, transitional and clinical research, and will more than double the level of cancer-related research activity in Manchester over the next five to eight years. Similarly, the bid for an academic biomedical research centre based in Manchester will further enhance this research activity. I am sure that the bid will be successful.
Finally, perhaps I may stray for a moment into the area of transport. The gracious Speech announced a draft Bill to improve public transport. Nothing would be more welcome in the city of Manchester than measures to stop the chaos and havoc that bus deregulation has brought and has inflicted on our roads in the city. The farcical situation we recently had where the logjam of buses almost led to each of them receiving a parking ticket in the city centre must stop. Further investment in our Metrolink system to provide high-quality public transport would also be exceedingly welcome.
In closing this maiden speech, I reiterate the honour and pride that I have in entering this noble place. As I have clearly shown, I will use this as a platform to champion and promote the city of Manchester and the north-west region. I believe that the people of Manchester deserve nothing less.
Lord Fowler (Conservative)
My Lords, the whole House would like to congratulate the noble Lord on his maiden speech and the manner in which he delivered it, and on the obvious love for Manchester that came through almost everything that he said. As well as education, he has a great knowledge of the health service—rather too much in my view. I see to my alarm that he was secretary of the Stockport Community Health Council between 1981 and 1987, which exactly coincides with the period when I was Secretary of State for Health. Although he did not quite say so, I know he feels how much better things were then than they are now. At least we had community health councils in those days.
The noble Lord had a very distinguished career in the other place from 1987, in which time he had a range of opposition and government jobs, all of which he did excellently. But I leave to last his greatest achievement. He was educated at Bishop Vesey's Grammar School in Sutton Coldfield. As Sutton Coldfield is a constituency that I represented for 27 years, I congratulate him on that. It is a fine school and it self-evidently has fine old boys. We very much look forward to hearing him again very soon.
It is always difficult with these broad debates to decide what subject to choose. I should dearly like to speak about pensions policy. I hear what the noble Lord, Lord Warner, said about the success of government policy. I would have preferred to talk about the destruction of occupational pensions, the ludicrous rule of compulsory annuities at 75 and the parliamentary commissioner's report which the Government have ignored. I would dearly like to have returned to the notorious
Instead, I should like to concentrate on an area where there are very few opportunities for debate and where all too often the whole subject is simply swept under the carpet. I refer to HIV/AIDS and sexually transmitted infection generally. I must say that I was confirmed in my decision to concentrate on that by listening to the replies by the noble Lord, Lord Warner, to questions this afternoon—rose-tinted replies which I fear would not be shared by very many people on the ground.
Perhaps I may summarise the position we face in this country. Currently, more than 70,000 people are living with HIV in the United Kingdom. On present trends, that number will go over the 100,000 mark in the next two or three years. Those who told me in 1986 that I was exaggerating the threat and over-reacting to it might like to reflect on those figures and on their breakdown, which show that there were almost 8,000 new HIV diagnoses in 2005. About a third of people with HIV do not realise that they have it. Gay men are at particular risk, quite apart from the heterosexually acquired HIV that is mostly acquired in Africa. There is now undoubted evidence that the safe-sex messages of the 1980s are being widely ignored.
In addition to the HIV figures, we have seen an explosion in other sexual diseases in the past 10 years. There were over 100,000 new diagnoses of chlamydia in 2005. That is a 20 per cent increase since 1996. There has been a 55 per cent increase in gonorrhoea since 1996, and a big increase in syphilis as well. As it happens, this is the 20th anniversary to the month of when I, with the support of a special Cabinet committee, launched our AIDS campaign, "Don't Die of Ignorance". We used television, radio and posters, and we sent leaflets to every home in the country. The results of that campaign were striking. Our follow-up reports showed that over 95 per cent of the public understood the danger of AIDS and the detail. Even more significantly perhaps, in a way, they also supported the Government by that proportion in mounting such a campaign. As far as the figures were concerned, our record compared well with that of other European countries, not only for HIV but for other sexually transmitted diseases, which came down.
Of course, we did other things, such as the clean-needle exchange for addicts, which brought HIV infection in that area permanently down. It is a great tragedy that other countries such as Russia do not follow our lead there. The irony is that we have known for 20 years some of the prevention policies that work. We have known how to promote good health and how to prevent infection. So with that knowledge, what has been the quality of our response in this country? Frankly, our response has been lamentable. I do not absolve my own Government from some responsibility here. But this is the Queen's Speech of this Government, and it is time to judge their policy. In all conscience, they carry a greater responsibility.
It took the new Government of 1997 four years to even publish a strategy, while all the time the figures were getting worse. It then took Ministers another three years to publish a White Paper, Choosing Health, in November 2004. Speaking personally, I was encouraged by what that White Paper said. I was encouraged that there might be new drive and new hope. I was encouraged that the White Paper recognised the Government's responsibility to young people. Above all, I was encouraged that new resources were to be devoted to this area. Between 2005 and 2008, £300 million was to be injected to improve sexual health services, including £50 million for a new national advertising campaign. That point was mentioned by my noble friend Lord Howe, at Questions today.
What has been the result? Ten days ago, the Government announced a new advertising campaign to combat sexual disease. It will cost not £50 million, or £40 million, or even £10 million. It will actually cost £3.6 million. There is no guarantee of more, and there is absolutely no guarantee of £50 million. I do not argue for a moment that the kind of campaign that I carried out 20 years ago could be repeated today. Time has moved on, and the challenge has developed. However, I argue that the scale of the campaign that we mounted was right. It concerns me that the scale of the current campaign is plainly inadequate and does not remotely match up to the challenge that this country faces.
I argue also that the overall strategy of the Department of Health over the past years has been wrong. You do not mount a high-profile, successful campaign in this area and then go off the air for the next two decades. Basically, that is what has happened. I deplore the inactivity and complacence that Ministers have shown and, most of all, I deplore the failure adequately to warn and guide people in this country.
Even worse in some ways has been the position regarding the spending of the other £250 million earmarked for improving clinics and better services. That spending was examined by the Independent Advisory Group on Sexual Health and HIV in its report of June 2006. The noble Baroness, Lady Gould, is chairman of that group. What did it find? Almost two-thirds of the primary care trusts surveyed had withheld some or all of their allocation for sexual health, primarily to reduce their financial deficits. Those deficits were not, goodness knows, caused by sexual health services; they were not remotely responsible. The group found that all aspects of sexual health covered by the White Paper had suffered. It found staff cuts, clinic closures and cuts in existing budgets, let alone extra spending.
The report was from an independent committee that was not, I suspect, prone to overstate its case. It summarised its conclusion in a sentence, stating:
"It is completely unacceptable that PCTs are inflicting such wholesale damage on sexual health services by withholding much-needed funding, just at the time when services need to be modernising to tackle the sexual health crisis".
That is the position and it is shameful. There is no ready-made lobby on health promotion that is ready to take to the streets, particularly in the area of sexual health, although I suspect that tens of thousands of young people would welcome good and objective advice in this area and that tens of thousands of parents would also welcome the fact that that good advice was being given.
We seem to have gone backwards in public debate in some ways. It was in 1916 that a royal commission was set up to look at the spread of venereal disease. It proposed clinics providing free, confidential and speedy treatment. Today, the crisis is great, but the response is broken-backed. There is only one way that the position can be changed—by a Government determined to see change, by Health Ministers backed by their colleagues. What is needed is political leadership and it is that leadership that this Government have failed to provide.
We are all accustomed to political arguments and debate, but this is a failure of policy that, frankly, makes me angry.
Baroness Walmsley (Spokesperson in the Lords (Education & Children), Education & Skills; Liberal Democrat)
My Lords, when the Prime Minister first came to power, he said that the first three priorities of his Government would be "education, education, education", yet his Government's mantra has been "legislation, legislation, legislation". I wonder when this Government will learn the lesson about genius, which is 1 per cent inspiration and 99 per cent perspiration. Similarly, good government is about 1 per cent good legislation and 99 per cent good administration. But there is a connection between the three main themes of this gracious Speech and that early promise. The solutions to crime, terrorism and immigration that the Prime Minister seeks to address in this Session of Parliament are, in fact, education, education and education.
First, on crime, all the research shows that children get involved in lawbreaking when they have a poor start in life or are disengaged either with their education or with society as a whole. The answer is to start at the very beginning—a very good place to start. I shall not sing that as I am sure that the Companion forbids me to sing in the Chamber. We must pool resources and effort into providing quality early-years settings, where children can build on their experiences at home, where parents are welcomed, where family support is available and where the individual child's needs are analysed and appropriate provision made. It will be a very good long-term investment and it does not need to cost more. We just need to spend the money differently and with a view to the long term. If we had the equivalent of the recent Stern environment report, contrasting the benefits of investment in early years with the cost of not investing, it would attract even more media attention and public concern.
Only this morning I visited a centre run by the charity I CAN, where young children with communication difficulties are being helped to overcome them so that they can benefit fully from their education. This organisation is seeking a strategic partnership with the DfES to promote speech and language development through schools and children's centres. The problem is widespread. Your Lordships will be shocked to hear that half of all five year-olds are arriving at school without the speech and language that they need to participate fully in their education. This is partly a 21st century environmental problem. Parents who do not have time for their children or who themselves watch a lot of television, childminder television and video and computer games are turning children into solitary non-communicators in many cases. I am not sure that the Government can do much about the causes but they could certainly do more to mitigate the effects by investing even more in the early years through multi-agency working and language therapy. The latter is vital for young people in custody, many of whom are almost inarticulate, as the noble Lord, Lord Ramsbotham, told us effectively in his debate a few weeks ago.
For children who have turned to crime, education is the answer too. I am very disappointed that this Queen's Speech has not included the youth justice Bill which many of us have wished for since the publication in September 2003 of Youth Justice—The Next Steps. Instead, more children are in custody, and the Government's programme means more ASBOs and conditional cautioning instead of more community sentences and restorative justice. This works for adults and young people alike, and we should be doing more of what works.
Of course, we should not keep most young offenders in custody at all, but the least we can do is give them full-time, high-quality education while they are there, with a proper expert analysis of their needs and drug and alcohol treatment where they need it. Then, when they are released, the National Offender Management Service should provide a seamless transition to an ongoing programme to turn around their lives. With so many young offenders reoffending, surely the fact that the current custodial regime is failing is crystal clear. How much money could we save on the criminal justice system if only we spent it on education? How much anguish could be saved for the victims of crime? How many young lives could be rescued if only we nipped offending behaviour in the bud before it became a habit?
For many of these young people, school failed to be a habit long ago. Truancy is commonplace in the backgrounds of many young offenders. Why? For many of them, school was a struggle right from the start. Class sizes were too large and their special needs were not recognised or catered for, so they switched off or found something else to do. We need more school/home co-ordinators to get them back into school. As I said in our debates on the then Education and Inspections Bill, we do not support a moratorium on special-school closures while a full review of special needs occurs, because we think that that would bring to a halt a lot of good things, but we believe that the statementing system needs a major overhaul. We need to iron out inequalities between postcodes and, although they initially rejected it, I hope that the Government will look again at the idea proposed by the noble Lord, Lord Dearing, and supported by these Benches—that needs analysis should be carried out by an organisation independent of the one that finds the money.
Although I welcome today's announcement about 77 more child psychologists, I am concerned about where they will come from and who will pay for their training, as I am aware that there has been some difficulty with the training changes for educational psychologists, for whom there is currently only an interim arrangement. We need a multi-agency professional team to support struggling families, not just a token number from one profession.
We need to ensure that the necessary money follows the pupil. The noble Lord, Lord Adonis, if he were here, would say, "Yes, but that is what we are doing with the academies. We are replacing failing schools with shiny new schools that are well funded and with the best staff we can attract, and we are allowing schools to opt out of their local authority and become independent trust schools".
I would say hooray to that if only the academies and trust schools were to be democratically accountable to their communities. I am delighted when extra resources are targeted at the children who need them most, both for their sake and for the sake of their classmates, whose own education is disrupted if a needy child is not being properly dealt with. I am also delighted when the business community brings its expertise into schools, but we do not need to hand over our schools to them with the democratic deficit that that entails.
Then there is the curriculum. Although this Session of Parliament has only one Bill on education, we will see the implementation of the Education and Inspections Act with the new national diplomas, which include vocational training alongside basic skills. While I wish that the Government had gone the whole hog and followed the recommendations of the Tomlinson report, I wish the diplomas a fair wind because that is all we are going to get by way of curriculum reform for a while. I hope that the pupils who were turned off by the old curriculum are turned on by this new one.
On the issue of terrorism, schools have a major role to play in community cohesion. The young July bombers were British, but clearly did not feel British. They were alienated. No child who feels that he really matters to those around him will turn into a suicide bomber. We need inclusive schools that celebrate all children and exclude none of them. That is why I would prefer it if there were no need for faith schools in this community. If every local school was a good school, where every child matters and his family culture is respected, the faith groups may not feel the need to run schools themselves. Religious teaching could be done in the home, the church, the mosque, the temple and the synagogue. Children of all faiths and none could get to know each other as friends and classmates.
This utopia is not available to us, of course. For hundreds of years the faith schools have been a valuable part of our education system and we cannot put the clock back. Although faith schools are not part of the problem of terrorism, I believe that they, as well as local authority-run community schools, can be part of the solution. In particular, I call upon all schools run by the faith communities to reach out to pupils of other faiths; admit them to your schools voluntarily; do what you can to attract them; show them tolerance by your own example; do not exclude them, I beg you. That way lies a divided society when none of us can lie easy in our beds.
Now as we begin the implementation phase of the Act, we need to encourage schools to grasp with relish and commitment their new responsibility to promote social cohesion, and give them every bit of support they need. I will watch with interest to see how Ofsted copes with monitoring how well they do it.
Thirdly, I mentioned immigration. Some schools struggle with numerous children with little or no English. Unless they address that, the children cannot fully benefit. The schools do a wonderful job, yet the burden of that task often leaves them languishing at the bottom of those iniquitous league tables. The most encouraging thing I have heard any Education Minister say in a long time was what the Secretary of State said last week about the need to re-evaluate what schools do in a more sophisticated way than through exam results. At last, someone has realised that exams and league tables measure only the quality of the intake. I hope that this Session of Parliament brings us a development in that direction. Of course, I point out that that is about administration, not legislation.
I see I have only one more minute, so I shall skip some of what I was going to say. Finally, I repeat the plea that I make every new Session for the Government to fully abide by their obligations under the UN Convention on the Rights of the Child; revoke their reservations about children in the services and in custody, and immigrant children; and to give children, at last, an equal right to protection from physical assaults as adults enjoy. Whatever happens in the way of Lords reform, I am not leaving your Lordships' House until this has been achieved.
Lord Low of Dalston (Crossbench)
My Lords, when I climbed up to the back of the Chamber the other day, the noble Baroness, Lady Howe, commented that I was brave to climb up all those steps. "Not half as brave as I'll need to be to open my mouth," I replied. My apprehension is tempered by my recollection of the warm and friendly welcome I have received from all your Lordships from the moment I entered this House—indeed, from before I did so. I hope I may count on your Lordships' continued understanding for at least a few minutes longer.
I place on record my appreciation for all the help and support I have received, both from your Lordships and from the staff of the House, which persuades me that there are few problems of access which cannot be overcome. In particular, I thank the noble Lord, Lord Morris of Manchester, and the noble Baroness, Lady Warnock, who supported me at my introduction into the House on
Though hailing originally from Scotland, where I spent the early part of my life, I have been exiled in England for the past 40 years, the last 16 of them in Dalston, whence I have taken my title. Dalston is in Hackney, recently voted the worst place to live in England, but never so bad that the London Borough of Hackney is incapable of making it worse with the enthusiastic encouragement of the Mayor of London, the Greater London Authority, the London Development Agency and the Department for Communities and Local Government. I might be thought to be verging on the controversial were I to proceed much further down this track, but I have detected some interest among your Lordships in London planning and housing issues, and so hope that we may have an opportunity of discussing them further before too long.
My appointment has rightly been described as a singular honour, and of this I am deeply conscious. What has given me greatest pleasure, however, is the way so many people have seen it as recognition not just for me, but of blind and disabled people generally. One person went so far as to say that it was "a great honour for every blind person in the world". However that may be, I hope I may add a little to the diversity of your Lordships' House.
In actual fact, so far as concerns me, the honour is not quite singular. There has been some speculation that I am the first blind person to sit in your Lordships' House, but this is not the case. The late Lord Kenswood, an early president of the National Federation of the Blind, and the late Lord Fraser of Lonsdale, for many years the distinguished chairman of St Dunstan's and the founder of Talking Books, both had wide-ranging public careers and sat in this place within living memory. With the aid of the History of Parliament Trust, I have been able to trace four more blind Peers, going back to medieval times. No one is able to say that there may not have been more.
Of course, other notable blind people have occupied prominent positions in public life. We know this, in our own day, from the remarkable example of David Blunkett, whom I salute. I like also to think of Henry Fawcett—perhaps because, for the last 10 years of his life, he was MP for Hackney—who, as Postmaster-General, introduced the parcel post in the 1880s.
The blind have a long tradition of independence and activism in pursuit of better conditions. The National League of the Blind, a trade union representing blind people in sheltered employment, was ahead of its time in organising a march from the north of England to London in 1920, which was instrumental in securing the Blind Persons Act of that year. Things have obviously improved for blind people since then in a number of ways, but the fact that some people are apparently undaunted by blindness should not be allowed to disguise the fact that many are severely set back by it and remain in a condition of considerable deprivation, isolation and social exclusion.
Indeed, it sometimes seems as though the conspicuous success of some highly visible blind people in overcoming their disability can lead to the deleterious impact of blindness on a person's life being downplayed in public consciousness and official thinking. This takes no account of the costs entailed, the toll taken in overcoming the difficulties or the insuperable obstacles they present for the much larger number of less visible people who are not so successful in overcoming them.
There is a paradox here: 86 per cent of people questioned in a recent survey said that sight was the sense they most feared losing, but much research confirms that, in the public consciousness, disability is largely conceived of in terms of physical disability, especially that which affects mobility. This probably has to do with the fact that, though feared in the abstract, sight loss is so grossly underestimated as a likely contingency as not properly to count as a disability at all. In the same survey, over half of those questioned estimated their chances of becoming blind as less than one in 1,000, whereas for the population as a whole the chances are more like one in 60, one in 12 for those over 60 and one in six for those over 75. It would be surprising then if something of this did not translate into official policy and practice.
There are two general points to be made here. First, though I have been a campaigner for inclusion and the mainstream provision of services all my life, we have to recognise that one size does not necessarily fit all. The loudest advocates of mainstream provision are usually the vocal and articulate elite who can cope best with it. We need a continuum of provision, including some specialist provision, especially in education and employment opportunities, attuned to the diverse needs of those who find disability more debilitating. Secondly, noble Lords may wonder why I have spoken so much about blindness and not about disability. The blind have some important interests in common with other disabled people—to be included in society, not to be discriminated against and to be involved in shaping their own destiny—but they also have important needs that are peculiar to the condition of blindness, notably the need for information in a non-visual form and for an environment largely designed for those who can see to be mediated for those who cannot. This is no small requirement, considering how critical the sense of sight is to man's interaction with the natural world and the world he has constructed. Couching everything in terms of disability has led to the central importance of sight being obscured in recent decades so that there is now a pressing need for blindness to be raised higher up the political and social agenda.
Blindness is one of the severest disabilities, yet under the Fair Access to Care Services framework of eligibility for social services, the needs to which it gives rise are rated only moderate to low. That effectively means that the blind get no service. Although research has shown that visually impaired people have greater difficulty with independent mobility than disabled people generally, they still only qualify for the lower rate of the mobility component of the disability living allowance.
Failure to bear in mind the needs of the blind reaches farcical proportions in the plan to lower pavements and remove barriers at traffic hot spots so that motorists and pedestrians will be more aware of one another and can demonstrate that awareness by means of eye contact.
Technology is a great force for inclusion, and we can now access much information that was formerly a closed book, but if the needs of the blind are not kept in mind when designing new devices, it can be just as great a force for exclusion—try operating an iPod, a touch-screen or a digital radio with your eyes closed. Most worrying of all, unless someone comes up with an accessibly electronic programme guide p.d.q., digital switchover will mean digital switch-off for the visually impaired population.
Ninety per cent of employers say that it would be difficult or impossible to employ someone with a visual impairment. As a result, scarcely over one-third of those of working age are in work. The proposals to move people off welfare and into work, referred to in the gracious Speech, are thus very welcome. Blind people do not want to be written off on welfare if there is a realistic prospect of their being found work, but the Pathways to Work pilots have not delivered for the visually impaired. The fact, which emerged in Committee in another place, that the £360 million allocated for rollout represents a real terms cut of 40 per cent does not inspire confidence. But we want rollout to work, and we will be looking to the Government to deliver on their promises for visually impaired people.
When I began my law studies over 40 years ago, someone said that where judges had to find a solution for every difficulty, academics would find a difficulty for every solution. My aim in this House will be to attempt to find solutions rather than difficulties.
Lord Morris of Manchester (Labour)
My Lords, the debate has been hugely enriched by a speech of high distinction from the noble Lord, Lord Low, and I count it a privilege to follow him. We have been friends for 35 years, working in increasingly close rapport to improve the status and advance the well-being of disabled people here and across the world. I have heard many speeches, both here and in the House of Commons, that were informed by his expertise. So it was with delight that today I heard him deploy his expertise in a parliamentary speech of his own. It was deeply moving—a speech of sparkling humour and excelling sincerity—and I congratulate him. The whole House will, I know, want to hear from him often again as the parliamentary Session unfolds.
An aphorism familiar to us all is:
"By their deeds ye shall know them".
I recall it now because in 1978, when I was the Minister for Disabled People, I appointed Colin Low, as the noble Lord then was, to a committee of inquiry into disability discrimination from whose landmark report all our legislation on disability rights lineally descends. Adapting the aphorism for Ministers to "By their appointees ye shall know them", I am wholly content to be known by that appointment. The noble Lord speaks with unquestioned authority on disability issues, a policy area in which, as he knows, I speak as a serial legislator. Thus I want briefly now to add to what he said.
First, I thank Caroline Ellis and Graham Nickson at the Disability Rights Commission (DRC) for the customary excellence of their briefing for this debate. None of us today—and many other noble Lords will have had their briefing—can possibly do justice to the range of informative comment it provides relative to the gracious Speech. And yet, none of it should go unheard and unseen by Ministers as they strive to turn precept into practice in implementing their legislative programme. Indeed, what bliss there would be if my noble friend Lord Hunt and I swapped briefs. His winding-up speech today would be widely acclaimed, while as an old ministerial hand I would know exactly how to deal with his brief.
The DRC's findings make disturbing reading. For example, even such basic healthcare as cholesterol tests and statins for those with heart conditions are delivered less often for people with mental health problems than for non-disabled people. This is despite annual health tests being incentivised through GP contracts. For people with learning difficulties who have diabetes, even their body mass index is checked less often than that of non-disabled people with diabetes. Similarly those who have had a stroke received fewer blood pressure checks than other stroke patients; and the same scenario is repeated with low cervical and breast cancer screening rates.
While documenting wrongs done to disabled people, the DRC also points the way forward with eminently sensible recommendations, not only on inequalities in health provision but in human rights. Others deal with transport; housing, about which my noble friend Lady Wilkins spoke to such good effect in the debate on last year's Queen's Speech; further education; and independent living, on which my noble friend Lord Ashley sought so ably to legislate earlier this year.
I urge Ministers also to take full note of the highly informative briefing for this debate from the National Rheumatoid Arthritis Society with its emphasis on the grave underfunding of local service provision for people with inflammatory arthritis, to which I hope the Minister will respond. I trust he will respond as well today to the plea of the Royal National Institute for Deaf People to help the many people now waiting for more than two years for digital hearing aids. I ask him also to respond to the concerns of the British Academy of Audiology about the serious consequences for patients of the Department of Health's failure to consult the professional organisations when setting up the Independent Sector programme.
Other findings worthy of a ministerial response in this debate are those of the Snowdon Survey 2006 on the denial of equal opportunities for disabled students in further and higher education, due to lack of funds and inadequate support services and advice. Happily, one of the survey's recommendations has already been acted on in the announcement last week on making further education free for under-25s. As a founder trustee and now vice-president of the Snowdon Award Scheme, I trust this can be taken as a good augury of further positive action to come on its findings, one of which is that students with severe visual, hearing or mobility impairment, although they make up only 10 per cent of all disabled students applying for higher education courses, account for 80 per cent of applications for Snowdon awards.
Turning from unmet need to what has been done, I congratulate Ministers on the major advances made in improving provision for disabled people. Only under them—I refer not least, indeed especially, to my noble friend Lady Hollis—could the DRC's new agenda on priorities for change have evolved or its many successes been achieved, because it did not exist until this Government came to power. Nor could the Special Educational Needs and Disability Act 2001, in whose enactment my niece Estelle, Lady Morris of Yardley, had such a leading role. The Government's achievements include, among others, the extended coverage from 2004 of the Disability Discrimination Act 1995, significantly improving protection in employment and occupation as well as access to services. For all this, I am grateful, as I am, too, for the inclusion in the gracious Speech of the new Mental Health Bill, to which my noble friend Lord Warner referred. The Mental Health Act 1983 needs to be updated urgently; and I am extremely glad that my right honourable friend Rosie Winterton, the Minister of State for Health Services, is promoting the Bill. No one is more certain to listen and respond to constructive points made in this House than she is, as her success with the mental capacity legislation so clearly demonstrates. She is a Minister who has proved herself to be eminently worthy of trust.
As Ministers know, I was much involved in originating the call for a United Nations Convention on the Rights of Disabled People, and I hope that we may hear before the debate concludes that when the time comes, probably very soon now, Britain will not only act quickly to ratify the convention but will even—not inappropriately—be the first to do so. What the convention underlines is that there is still a long unfinished agenda of unmet need worldwide: one that only the closest possible working together of statutory and voluntary agencies can meaningfully address. With others on all parts of this House—and most certainly with the noble Lord, Lord Low—I shall be doing all that I can to ensure the success of that endeavour.
I conclude by paying tribute to the earlier maiden speech of my noble friend Lord Bradley, who for 10 years represented my native city with me. I had to wait until my 23rd year in the House of Commons to hear his maiden speech there, but here in your Lordships' House I have achieved it in my 10th. It was well worth waiting for, and I congratulate him on a memorably effective maiden speech.
Lord James of Blackheath (Conservative)
My Lords, I am still such a new boy here that I do not know where to stand on the Bench, although I may not be a new boy for very much longer in the sense that I can still regard the House from the same perspective as the vast majority of the citizens of this nation. That means that, never having set foot in this Chamber before my introduction, I have now witnessed first hand—I would almost say that it has been a revelation—the wealth of experience, the depth of knowledge and the fierce independence at work in this Chamber, which are almost certainly beyond the recognition and appreciation of the wider British public. It would be a tragedy if the public discovered what they had had only by losing it. Yet they depend on this House to provide vital safeguards to the liberties and workings of the British constitution without in any way understanding the vital role played by your Lordships. Perhaps someone needs reminding of an old American saying, which can be paraphrased as, "This ain't broke. Don't try to mend it". I thank all noble Lords and the wonderfully helpful staff for their extraordinary warmth and kindness in helping all us new arrivals to begin to feel comfortable.
It is gratifying that both the Government and the Opposition appear to support a broad commitment to sustaining funding for the National Health Service at levels equal to, or even enhancing, current allocations from fiscal revenue. This accord, however, should not be taken as a licence for the National Health Service and all responsible government officers to depart from diligently seeking to curtail unnecessary expenditure wherever it can be identified. This brings us to the interesting case that arises from the gracious Speech. I can refer to it only by echoing Sherlock Holmes's famous piece of evidence as the mysterious case of the dog that did not bark in the night.
Before the last election, the Government undertook considerable work with their own Gershon report, which sought to identify potential areas of cuts and economies to reduce the cost burden of the National Health Service on all taxpayers. Separately, the Opposition undertook a parallel assessment of potential departmental savings. I had the privilege of chairing that process on behalf of Michael Howard, who, from the outset, was adamant that the aim was not tax cuts but a programme of bureaucratic simplification that would improve efficiency of service delivery and release funding for redeployment elsewhere in the NHS.
The James report broadly supported Gershon's assumption of £6.5 billion savings for the NHS, but added another £1.5 billion of its own recommendations, making a total considered achievable of just on £8 billion, which was a buffer that one might expect the Government to be able to employ to compensate for any overruns on their NHS budget calculations. Instead, perhaps surprisingly, in the year since returning to power the Government have embarked on a radical series of direct cuts to the NHS, which directly affects nursing levels, will close beds and hospitals, and will do virtually nothing to improve service delivery for the taxpaying public. Action is urgently needed. The finances of the NHS are getting progressively worse as we wait.
The NHS has been suffering an ever-worsening financial crisis for years, with a decline from a surplus of £96 million in 2002-03 to the predicted deficit of £650 million in 2005-06, which is the worst figure in the history of the NHS. As a result of the NHS financial crisis, patients are suffering. It now looks like a most brazen and cynical act for the Government to have claimed that the Conservative-proposed economies were aimed solely at funding tax cuts, while seeking to fund budget overruns due to their own NHS mismanagement by simply slashing 9,000 staff from the sharp end of delivery in NHS hospitals and so ignoring the better way that was set out for them by their own Gershon report. North Staffordshire has been hit with the loss of 1,000 staff; Worcester has lost 720; Durham and Darlington have lost 700; Norfolk and Norwich have lost 700; West Hertfordshire has lost 700; and the Royal Free Hospital in Hampstead has lost 480 staff. Yet the Secretary of State for Health, to justify these cuts, claims that deficits are arising in such areas, which are healthier and wealthier. That must be a big comfort and probably an even bigger surprise to the citizens of the locations that I have just listed.
The financial problems of the NHS are of the Government's own making. The Government underestimated the costs of their new staff contracts by almost £500 million, failed to provide the NHS with its central price list of treatments for 2006-07 until just 10 working days before the start of the new financial year, and allowed local NHS bosses to freeze the NHS budget in real terms in order to recover the deficit. As a result of this financial mismanagement, productivity has declined by up to 1.3 per cent in each of the years since this Government came to power in 1997—a record about which we do not hear much boasting.
The dog that did not bark in the gracious Speech is that nothing was said to commit the Government to revisit and implement the most achievable and constructive cost-saving strategies for the NHS resulting from even the recommendations of their own Gershon report, even without the Conservative additions. The Opposition rightly took the view that this issue was too important to become mired in party politics. They were prepared to offer the Government every assistance to achieve positive benefits for taxpayers. Accordingly, the Opposition decided freely to offer the services of their advisers, together with their working papers, to support and assist the new committee of senior government officers formed under Gershon's successor, John Oughton, to review the Gershon and James reports with a view to implementing a programme for further NHS cost savings.
The Queen's Speech was completely silent on any resumption of the process of John Oughton's committee or any acceptance of the need for progressive and further economies to balance the books of the NHS. Just continuing fully through the implementation of parts of the recommendations would have produced already more than enough cash savings to avoid the 9,000 staff losses that have been inflicted on the locations that I noted.
We argued for the abolition of strategic health authorities: there was a reduction from 28 to 10 at the beginning of July. We also argued for a reduction in the number of primary care trusts, which fell from 303 to 152 at the beginning of October. So the basic strategy for economies was clearly accepted. Yet these reforms were intended to reduce headcount by 30,000 and to yield savings to spend on patient care of more than £1 billion. I neither see the restructuring costs of 30,000 fewer bureaucrats nor notice the NHS benefiting from an improved cash flow of £1 billion.
We also suggested a significant reduction of over 1,000 staff at the core Department of Health. Just two weeks ago, the Minister of Health reported to the other place that the department had indeed achieved almost that reduction since 2003—yet with only 24 redundancies made in 2004-05 and just eight last year, noble Lords may ask what has happened to the rest. In the spirit of redirecting resources to the front line, a policy supported by this Government, those bureaucrats, secretaries and press officers must have all been retrained in record time, perhaps as brain surgeons or anaesthetists—or, horror of horrors, are the missing heads now to be found lurking somewhere in Whitehall as perhaps a new department for setting and monitoring silly targets and useless statistics?
Implementation of the full sequence of these and similar savings now would release the same funds to be recycled to provide for the proper business of nursing the sick. Funding would become available for investment in vital life-saving equipment and costly medication and adequate levels of pay could be maintained to ensure continuity of appropriate numbers and quality of nursing staff. The proposed Gershon cuts alone would have freed revenue sufficient to double the pay of the entire nursing population of Great Britain. I would not suggest that it be used for that, but at least a proportion of it would have saved the 9,000 jobs whose loss has afflicted so many of the areas that we have talked about. The already overstretched number of beds available in the UK could have been maintained, we would have avoided the inflationary effect that will be an inevitable consequence of maintaining redundant levels of bureaucratic overhead, and medical staff would be released from unnecessary bureaucracy to apply their skills where most needed—in treating the sick.
We are here concerned literally with protecting both the health and wealth of this nation. It remains a subject too important to suffer from the confines of party politics and I urge the Government to consider not only reactivating the Oughton committee, but also embracing the offer of help from the Opposition with regard to the data and accompanying analyses that surrounded their own recommendations. The Opposition should not be too proud to offer help and the Government should not be too proud to accept it.
Finally, I thank noble Lords for listening to me on the first occasion that I have addressed the House. The last piece of advice that I received from a friendly noble Lord on arriving here was given when I asked him how I should properly avoid contentious matter in my maiden speech, and how would I be able to judge whether I had succeeded. His reply to me was this: "Just remember the advice of Sir Harry Lauder about performing at the Glasgow Music Hall on a difficult Saturday night. He said, 'If you do not offend them too much, they usually let you live'". I thank noble Lords for their courtesy and patience, and hope to live and debate among them for many years to come.
Baroness Sharp of Guildford (Spokesperson in the Lords (Further & Higher Education), Education & Skills; Liberal Democrat)
My Lords, it is a pleasure to follow the noble Lord, Lord James of Blackheath, and to congratulate him on his excellent and very stimulating maiden speech. The noble Lord has had a most distinguished career in the City of London and in that respect he will contribute greatly to the deliberations of this House. He is also well known for his restorative powers, not least to ailing institutions; the Millennium Dome can be mentioned in this respect. He has already shown us how his quick analytical powers can cut through the problems of the National Health Service. It is perhaps significant that he has arrived here at a time when the Government are of the view that the composition and functions of this House need a fundamental overhaul. I have to say that it was gratifying to hear that his initial reactions at least are that this House works efficiently and well. However, I am sure that in this and many other ways, he will make a very substantial contribution to the workings of the House and we look forward very much to hearing from him in the future.
My contribution to this debate will concentrate mainly on education. Like my noble friend Lady Walmsley, I was somewhat depressed to see yet again in the gracious Speech that the programme of legislation was dominated by issues of law and order. The more repressive we are, the less we seem able to control the underlying problems of terrorism, crimes of violence, binge drinking, wanton vandalism and hooliganism. My noble friend quoted the soundbite on which this Government came to power: "Education, education, education". They also used another soundbite: "Tough on crime, tough on the causes of crime". No one will deny that they have been tough on crime but many will feel that they have been rather light on the causes of crime. Certainly so far as education is concerned, they have not really hit on the causes of crime.
As my noble friend indicated, the pattern is well known and well documented: those who fall behind in school find it difficult to catch up. Roughly one in eight children leaves primary school without an adequate grasp of reading or maths to cope with their secondary school education—that is three out of every class of 25. In secondary school, they fall further behind. Eventually, those three out of 25 are likely to truant and drop out of school completely. Then they join the 16 to 19 year-olds known as the NEET group—not in education, employment or training. There are 200,000 young people in the NEET group and it is an indictment of the education policies of this Government that in nine years they have failed to shift those numbers.
Without a job, and without education or training to qualify for a job, it is all too easy for those young people, when they are desperate for money to buy themselves the toys that so many young people have, to fall into a life of trading drugs and crime. We know that this is the cause of much of our crime and the more we can do to prevent these failures, the more we can do to limit the new entrants into crime. My noble friend stressed the importance of trying to stamp this out at an early stage and she instanced a visit she paid this morning to the I CAN initiative.
In a Question on
"In educational terms it's an extremely expensive initiative—paying a highly trained teacher half-time costs around £20K a year—and only a handful of pupils benefit. But what you've got to look at is how much those pupils benefit, and also at what the cost would be to society, in the years ahead, if they hadn't mastered literary skills at this stage".
We should remember that the cost of keeping one young person in a young offender institution is now approximately £60,000 a year, leaving aside any costs that they may have caused to society through vandalism, hooliganism, court procedures and so on. On this basis, saving one youngster from a life of crime is very much worth while, but that half-time teacher at £20,000 a year will save not only one young person but probably anything up to a dozen a year. Therefore it is eminently worth while. Sadly, with parliamentary terms averaging four years, taking account of the long term is not one of the strengths—indeed, it is one of the weaknesses—of our form of government.
The only mention of education in the gracious Speech related to the Further Education and Training Bill. It stated:
"A Bill will be introduced to reform the further education system so that it can better equip people with the skills that they and the economy need".
At this point I should declare an interest as a member of the Corporation of Guildford College.
More specifically, the Bill will be concerned with the restructuring of the Learning and Skills Council, aligning it more closely with the regional development agencies and putting more emphasis on employer involvement and matching local training provision to local employer needs; it will give degree-awarding powers to some further education colleges to encourage the expansion of the two-year foundation degrees; and it will give the Learning and Skills Council powers to intervene to remove principals from failing colleges where their boards of governors fail to act.
I do not want to say much about the first or the third issue. On the restructuring of the Learning and Skills Council, I point out that when the Learning and Skills Act 2000 was before this House, we on these Benches argued strongly in favour of aligning the operations of the 47 local learning and skills councils with the RDAs. That is, in effect, happening, and I am glad that the Government have finally learnt from the wisdom of our arguments.
Nor do I wish to say much about the proposals for the dismissal of principals. As they stand, the proposals go well beyond the powers of intervention provided in the Education and Inspections Act 2006 for local education authorities to intervene and remove the head teachers in failing schools. The powers proposed for further education colleges are disproportionate; they are also unnecessary. There are many cases where governing bodies have dismissed principals or persuaded them to step down. In this respect, the proposals also undermine the independent status of these boards. This is hardly an encouragement to the industrialists to join the boards, yet given the need for colleges to get closer to employers, those are precisely the people we want to encourage to join the boards of further education colleges.
Coming from a higher education background, I was initially somewhat unhappy at the proposition to extend degree-awarding powers to further education colleges. Many colleges already work closely with universities—in fact, 11 per cent of higher education is performed in further education. The collaborative links are already great, with the further education colleges being accredited by the universities. Equally, some of the large further education colleges are substantially bigger and more specialised than some of the smaller higher education institutions—the former teacher-training colleges—which now have degree-awarding powers. It will ultimately be for the Quality Assurance Agency and the Privy Council to decide who gets the degree. It is very important that the QAA maintain its rigorous accreditation procedures.
We on these Benches have long argued that Britain badly needs a move towards a national system in which degrees are awarded on a modular basis, with credits acquired for work done, and are transferable from one institution to another. The former CNAA—the QAA's predecessor—introduced a system on that basis. The Open University and many other modern universities work to the system of having 360 credits for a bachelor's degree, but many older universities are holding out against it. Until all agree, the system will fail to gain general acceptance.
Such a system lends itself to what the Government are hoping to introduce through the foundation degree—namely, what we would call a "way stage" qualification. One year's credits lead to a certificate of higher education, two years to a diploma—equivalent to the old HND—three to a general degree and four to an honours degree. It makes a lot of sense at a time when we are trying to increase participation in higher education among those not traditionally attending university. You can offer the individual considerable flexibility: they can study part-time, put a toe in the water, get a feel for it and, if it works, they can continue and build up gradually. In this respect, the foundation degree moves in the right direction.
We have two reservations about what is proposed. First, the system needs to encourage close collaboration between the university and college sectors. It is easy to envisage colleges, especially for part-timers, providing foundation courses for first or second-year degrees. But they could also mix and match so that for some courses you would attend your further education institution and for others you would go on to the local university—and do others still by distant learning. You could put the whole lot together. We are not sure that giving colleges degree-awarding powers does not encourage more fragmentation of the system rather than this clustering and collaboration that we hope to see.
The other problem is that if one wants to encourage part-time study and to try to pull in some of those who have not traditionally participated in higher education, part-time is very important, yet the Government continue to discriminate against the part-time student. Although grants have improved over the past few years, part-time students still have no access to the loans now available to full-time students. They have to pay their fees up front; they have very limited access to grants for books or travel, let alone for maintenance, and the 16-hour rule means that if they lose their job and go on to benefits they can study for only 16 hours a week. Foundation degrees could be a very important way forward, but to date they have not proved very attractive to students. They were introduced five years ago, and we still have only 50,000 students signed up to them.
My message to the Government is that if they want foundation degrees to be regarded as a mainstream route into higher education, they must give part-time study far more priority than they do at the moment.
Baroness Butler-Sloss (Crossbench)
My Lords, I express my thanks for the very warm welcome that I have received in this House and the endless kindness of the staff in helping a new girl to find her way around a bewildering place. The three and a half miles of red carpet in the Royal Courts of Justice was something of a challenge, but in the past few weeks I have found myself equally challenged here, although staff have been incredibly kind in pointing me in the right direction. However, the carpet, which I was told was the indicator, is not always helpful because between the Chamber and the Royal Gallery it is a different colour, so I had a period of walking around wondering where I should go.
I was pleased to see in Her Majesty's gracious Speech a reference to,
"raising standards in schools to help all children achieve their full potential".
This is a pledge that I have no doubt we would all support. However, I should like to refer to a group of children who are signally failing to achieve acceptable standards in education: looked-after children, or children in care.
An excellent Green Paper from the Department for Education and Skills, entitled Care Matters: Transforming the Lives of Children and Young People inCare, published in October, refers at Chapter 5 to a "first-class education" but recognises the pressing need to improve the performance of this group of children. It acknowledges that children in the care system do markedly less well in examinations such as GCSEs than does their peer group. Such children have significantly underperformed at all stages of school life, so it is not surprising that a high proportion of children leaving care have major difficulties in obtaining employment and are ill equipped with the right skills and qualifications for their adult life.
There are many reasons for this, one of which may be the unsettled and unstable lifestyle they have endured before admission to care. Another reason is the inevitable upheaval of the move from home, and probably being moved several times. For some children there are multiple moves. I know of at least one child who was moved 40 times during her time in care. Each move is, of course, an upheaval. There is a need to meet new carers and other people, to get accustomed to a new home and new friends; there is the loss of what has become familiar, and, almost always, a new school.
The pattern for children in care is of movement, with a lack of stability and continuity. Many of these children have no single point of continuity throughout their time in care. Each looked-after child should have an allocated social worker. For many children the allocated social worker changes with frequency; for some, that happens every six months, if indeed a social worker is allocated at all. The failure of social services in many areas to provide the child with the continuity of a social worker, who could be a friend and support, is an indication and a sad reflection of the serious lack of social workers around the country.
Social workers have a poor image in society. They are damned if they do—that is to say, if they move a child—and they are damned if they don't. They are poorly regarded by comparison with nurses or teachers. They are at, or near, the bottom of the list of careers that young people would choose, or indeed that advisers would encourage. All local authorities have vacancies that are hard to fill. Some in the inner cities, such as London, may have vacancies as high as 70 per cent. Social workers in deprived areas, where more children are likely to be at risk, are understaffed, under-resourced, overworked and have far too many children allocated to them. Some social workers are at present not very well trained, and I support the social work degree course. Too many social workers are also leaving and not being replaced.
I make a plea to your Lordships' House for a new understanding of social workers, and a recognition of the extent to which their role is underappreciated. The work they do in the protection of children, as well as the care of the elderly or of those with mental problems in the community, is as difficult, sensitive and demanding as that of nurses or teachers. In particular, without social workers, there would be no front-line protection of children at risk other than from the police. I know some local authorities are recruiting from abroad, one at least from the United States. It is significant, in my view, that the career of a social worker in the United States is well recognised, well respected and well paid.
From my previous experience in the family courts dealing with children in care, I feel strongly about the need to improve the image of the social worker. That is why I have agreed to be a patron of a Conservative Party commission set up to investigate the status and role of social workers. I should happily support any other initiative that might lead to a reassessment and recognition of the importance of the work of the social worker. Public recognition of status should lead to improved recruitment and retention of social workers. The child in care might then be able to rely upon the support and friendship of the same social worker for a significant period of his or her time in care. That in turn should provide some help, both in settling the child in his or her placement and with improving ability and performance at school.
Baroness Massey of Darwen (Labour)
My Lords, I am delighted to be able, on behalf of the whole House, to congratulate the noble Baroness, Lady Butler-Sloss, on her maiden speech. It was typically penetrating, compassionate and challenging. It has provided me with a challenge in trying to say something different about looked-after children.
I have long admired the noble Baroness, Lady Butler-Sloss, from afar, and now she is a good deal nearer. We share similar interests in children and families, and I am delighted that she has joined us in your Lordships' House, where I know she will make a significant contribution to its work—and not just in the Chamber. The list of her achievements is enormous: practising barrister, High Court judge in the Family Division, and president of the Family Division until last year. Her work on behalf of children and families is extraordinary and well respected. She is chairman of St Paul's Cathedral Council, a governor of the Coram Family and Merchant Taylors' School, and chancellor of the University of the West of England. She is a DBE and a GBE, this latter honour so grand that no one I asked knew what it meant. It is not so grand, however, as her wonderful maiden speech today. We all look forward to hearing much more from her.
I was pleased that the gracious Speech reinforced the Government's commitment to supporting vulnerable groups in society and to examining the welfare system and reducing poverty. I shall speak today, as did the noble Baroness, Lady Butler-Sloss, about vulnerable children and highlight some of the issues that we need to address if we are to seriously implement strategies to improve their lives. I pay tribute to the Government for what they have done in the past few years to help the vulnerable and also to highlight the needs of children. I am pleased to have the noble Baroness, Lady Butler-Sloss, as an ally in this.
Now we must further improve welfare and reduce underachievement. I pay tribute to the many individuals and organisations, in the statutory and the voluntary sector, who have worked so hard to support children and young people. I have the privilege of chairing the All-Party Parliamentary Group on Children in this House. It is encouraging to find across your Lordships' House, and across both Chambers, such a dedication to making life better for children, young people and their families. The focus must be on the child—this is paramount. Sometimes, sadly, families and children need to be separated so that the child can flourish. It is time to look again at organisations such as the Child Support Agency and to give children a better deal.
Vulnerable children are found in many contexts, including the criminal justice system, asylum seekers, young carers and children in care. I should like today to focus particularly on children in care. I shall be referring to the new consultation document Care Matters a little later.
As a recent inquiry by the Children's Society points out, children's well-being in the UK is among the lowest in Europe, despite all the reports, legislation and policies. Once policies and legislation are implemented—and I want to emphasise today the importance of implementation—we hope to see a difference. But we need to watch for that difference and challenge things that get in the way of making a difference. I know that the children's commissioners across the UK and the children's Minister are taking a keen interest in how we make a difference to children's lives.
"The Government is committed to supporting multi-agency working to help support all children and young people to improve the outcomes they achieve in life".
A key issue, as pointed out in Every Child Matters, that seminal document, is the willingness and preparedness of systems which support children to work together. I ask the Minister how government departments are working together on children's behalf and how they are encouraging collaborative work across the systems.
The Youth Justice Board has prioritised the provision of education and training, health and mental health care for children in custody, but the systems make it difficult to offer consistent, targeted and meaningful services. A National Children's Bureau guide has said that plans for health and education are vague and not well explained to young people. I suspect the same is true when dealing with any vulnerable children. A Barnardo's report, Giving children back their future, says that educational underachievement in looked-after children has been well researched, but despite a long-standing recognition of the problem there has been no substantial improvement in recent years.
What can happen to these children is indeed shocking. Some 6,000 will leave care this year, and within two years of leaving half will be unemployed. More than 2,000 will be mothers or pregnant, and 1,200 will be homeless. They will be four times as likely to have mental health problems and three times as likely to end up in trouble with the law. Some, however, do well. The Barnardo's report highlights some positive outcomes. We would do well to study what works, as opposed to what goes wrong, across a whole variety of issues, vulnerable children being one of them. One thing that works is not just supporting children but giving them the skills to be assertive and confident and to develop their own protective factors.
I was delighted to see the recent consultation document Care Matters—Transforming the Lives of Children and Young People in Care; I hope that it will be taken very seriously once the consultation is over. Again, I am looking for effective implementation. The document makes it clear that there is an urgent need for reform, and it makes a pledge to children in care that care must be a positive experience and must offer everything that a good parent offers. It states that outcomes can be improved by support from a social worker, twice yearly health assessments for under-fives, annual assessments for older children, having an independent advocate and having influence on local authorities through participation in children-in-care councils. It is good to hear the voice of children in care being included.
We are looking to the systems that Every Child Matters recommended so powerfully: integrated care through health, education and social services. Other factors are key, and we could learn much from other countries. German children go into care for much the same reasons as do British children, yet the majority of those children go on to further education and jobs and have little trouble with the law. There is a big difference in Germany in the way that care homes are staffed and managed, with a reputation for good structures and good discipline. Over 95 per cent of staff in German care homes have a degree, and they are paid at a much higher level than their counterparts here. Thus, they avoid the constant turnover of staff that is so bad for children who need stability. There is a 30 per cent turnover here compared to 8 per cent in Germany. One child in England said, "They come and go and never say goodbye, just like my mum".
Neglect of these children, and of any children, is a tragedy, for both the child and society. Neglect may result in the reinforcement of the vicious circle of child neglect and underachievement. Neglect may result in criminality, substance misuse, violence, hazardous sexual behaviour and academic underachievement. I hope that every government department has its eye on the issue of vulnerable children and how to implement measures to improve their lives and to impact on the well-being of society. The Minister is sympathetic to these issues, and he will know that, having brought to the fore the fact that care matters, many of us will be watching carefully for effective strategies to benefit these vulnerable children and to see improvements.
Baroness Verma (Conservative)
My Lords, the proposals in the most gracious Speech sadly lacked any real substance in trying to answer the question that the Government are intent on leading with in newspaper headlines on the respect and responsibility agenda. At a time when the adult population in Great Britain is in over £1 trillion in personal debt, personal bankruptcies are on the increase, and a fear culture is developing around the presence of our young people, it is deeply depressing to know that while publicity-grabbing headlines make good reading, they fall incredibly short of actual solutions.
I recently met a group of student teachers who were training to teach citizenship classes. They all commented on the greyness of the range that they were expected to teach. While, ideally, it would be useful for children to learn respect and responsibility from home, it is difficult to imagine—given the circumstances surrounding many of our families today with low skills both educationally and vocationally, and given the increasing problems around drug and alcohol abuse—how this agenda, so trumpeted by the Government, will be delivered.
Most young people want structured and consistent lives. Short-term fixes and persistent attacks on parenting are not the solution. The group of student teachers whom I spoke to said that part of their role should be about real-life skills development, such as managing debt, organising budgets and knowing how to buy a first car or how to pay an electricity bill—just practical knowledge. While the parent at home can be sent to prison for having a child who persistently truants, the absent parent—in many cases, the father—seems to be absolved from responsibility. The Government have failed to reconcile the causes behind the behaviour that leads to truancy. The numbers of children truanting are seriously high. Deliberate absenteeism from school needs to be addressed.
The fabric and future of our nation depend on what we do for our young people. I have the good fortune to regularly meet excellent, foresighted young people who, like us, all have aspirations to be positive contributors to society. Not all are academic; some have great artistic talents, while others are hugely skilled in practical activity. All are a credit to our country, and it would bode well if we were able to celebrate equally their contributions as much as we highlight the difficulties that we have with some others of our young people. Consistently not seeing and addressing diversity at the head and heart of organisations results in a continued failure to provide role models for children from communities that do not see role models. That leads to alienation, absenteeism and a lack of full engagement in community and society.
Another area that distresses me greatly is the treatment of our most vulnerable, especially the elderly, when they are admitted to hospital. I declare an interest as a provider of care, predominantly to the elderly and disabled in our communities. I will highlight the poor nutrition faced by many in our hospitals. A recent case that was highlighted to me showed only too well how poorly nutrition is provided. An elderly gentleman who was admitted to hospital with a chest infection was left with food that he was unable to eat himself, and it fell to his elderly wife to make the trip twice a day to feed him. Untouched food trays are removed without any effort to assist people to eat. This elderly gentleman remained in bed all day long, and no attempt was made to move him to prevent sores. I could go on and on. Sadly, he passed away.
That is not a rare occurrence. We see many headlines about nutritional choice, but it is no choice if food lies by your bedside and you are unable to eat it. It is a poor choice if you go into hospital and leave either worse-off or with a new problem, such as bed sores or hospital-acquired infections. Many of our hospitals still fall short of the standards and levels of cleanliness that we all expect. We know that hospital staff do not always have the time to spend with patients to ensure that they have eaten. It is easy to talk up headlines. The reality is that too many people are unable to raise their voices and are too often being missed or, worse still, completely ignored.
Baroness Meacher (Crossbench)
My Lords, I begin by endorsing the comments made in earlier maiden speeches in recognition of the remarkable friendship that your Lordships have extended to so many newcomers, including me, in recent months.
I warmly welcome the Government's plans for a Welfare Reform Bill and their laudable objective to reduce by 1 million over 10 years the number of people claiming what are currently called incapacity benefits. I should at the outset perhaps explain that my interest in benefits, employment and mental health go back a very long way. Some 35 years ago, I produced the Child Poverty Action Group's first research report on the benefits system and, shortly after, edited a book on new methods of mental health care—albeit that those new methods look anything but innovative today. Since the early 1970s, apart from nine years with the Police Complaints Authority and four years in Russia working on the development of the Russian employment service, I have concentrated on employment and mental health issues in this country. I should also declare my current interest: I chair the East London and the City Mental Health NHS Trust.
Not surprisingly perhaps, I want to focus on the implications of the Government's welfare reform plans for the 50 per cent or so of incapacity benefit claimants who have mental health problems, 40 per cent of them as their primary diagnosis. As has already been alluded to, the cost to the Exchequer in benefits and lost taxes is huge—nearly £10 billion—and the social cost measured in misery is still more shocking.
The welfare reform programme has many positive features. As has also been referred to, the Pathways to Work pilots of the reform show a clear benefit for many in terms of earnings and employment. However, the pilots show no significant benefit for people with mental health problems. If the reform is to succeed, the barriers to employment for this sizeable group—about 1 million people—must be overcome. What, then, are these barriers?
The Social Exclusion Unit's report Mental Health and Social Exclusion identifies low confidence, low expectations and stigma as some of the key problems. The reform programme as it stands does not effectively address these barriers. Indeed, the new system, without adjustment, could make matters worse. Without the right support, anyone with depression or anxiety, or with more complex disorders, may fail to attend a work-focused interview, fail to pursue an action plan on time or fail to engage effectively in work-related activity, thereby risking financial penalties.
Probably the single most important reform to deal with all these barriers and risks will be the provision of evidence-based psychological therapies—notably cognitive behavioural therapy, although there are others, too. As proposed by NICE, these therapies should be automatically available to anyone suffering from psychological disorders. This includes people out of work and claiming the future employment and support allowance and people in work who are at risk of losing their jobs. All condition management, in my view, should become evidence-based psychological therapy delivered by well trained and supervised therapists. This will be a low-cost, high-return investment. Indeed the cost of £750 per person treated is small relative to almost any medical treatment for a comparable level of suffering. Moreover, it has been estimated that the resulting Exchequer gain due to the increased employment would fully offset the cost.
The second set of issues that I wish to draw to the attention of the House is the fluctuating nature of many mental disorders combined with the particular sensitivity to stress of this group of claimants. It is simply not realistic to treat people with mental health problems exactly the same as anyone else. These problems—the fluctuating disorders and terrific sensitivity to stress—also contribute to the lack of success of the Pathways to Work pilots with this substantial group, which numbers 1 million.
The majority of people with mental health problems receiving benefits may need to begin by taking temporary jobs. This is particularly true for those whose disorders fluctuate, but it applies more generally. Such is the stigma of mental illness that a permanent full-time job may be impossible to get, at least in the early stages of their return to employment.
Now we come to the problem—and it is a major one. At the end of a temporary job, the individual can expect to have no money for two to three months or more while their benefits are restored. The linking rules extended this year should have provided an answer. However, jobcentre staff whom I visited recently in the East End of London made it clear to me that my fears were reality—that the linking rules simply do not work and that, yes, claimants trying to restore benefits after a spell in employment would indeed wait months for any money. I ask your Lordships: how many of us could really cope with that situation?
The situation can be even more alarming with respect to housing benefit, which too often for people with mental health problems leads to threats of eviction and maybe homelessness. How many of the people whom we have seen on the streets have had their housing benefit denied? It is not surprising, then, that a mental health service user said to me recently that the prospect of taking a job was like "jumping off a cliff". He meant it. Yet people with mental health problems are not workshy—far from it. The majority want employment and are prepared to consider losing financially, within reason, in order to achieve it.
We need a system that enables this particularly vulnerable sector of our society to move smoothly and securely between benefits and work until they are settled and stable. To achieve this, I have proposed a register of claimants with identified fluctuating or severe disorders, for whom benefits would be speedily and automatically restored. I know that the noble Lord, Lord Hunt, for whom I have great respect, does not much like my proposal. If he can think of a better solution, that would be splendid. But a solution must be found if the Government's reform is to succeed—and I, for one, want it to.
Finally, Ministers often emphasise the importance of mental health, but their recent response to the financial crisis in the NHS leads me to question their commitment. Indeed, their response has been absolutely devastating to the mental health community. I give just one example. In August, the East London and the City Mental Health NHS Trust was required to produce £4.7 million within the year to help to pay the bills of other trusts, mainly acute trusts that have deficits. This has resulted in savage cuts to many services, including psychological therapies, thus undermining the efforts that will become essential to the success of the Government's welfare reform programme.
If the welfare policy is to succeed in restoring people with mental health problems to employment and normal lives, the Department of Health cannot afford to treat this section of the community as the least deserving. People racked by anxiety or depression need proper treatment, as we assume with any other disorder. They also deserve a benefits system that supports their return to employment, rather than one that presents hurdles that they are likely to fall over.
Baroness Turner of Camden (Labour)
My Lords, it is a great honour and privilege to congratulate the noble Baroness on her maiden speech, which I personally found extremely moving. Of course, I knew of her by reputation before she came here but I had not realised the depth and width of her experience, nor the fact that she was the author of some well known publications in the area of mental health. We have often discussed that subject in this House. We look forward to hearing more from her and I am very glad to welcome her here. It is delightful to see her and I thank her very much for what she said this afternoon.
It is clear from the Queen's Speech that one of the most important Bills in the new Session will be about pensions. It seems that there is a fair degree of consensus about what needs to be done. Many of the provisions will arise from the Turner report, which was widely welcomed. However, I remember that back in the 1970s there was cross-party agreement on the Castle plan, which introduced SERPS. I believe that that scheme was probably the best attempt that we have ever made to ensure security in retirement for working people.
Unfortunately, successive Governments undermined SERPS and worsened state provision by detaching the basic state pension from the wages index. For a number of years, we believed that we had the best pension provision in Europe because of the growth of occupational pensions, many of which provided pensions based on the final-salary formula. However, as we know, those who retired during that period with pensions related to final salaries were the lucky ones, and many who were expecting to do so as well have been gravely disappointed. Moreover, those without adequate private or occupational pension provision have become increasingly dependent on means-tested benefits. Although pension credits have been of great benefit to many pensioners, they are means-tested, and that inevitably means that many who should have them do not, for various reasons.
It is becoming increasingly obvious that the worst sufferers under the present system are women. The reasons for that are well known: pension entitlement is related to contributions paid and normally that involves full-time employment. Many women have a broken work record, and therefore less than 30 per cent of women receive a full basic state pension in their own right. The Government have attempted to deal with that via home responsibility payments. Perhaps it has been thought that, as more women are encouraged to return to waged employment, the problem will gradually be sorted out over time.
The White Paper has made further moves towards helping women and those will no doubt appear in the Bill. Of course, it will assist if the number of years' contributions leading to entitlement to the BSP is shortened for both women and men. The question nevertheless arises whether these moves are sufficient, taking account of the pattern of many working women's lives.
It is, however, good to learn that the Government have at length accepted that the basic state pension should rise in line with the wages index, although pensioners will have to wait for that until 2012 and there will therefore be no immediate benefit to present-day pensioners from this change of policy. Had the policy been in operation, as Barbara Castle originally intended, the basic state pension would now be worth about £135 per week. That could have meant fewer people being dependent on means-testing.
I have always been opposed to means-testing. Many older people find it humiliating. Often they find it difficult to claim, and that accounts for people who are eligible for pension credit not getting it. It also tends to discourage savings. The argument against increasing the basic state pension to an adequate level has always been that it would simply benefit the better-off, who already have good private provision. My answer to that has been that this could be corrected via the tax system—the better-off would simply pay more tax.
The Government still seem to have concerns about affordability. It has been suggested that the increased cost of linking the BSP to the wages index could be borne by increasing the age at which the basic state pension is paid, and to do so in stages. I understand that there is an argument for this, as the expectation is that everyone will live longer, but I question whether it is a good idea for all employment. Many would like to continue working; others are only too glad to leave, possibly for lighter work, should it be available, but there are clearly industries—part of the construction industry, for example—where not only older workers but their co-workers might be at risk.
The Government are clearly concerned that people do not save enough for retirement, and are anxious to encourage them to do so. It has to be recognised that many people find this difficult. Many people in mid-life, and younger, already have substantial debts; housing costs are very high; and there is a shortage of affordable housing in many large cities, notably in London. Recently the Financial Services Authority announced concerns about the willingness of mortgage lenders to lend up to five times a joint annual salary, and sometimes more, to people buying houses. That means an awful lot of debt. Younger people who have been to university are often in debt as a result of fees which have to be paid. If there are children, the wife may not be working. To a number of people, the need to save for retirement may not look like a very pressing requirement.
The Government therefore intend to introduce personal pension plans into which employees can be automatically enrolled—with the right to opt out—with a compulsory employer contribution of a minimum of 3 per cent. I understand that there will be 1 per cent tax relief and that the employee will pay 7 per cent. However, it must be said that a good pension scheme will cost an employer a great deal more than 3 per cent. Trade unions have always regarded pensions as deferred pay. Indeed, it has always been customary for employers to take pension provision into account in pay negotiations. I should be interested to learn how the Government envisage that the scheme will be managed. Presumably there will be some form of regulation to ensure that the investments are suitably managed, but what if the investments go wrong? Moreover, unlike a good pension scheme, there will be no dependency benefits. Employers might cut back to the minimum level instead of providing a good scheme themselves.
Trade unions are deeply involved with pension provision. They will no doubt maintain their campaigns to keep good schemes running and try to get them introduced where they do not currently exist. But that is becoming increasingly difficult. Employers have already turned away from final-salary provision and, increasingly, where pensions are on offer, they are of the money-purchase variety. Any legislative provision which might encourage employers to limit their contribution to 3 per cent might not be helpful. Unions have long believed that employers should make compulsory payments into schemes.
We have of course discussed many of these issues before in this House. It is not so long ago that we had new pensions legislation to discuss. The Government have attempted to deal with some of these problems but the question is: have they gone far enough? I do not think so.
The proposals, if enacted, are likely to add to the complexity of what is already too difficult to understand. It will leave too many people—most of them women—at the mercy of means-testing. I remember suggesting during the debate on the last pensions Bill that we should have a citizenship pension based on a residency test. That, plus the second-tier state pension, would eventually mean a retirement for most people without reliance on means-tested benefits. Of course, the matter of affordability will be raised but I understand that the National Insurance Fund is in considerable surplus. Why do the Government not use it for pensions? I believe that successive Governments have used the fund for all sorts of different requirements and I can never understand why it has not been used simply for pensions. Many people think that that is what it was there for originally.
So far as concerns occupational pensions, the Government have introduced the financial assistance scheme to help people who have been affected by the winding up of underfunded schemes. There was concern that the arrangements were insufficient, but the Minister has written to me outlining major improvements which have been made to ensure that larger numbers will benefit, and I am very grateful to him for that. I understand that there are to be regulations and that there will be consultation about those regulations, so we will have the opportunity to try to ensure that those who are eligible receive assistance under the scheme.
These are all issues which will no doubt be more fully explored when the Bill is ultimately before the House.
Lord Colwyn (Conservative)
My Lords, I listened with great interest to the opening speech of the noble Lord, Lord Warner, and I am now looking forward to the closing speech of an ex-Department of Health Minister, the noble Lord, Lord Hunt of Kings Heath. Under both Ministers the Government have discussed bold healthcare policies. I accept that these take time and that tough decisions have to be made. I shall confine my remarks this evening to the provision of dental services, and declare an interest in that I am a registered dental surgeon. Sadly I have hung up my drill, but I still continue to provide sedation services.
The Health and Social Care (Community Health and Standards) Act 2003 represented some of the biggest changes to dental commissioning in the history of the NHS. The Government have made strides to change a system that remained basically unchanged since the inception of the NHS in 1948, but there are severe endemic problems within the system.
The reforms to NHS dentistry have not improved access for patients. According to a recent survey by the British Dental Association, 55 per cent said that the new contractual arrangements did not allow them to see more patients. A further 23 per cent said that they were seeing about the same number, and 62 per cent were not optimistic that they would be able to see more patients in the future.
I am reluctant to repeat the Prime Minister's 1999 pledge on NHS dental access, but there is still an inability to get to grips with the cumbersome, gigantic system of NHS dentistry. The changes being offered do not reflect enough radical, bold and brave thinking. The Government have accepted that 2 million people who wanted to see an NHS dentist prior to
About 1,700 dentists who previously had an NHS commitment did not sign the new contract, and although about 90 per cent of dentists did sign the contract, it included those who signed in dispute—many of whom are still negotiating individual aspects of the contract with their PCT. The latest figures from the Department of Health show that 1,130 of the new contracts originally signed by dentists in dispute have yet to be resolved. The number in dispute at the onset of the new contract was 2,770.
At a time when the Government are trying to increase access to NHS dentistry, the loss of any dentist to the service has an impact. These figures reflect the uncertainty felt by both dentists and patients. The significant number of contracts that have yet to be resolved means that uncertainty is set to continue, and it may be well into 2007 before all these disputes are dealt with.
Prior to the implementation of the new contract, 32 per cent of respondents performed 95 per cent or more of their work in the NHS. That figure had reduced to 25 per cent in the months after implementation. Furthermore, only 15 per cent believed that they would be carrying out that much NHS work by the middle of 2007, and only 9 per cent thought they would by mid-2009. There are many and varied reasons for this drop in NHS work that need to be examined, but perhaps not this evening.
As I said in Questions this afternoon, the Government's reform has simply exchanged the drill-and-fill treadmill with another treadmill—this time driven by targets. This new system for measuring the work undertaken by NHS dentists and setting targets for their productivity was never tested. Last year the PCTs measured the number and type of courses of treatment delivered by all NHS dentists in their areas. Based on this information, PCTs wrote into each contract a target for the number of courses of treatment each dentist or practice should perform. There are different targets for different areas. Dentists must meet their target to receive payment.
Dentists believe that the new contract will not help prevent tooth decay, nor will it promote or maintain good oral health. For some reason, preventive care does not have a specific value in the new contract and therefore does not count towards the work that dentists perform to meet their target. For preventive care to be effective, dentists need to be able to spend time with their patients to discuss diet, drinking and smoking habits; to show them how to clean their teeth properly; and to discuss any areas of concern.
The dental contract includes a 5 per cent reduction in previous activity levels during which dentists are meant to spend extra time with their patients for clinical governance, and on practice meetings, administration and continuing professional development. However, contrary to these admirable aims, very little time is freed up for preventive oral health advice. If an average dentist were to see 30 patients a day for five days, it is calculated that an extra one and a half minutes becomes available for this important activity.
Dentists are no longer allowed to make a charge for missed appointments—a problem that has become worse since the new contract. In an answer to a Question about this on
The figures present a worrying picture for the future of NHS dentistry. The new contract is failing to achieve its aim of making access to NHS dentistry easier for patients. The results reflect anxiety and frustration among the dental profession and highlight the need for an urgent and thorough impact review of the recent reforms.
There are also concerns regarding growth funding. The Government's current spending commitment for NHS dentistry is limited up to 2008-09. The ring-fencing of PCT funding will stop on
The squeeze in fee levels by successive Governments over the past 10 years has led to underinvestment in dental practices. The dental share of the total NHS budget was 5 per cent in 1992 but has now fallen to just 3 per cent. It is essential that funding and future funding details are made available so that practices can plan for the future.
So many of my colleagues have an ideological commitment to the NHS—to the principle of providing the highest quality of care available to all patients, no matter where they live or what their background may be. But the reformed health service, despite the Government's good intentions, just does not allow them enough time to deliver the quality of care they feel their patients deserve.
In conclusion, I shall comment on dental research and teaching, which is an important part of the debate about patient access and how good oral health is central to good general health. The UK is a major contributor in oral and dental research but often lacks the infrastructure to take on the opportunities to develop the applications. The adoption of new technologies is more likely when they are demanded by patients and when financial incentives are available.
Despite a marginal increase of 1 per cent, the number of dental clinical academics is still 7 per cent lower than the 2003 figures. It is vital to increase the number of individuals entering academic dentistry at clinical lecturer level to replace those moving onwards through the normal cycle of promotion and retirement.
Earlier this year, the Government announced the creation of 100 new student places in dentistry in addition to the new places announced in 2005, and the new dental school in the south-west—the Peninsula Dental School—will take 62 of these students from autumn 2007. These new places should be welcomed, but an increase in clinical academics will be required to meet the educational needs of these new students.
The Department of Health must conduct a full review of funding and the effects of the new contract on patient access and care and the NHS dentist workforce. Why not consider the first year of the contract as a test year to take note of all the lessons that have been learnt and the changes that could be made? The Health Select Committee has called for a review and the implementation review group is monitoring the effects of the new contract. I look forward to the publication of this report, as it will have a significant and vital effect on NHS dentistry in the future.
Baroness Greengross (Crossbench)
My Lords, I propose to concentrate my remarks on the most vulnerable people in our ageing society—those who are frail, usually very elderly, and whose numbers are fast rising. I shall touch on three issues: social care, dignity in care, and end-of-life care.
First, in the coming Comprehensive Spending Review, the Government must recognise the likely scale of future needs and determine how they will be met. Spending on social care has risen by 14 per cent under this Government, while overall health spending has risen by 90 per cent. Therefore, reconfiguring social care services must be a priority for the next spending review. We should also take on board the fact that much of what constitutes good practice in social care is not really very expensive.
The Government must be congratulated on several initiatives, such as A Sure Start to Later Life, better support for carers and the rights accorded to them. But we also need much more flexible provision to allow people to remain in their own homes if they so choose, and to recognise the role of low-level care, which is important to the quality of life of many older people. By the middle of this century, the number of people aged over 65 will rise by some 80 per cent to nearly 17 million. However, there will be an even bigger growth of the number of people over 85, which will nearly quadruple to 4 million. Informal carers are therefore likely to play an even greater role than at present. There are already 5.8 million carers, most of whom care for people over the age of 65. Many are themselves already older people.
The Government have recognised that informal carers have rights, but they also require more support as they increasingly have needs themselves. The incidence of dementia is estimated to double over the next 30 years, and this is the group with the most complex needs, where the most significant expenditure will be required. Some consensus must be found for the funding of social care, particularly long-term care. Partnership funding such as that recommended in the Wanless and Rowntree reports, with a reasonable split of 80/20 public and private funding, must be considered. Mechanisms such as more flexible equity release schemes, enabling money to be used for care and repayments made from a person's estate after their death, must also be considered.
I welcome the government Dignity in Care initiative, which embraces all aspects of care in its proposals. It is holistic, and includes malnutrition, which, as has already been mentioned, is a huge problem in hospitals and care homes, but also in the community, where International Longevity has done quite a lot of work. The approach involves listening and responding to what so many people in care have themselves said, so I welcome it.
I commend the campaigns led by Help the Aged and Age Concern to ensure dignity in hospitals, as well as the new approach, Behind Closed Doors, which the British Geriatric Society and many other organisations are launching, to ensure that older people and other vulnerable adults can be certain of privacy when they need to use the lavatory in a hospital or care home. Terrible incidents have been reported, such as elderly residents being fed their breakfast while using the toilet. It is hard to imagine a more degrading example.
Such campaigns cannot achieve their aims without a more professional workforce, which is the key to any improvements. Staff are the linchpin of service delivery. Yet those who do the bulk of this difficult and stressful work—particularly care assistants looking after frail, elderly people—are often not qualified, extremely low paid and largely unrecognised. Many, understandably, leave to work on the checkout tills at Tesco because, as is often said, they get a bit of social life and better pay there. That is appalling. Some work is being done by a group led by a charity, Friends of the Elderly, to see whether a qualification at NVQ level 2 can be introduced to improve that. Much needs to be done as a priority.
Another priority for the Government must be to remove the Human Rights Act loophole which fails to protect the majority of care recipients because independent providers are not considered to be public bodies. In 2004, over 91 per cent of care home places, and two-thirds of domiciliary care, was provided by private and voluntary agencies. The Government have intervened in a judicial review, where some local authority care homes were transferred into private ownership. The judge did not overturn the earlier ruling that independent providers fall outside the scope of the Human Rights Act, but confirmed that the local authority remained responsible for protecting the human rights of residents, even after their homes had been transferred. The picture is ever more confused and totally unacceptable.
The Minister in your Lordships' House acknowledged during Report stage of the Equality Bill, over a year ago, that action was required. The Government must close this loophole, if only to be consistent with their own Dignity in Care campaign. My rights as a human being are derived from my basic humanity; they do not change depending on where I happen to be in this country at a given time. We would never tolerate this sort of discrepancy in children's rights, and rightly so. Legislation on animal welfare now seems to provide more protection than that offered to many frail, elderly people. That is quite unacceptable.
I feel strongly about end-of-life care, but am also raising some points that my noble friend Lady Murphy would have brought up were she able to be present for this debate. There are specific difficulties for many older people at the end of life, sometimes in communicating their needs, because they suffer from multiple conditions and failing powers. Great sensitivity is required in how they are treated. How we address their needs is perhaps the ultimate test of dignified care. Where a person is dying, when and how they die, who is with them when they die, and what, if any, intervention they may need are all critical points which must be treated fairly and well. What is the Government's policy on end-of-life care for people with dementia, for example? We have a Gold Standard Framework, led by Professor Ian Philp, but we must know how it can be implemented without specialist care teams—including geriatricians, old-age psychiatrists and palliative care doctors—going into care homes to ensure care is adequate.
I regret that the Bill of the noble Lord, Lord Joffe, did not proceed to Second Reading, as it included a provision that a patient suffering from a terminal illness should be entitled, as of right, to receive sufficient medication to keep them free from pain and distress as far as possible. I am pleased that my noble friend Lady Finlay is introducing a Bill which will hopefully improve this situation. It is urgently needed, as according to a recent study 46 per cent of doctors expressed reservations about prescribing opiates since the Shipman case. There have also been many reports of doctors being reluctant to prescribe adequate pain relief for patients cared for at home since that case.
Only a couple of weeks ago, on "Woman's Hour", a daughter movingly described how her mother—dying in agony, totally neglected and suffering from Alzheimer's disease—died in a mental health unit where nobody was trained to manage her pain. Some states in the USA have recently legislated to make it clear that it is lawful to provide pain relief, even if it hastens death to some extent. We need stronger guidance from the GMC and the BMA to give doctors confidence in prescribing appropriate doses of palliative drugs for dying patients, regardless of their diagnosis. Perhaps the Government could include palliative care expertise in the quality target scores for funding GPs.
Despite the immense importance of this issue, the National Council for Palliative Care recently reported that about half of all palliative care services are facing a reduction in NHS funding. Again, this undermines the Government's own aims in Dignity in Care and must be reversed.
In conclusion, I urge the Government to take on board the following three points. First, in the Comprehensive Spending Review, they must include adequate funding for social care, including training for front-line providers. Secondly, the Government must close the loophole in the Human Rights Act regarding public bodies as a matter of urgency. Thirdly, they must ensure that end-of-life pain relief is available wherever and whenever it is needed, and consider whether some additional legislation is needed to ensure it is available and effective. Above all, people's dignity must be protected throughout, and at the end of, life if we are to consider ourselves worthy of being called part of a civilised society.
Lord Morrow (DUP)
My Lords, I feel it proper on this occasion of my first contribution in the House to place on record my gratitude and thanks to your Lordships and all officers and staff of this House for the kindness, consideration and assistance I have received since my arrival. I also include my sponsors, my noble friend Lord Molyneaux of Killead and the noble Lord, Lord Foulkes of Cumnock, for being courageous enough to sponsor me. I assure the House that my appreciation is sincere. I suspect that I have a lot of learning ahead of me as I seek to familiarise myself with the workings of this House.
Having served in local government in Northern Ireland for more than 30 years, a period of time that coincides with what is euphemistically called the Troubles, I want to pay tribute to all the innocent victims who lost their lives during this torturous and agonising period in our history. Of course, I am acutely aware that any words I might use in such a tribute will fall far short of what should be said. Right across the religious divide in Northern Ireland, too many were innocent victims of an awful onslaught. To their surviving family members, I sincerely say that the price your loved ones have been forced to pay cannot be repaid, but their illustrious memory must and, I pray, will live on and never be forgotten.
We are told that progress is being made in Northern Ireland to find a way forward to establish a democratic form of government. However, the question being posed today is whether this is another false dawn or indeed the sunrise to a bright new future for the next generation. Only time will tell. It has been well said that:
"True reconciliation is never cheap, for it is based on forgiveness which is costly. Forgiveness in turn depends on repentance, which has to be based on an acknowledgement of what was done wrong".
I have little doubt that the way forward will be fraught with difficulties.
I have been well warned that my first contribution should be non-controversial, and I will make an honest attempt to comply with convention. Someone said:
"The youth of a nation are the trustees of posterity".
However, I am confident that the prospects of our www generation, so used to being a mere click away from instant knowledge and solutions, can be measured by the potential of our education system. We are truly blessed in Northern Ireland with an abundance of schools, colleges and universities that are some of the finest in the United Kingdom. It is heartening to note that our education and training policies are inspiring similar approaches in Scotland, Wales and, more recently, England.
Indeed, among the unsung heroes of our troubled past have been our classroom teachers, college lecturers and courageous principals. Together they have resolutely safeguarded our schools and further education colleges as neutral havens of learning, as free from prejudice as they were from the onslaught of educational experimentation. The quality of teachers, managers and governors right across our education galaxy, from nursery and primary schools to post-primary, further and higher education, is second to none. They can be rightly proud of their achievements.
The success of our learners in public examinations is better than ever and certainly stronger than in many other regions of the United Kingdom. However, I have been even more impressed by the extent to which our young people leaving schools and further education colleges are confident in themselves, positive about their futures, aware of the importance of lifelong learning, interested in the world about them and keen to contribute to society in Northern Ireland.
Despite the substantial successes of our education and training system, especially among our able and not-so-able learners, I am keenly aware that the gap between those achieving the highest and lowest levels of attainment is unacceptably wide, as was highlighted in the chief inspector's last report. Low and under achievement, particularly among young males, and the need to ensure that all school leavers and trainees are numerate, literate and have the necessary employability skills, remain major challenges for our schools and colleges.
Let us pause and reflect on the enormous challenge that we have set for those who lead, manage and teach in our education system to provide the bedrock for mutual respect and a prosperous economy, so richly deserved and needed after three dark decades of violence, misery and division. Peace and prosperity are but two sides of the same coin and our Northern Ireland economy has much to catch up with. Schools and colleges have been challenged to go beyond their traditional remits to instil a love of learning in our young people and equip them with the necessary nationally recognised qualifications that will ensure their onward progression to university, college, and/or the world of work.
Now they are being asked to be the guarantors not only of social mobility but also of social cohesion in an increasingly diverse society and to be the suppliers and drivers of a dynamic new knowledge economy. Much of our future indigenous economic success will depend on the synergy and partnerships between our public and private sectors. We are asking our large and small employers to speak up through their respective sector skills councils to influence the design and content of our professional and technical qualifications and to determine training needs within their respective industries, committing themselves to genuine collaboration and partnership through sector skills agreements.
Key public agencies, employers of all sizes in our private, public and voluntary sectors, schools, FE colleges, universities, training providers, trades unions and individuals all have a specific and necessary role to play to underwrite the networks of stakeholder partnerships that will be so vital to securing future economic growth and prosperity. In particular, I commend to the House the innovative vocational enhancement programme that promotes collaborative working between our schools and further education colleges. This integral partnership within our education system will be further enhanced next year with the planned introduction of a statutory entitlement framework and the development within our post-primary schools of a more skills-focused curriculum.
Our further education sector, one of the brightest gems in our education crown, is already transforming its mission and structure to deliver a much more economically focused curriculum together with a more coherent sectoral approach to the demands of employers and industry. The Northern Ireland further education sector, often overshadowed by its neighbour in higher education, is to be commended for its unique contribution to the promotion of lifelong learning, good relations and cultural diversity in Northern Ireland, as well as for being the key driver for local, sub-regional and regional economic development.
Lord Brooke of Alverthorpe (Labour)
My Lords, I am delighted to follow the noble Lord, Lord Morrow, and to have the pleasure of congratulating him on behalf of the whole House on his maiden speech, which focused particularly on education and the future of Northern Ireland. He has a long record of political and public service in Northern Ireland and I am sure that he will soon make an impact in this House, too. As an auctioneer and estate agent, he will have particularly noted the Government's Consumers, Estate Agents and Redress Bill, and I am sure that we can anticipate a positive contribution from him when we come to debate it. I am sure that he will also give us the benefit of his experience and intelligence on a wide range of other topics in future. We extend to him a warm welcome to our deliberations.
In supporting the Motion on the gracious Speech, I shall speak about health. I am pleased that, after much consultation and analysis, the Government have again tabled a Mental Health Bill. It may not be enough for everyone, but I hope that this time it will be possible to get some much needed changes on to the statute book. My particular concern is with drug and alcohol addicts who sometimes have to be sectioned. Today, I want to take a liberty similar to that exercised earlier by the noble Lord, Lord Fowler, and use this opportunity to draw to the attention of noble Lords a serious problem in this field—the significant number of beds in residential drug and alcohol treatment centres that are reported to be empty.
I preface my remarks by acknowledging that this Government have made more money available than any Government before and have made a determined effort to achieve their drug strategy aims. They are to be congratulated because, since the strategy was published in 1998, much has been done to improve the availability of and access to treatment for drug users.
However, the residential treatment sector has been largely neglected for the past eight and a half years. This is in spite of the impressive evidence to indicate that this sector achieves some of the greatest treatment gains while treating people who present with the most severe problems and complex needs. Recently, the Department of Health, the Home Office and the National Treatment Agency made it clear that as a matter of policy they expect to see an increase in the use of tier 4 services. However, rather than experiencing an increase, a significant number of established providers in the voluntary sector have experienced a steep and sustained downturn in funded referrals since the beginning of the financial year. Current capacity is underused by up to, and even beyond, 25 per cent on any given day in some centres. This situation has developed over the past year and has become much worse since April, in spite of a 28 per cent uplift in already substantial funds passing from the National Treatment Agency to local commissioners.
The crisis is having a severe financial impact on providers. Some services have already closed and, if the typical autumn and early winter decline in referrals comes on top of this, others will follow. Once lost, they and all their experience will not be easily recovered. Severe damage will have been inflicted on this important national resource and on the country's ability and capacity to treat effectively drug misusers and alcohol-dependent people. Indeed, some high-quality structured day treatment programmes have been similarly badly affected. This dire situation coincides with an announcement by the Department of Health of a capital investment programme of £54.9 million to increase capacity in the tier 4 sector, to create more beds. While prima facie this is a move in the right direction—and in normal circumstances I would wholeheartedly welcome it—it does not make sense to launch it when currently capacity is significantly underused. This needs addressing first and urgently. Adding more beds will only exacerbate the current problem, especially as revenue appears inadequate to sustain existing provision. The risk of wasting a large amount of public money in this area is very high indeed while many unfilled beds exist.
From conversations with Ministers from the Department of Health, with the European Association for the Treatment of Addiction—with which I declare a connection and an interest—and with some of the treatment providers, I know that action is currently being taken to try to establish the gravity of the position. There have been some disagreements about the seriousness of the crisis, and questions have been asked about the failure of some of the providers to report a clear picture of the occupancy levels, the relevance of the department's data-gathering operations and the accuracy of some of the data.
Although there may be problems over the data, we have to recognise that the people at the sharp end who are running the treatment centres know whether they have empty beds that should be filled. They know whether they have to close down their facilities—and some are currently having to be closed. Unfortunately, it is they who at the end of the day will have to sack employees. They are fully aware of that, notwithstanding what civil servants or the department may say about the data.
It has been suggested that treatment demands may be changing and that that is why some beds remain unfilled. First, I find that difficult to accept. There is little evidence of it happening in the private sector, where it is clearly recognised that, even at very high costs, residential treatment offers the best chance of quality, lasting recovery. While the private sector is still bringing in so many people, I am not convinced on that score. Secondly, if there is a case for a change in direction, I find it rather odd that the Government are contemplating injecting nearly £55 million extra into creating even more beds. So a number of questions need to be asked.
I told my noble friend—and I forewarned him that I may not be quite on the gracious Speech all the way through my address—that I would pose a number of questions. If he cannot answer them today, perhaps he will take them away and, in the light of the House's interest in this subject, send me a reply that will subsequently be placed in the Library. First, what is the latest position on the review that is taking place? Secondly, will any emergency revenue funding be provided to secure the current capacity in the existing sector as I have described it? Thirdly, does he believe that it is wise to proceed with a capacity-building programme with an injection of nearly £55 million if it does not take into account the long-term availability of sufficient revenue to sustain the beds once created?
We should also be asking why this is happening. The truth is that there is no one simple reason for the problem—or one simple solution to it, probably. We know that there are long-standing structural and systemic faults in funding and arranging residential treatment, which, despite eight and a half years of the drug strategy and five and a half years of the NTA, have still not been properly addressed.
The harmful effects of the historic neglect of the valuable national resource that is residential treatment have been compounded by the treatment policy of the past five years, which has resulted in an embedded methadone-prescribing culture that seldom presents the alternative of abstinence in a positive light. We now sustain thousands of addicts in the methadone cul-de-sac funded by public moneys. This has severely limited the number of people given the chance to exit from dependence—a principal aim of the drug strategy. The situation has been exacerbated by pressure on commissioners and purchasers to meet what I suppose I would describe as headline-grabbing targets, which relate to the quantity—numbers of people being treated—rather than to the quality and effectiveness of that treatment.
Is it not ironic that current policy puts addicts on to methadone to avoid them self-harming and to reduce the risk of them committing crime to fund their drug dependency? Yet they still commit crimes and are still sent back to prison and, as we have seen in the past two weeks, they can now successfully sue the Home Office for damages if they are not allowed to stay on methadone while in prison. What a contradiction and what a crazy world we appear to be living in. Some of these fundamental issues must be revisited to look for alternative solutions.
We have come a long way and made great progress, but there is much more work to be done. I believe that we can in some areas get some sanity back into elements of the policy. Residential services have a good level of success in getting addicts to recover and in achieving long-term sobriety. They should be given more support than they have hitherto been given by the Government and the National Treatment Agency.
I conclude by suggesting the introduction of a system of core funding, as is common in other European countries. This would take the form of approved and registered providers receiving an annual amount of funds in return for which they will contract to provide an agreed number of beds and treatment episodes. This should be provided by creating a national ring-fenced budget allocation administered through the National Treatment Agency and the PCT network. That would greatly reduce the bureaucracy, which has increased apace in recent years, and get the money to where it is needed—at the front line, treating the addicts.
Baroness Finlay of Llandaff (Crossbench)
My Lords, at first sight it might seem as though health featured relatively little in the gracious Speech. I say "relatively", as that first sight was deceptive, and the six excellent maiden speeches that we have had today demonstrate the huge concerns that there are for social and health affairs. Those speeches also demonstrated that those noble Lords entering this House bring a degree of expertise that will enrich us.
The pace of change in the NHS under the word "reform" is indeed very rapid and I am concerned that some of it has not been evaluated for cost efficacy and is now more driven by cost cutting. The recent salary changes across the board have indeed been high, rewarding professionals who often go more than the extra mile to meet the needs of vulnerable patients. But now we face the spectre of medical, nursing and allied professionals being trained for posts that do not exist. We have an outpouring from our universities of students laden with debt who may not have jobs to go to. It seems a sad irony that we are now training people as jobs are being cut.
To address one item in the Queen's Speech, I shall comment briefly on the mental health proposals, which we will soon be debating at length. I hope that when we reach that debate the Minister will provide some assurance that the proposals will have a therapeutic benefit. I am concerned that mental health services do not have the resources and capacity to cope with any proposed change in load. We know that our prisons are full and that many who are given a custodial sentence have mental health problems. In many cases, those mental health problems underlie the offending behaviour, because they were not well managed initially.
Supervised treatment orders in the community may go some way to help to maintain some of those people in the community, but I hope that the real resource implications of that for health have been fully costed and that it is not being viewed as a cost-saving expedient, because I do not believe that it will be. Like many who will speak on the Bill, I am concerned that the criteria for compulsion are too wide. However, the Bournewood gap needs to be addressed, because some people severely lack capacity and are very vulnerable; they must be detained not arbitrarily, but only in their best interests, to protect them.
The gracious Speech also referred to the merger of the Human Fertilisation and Embryology Authority and the Human Tissue Authority. The problem is that the two bodies have quite different functions and remits. I am concerned that there is a subtle subtext here—a real danger that the embryo will be viewed in the same way as tissue removed because it is diseased.
The type of decision that the HFEA takes is ethically complex. In his opening speech, we heard from the Minister that Britain has been at the forefront of research and regulatory oversight for such decisions. The authority has indeed developed great expertise in that area—expertise to which the rest of the world refers. The Human Tissue Authority is now developing its own expertise in its area and is relatively new. The debate needs to be held on whether a new joint authority called RATE—I find that a slightly amusing name; how will we rate RATE?—needs to be established and what the benefits and risks of such a merger will be. Will we just create an umbrella organisation with two separate branches that will be disrupted in the process and lose momentum in the development of their individual expertise?
It is important to remember that an embryo, with its potential for life, is fundamentally different from tissue that is dead, diseased or discarded. That potential for life leads to very complex and important ethical challenges when we become involved in decisions about it. I know that the gracious Speech has laid out plans for the very vulnerable at the beginning of life, and I am concerned that those may be jeopardised.
We must not forget the debate about service provision, which we have not had openly and honestly, and about just what the NHS does and does not do. Need and demand are not the same, although they often overlap. We seem to be increasingly driven by demand, yet we hear horror stories of those in need falling through the net. Nowhere has such a debate been mentioned, but we need to debate how drugs excluded by NICE are funded if a clinician feels that a patient would particularly benefit from them. Perhaps we could learn lessons from some other countries in Europe. I understand that in France there is a system whereby patients can part-pay for some such treatments, so there is a mixed economy of state-funded and personally funded care at the margins of their system for those patients who here would simply be given the decision that the NHS will not fund that treatment.
Much of today's debate has addressed the social and health interface, where the most vulnerable in our society fall through the net. I was grateful to the noble Baroness, Lady Greengross, for referring to the need for good palliative care for everyone. Indeed, it is to that end that I have introduced my Bill. I know that the Government are developing a national strategy for palliative care, because the devolved NHS is leading to fewer, not more, hospice services. It is of course completely within the law for a doctor and nurse to prescribe drugs to keep a patient free from distress, whatever the dose of drugs that that patient needs. There are many myths around morphine and similar drugs. There is no evidence that those drugs shorten life when given for the relief of pain and distress. I would like to have that firmly on the record, because there is tremendous fear of morphine and a view that it somehow shortens life when given for pain relief.
Patients can and should be able to approach their natural death with care that enhances their dignity and be secure in the knowledge that that care will be provided. Our living and our dying affect all around us. At the moment, we know what to do but, sadly, our NHS is still not delivering it to everyone who is vulnerable.
Lord Cameron of Dillington (Crossbench)
My Lords, I have a long-standing interest in the quality of life in rural England. With that in mind, I want to look today at the delivery of healthcare to our countryside.
The reality is that delivery of all services to rural Britain suffers from many of the same problems. The first and most important of these is a misunderstanding of the deprivation that exists there. Such deprivation and poverty is very real but, unfortunately for the people concerned, they are sprinkled—often liberally—among people of means and even quite considerable wealth. The result is that, both in deprivation indices and health inequalities, such deprivation does not show on anyone's radar because the average statistics of the community hide the uncomfortable truth of its existence.
The second major problem of rural delivery stems from the dispersed nature of the population. Transport, for instance, is a major and costly barrier to access. The distances involved often mean that twice the time and thus twice the cost is spent on the job, compared to carrying out the same job in an urban setting. It is not only a problem for GPs on home visits, for patients accessing A&E and other specialist treatment, but for carers and even for hospital visitors. I remember once on a visit to the east Midlands being told that a visitor to the nearest hospital in Lincoln on public transport was left with only a 25-minute turnaround at the hospital if they wanted to get there and back within a day.
The sparsity of the population also results in extra fixed costs: the number of small outlets required means that the core costs of delivery are multiplied. Numerous small health centres and community hospitals are good examples of that. There was a recent National Audit Office report on the costs of out-of-hours cover needed for the new opt-out doctors' contracts. We know from that report that out-of-hours cover costs more than 70 per cent more in rural areas than urban ones. I suspect that the same differential applies to cover for training and continued professional development. Indeed, I know that one problem that remote practices have is the time it takes to get to training. A few hours training can often take a whole day, or even a day and a half. Smaller rural practices also appear to have a problem attracting young doctors and other qualified staff to remote communities and to what they see as a possible career dead-end. It is true that older doctors sometimes prefer rural practices, but of course they tend to be more expensive than young doctors.
As a result of all these problems, it is interesting to note that, following the Scotland Office paper, Fair Shares for All, rurality adjustments have been made to the funding formula in Scotland, with some rural areas receiving more than 31 per cent of extra resources. Without this extra funding in England, it is unsurprising that, although the rural population is only 20 per cent of the total English population, last year half the PCTs in deficit were rural, while most of those in surplus were urban. My main point today, therefore, is that a specific and adequate rural weighting must be built into the proposed review of the health funding formula, which I gather is due to start next month.
I shall touch on a few other aspects of rural healthcare. We have recently entered a new era. The average population of a PCT catchment area has increased from 65,000 to almost 1 million. I totally understand the economic reasons for this, but it gives me even more reason to be concerned about rural healthcare. The larger the area, the easier it is for poor rural statistics to be hidden within the better urban average. I have heard various stories about PCTs being able to meet their Treasury targets best by focusing all their efforts on delivering to their one or two large urban centres and abandoning healthcare delivery to the countryside altogether. Of course none of them will have done that, but I suspect that lesser versions of that thinking must always be there when targets are looming.
In the new regime, and in next year's Comprehensive Spending Review, it is therefore important that the Treasury sets targets that require a universal and high standard of delivery across the board. In other words, we must rural-proof Treasury targets. Furthermore, the Department of Health must rural-proof all its policies at both a national and local level. Having said that, the first requirement of rural-proofing is to produce specific rural data sets so that we know what is going on and whether we are delivering effectively to the 20 per cent of our population that lives in rural England. So far as I can find out, only the ambulance trusts currently monitor rural/urban differences in patient care. Apparently, other parts of the service could flag their rural data, but choose not to do so.
A difference that probably should be monitored is that of unpresented needs in rural communities, which could have considerable future costs attached. Research indicates that rural folk access out-of-hours treatment less than their urban neighbours, and I suspect that that reluctance also applies to more regular healthcare, particularly when it is preventive. There is evidence, for example, that distance is a key factor in the uptake of breast-screening services, and that the utilisation rates of both general practice and hospital out-patient services decline according to distance from the service. The same is true of specialist services such as family planning, sexual healthcare, and even regular preventive dentistry. I do not know whether rural people are more stoical or simply feel disempowered, but one thing is certain: old people are less willing and sometimes less able to travel, and in remote rural areas 28 per cent of the population is over 60. Again, all this emphasises the likely extra costs of rural healthcare in the future.
I welcome the recent reinvention, or falling back into favour, of rural community hospitals. Given the major difficulty of transport, they have a vital role to play in our countryside. I hope that they will continue to take on more diagnostics, more minor procedures, and more pre-operative and post-operative procedures and other consultations. I also hope that they will provide more walk-in clinics to help with the high costs of rural out-of-hours treatment that have already been mentioned. Community hospitals are much loved and, indeed, much supported. I visited Tenbury Community Hospital in the Malverns, which, with a local catchment population of only 12,000 people, manages to raise more than £300,000 per annum for the hospital. I am sure that similar examples of that could be given all over England.
What is less welcome in the countryside is the whole competition debate. A rural catchment area is unlikely to be attractive to new private deliverers; as I have already explained, it costs more. At its best, this debate can be said to be meaningless to the rural population. But there is a real danger that a competition agenda, if taken to its logical conclusion, could undermine the vital partnership work that is essential for the best-value delivery of healthcare in rural areas.
In conclusion, I re-emphasise my main point about having an adequate funding formula for rural healthcare delivery. It should be noted that the rural population is growing three times faster than the urban population, and much of this growth comes from elderly in-migrants, who by their very age are more likely to put pressure on the health service. The difficulties of serving this population will not go away. I have hardly touched on the existing problems of dental care in rural England. I recognise that, on the surface, the indications are that country folk have better health than townsfolk. But as I said at the start of my speech, such average statistics mean nothing to the 20 to 30 per cent of deprived rural people who have difficulty accessing 21st-century healthcare in rural England.
Baroness Warwick of Undercliffe (Labour)
My Lords, I shall talk briefly about several key parts of the Government's legislative programme, which was announced in the gracious Speech.
It is clear from that programme that education remains a priority for the Government, who have backed it up with a strong record of investment. This is particularly true of science and technology, and I hope that the House will permit me to pay tribute to the noble Lord, Lord Sainsbury, who was Minister for Science and Innovation until recently. He has made an outstanding contribution to science and innovation in this country, and I know it is in a better shape for his hands-on approach. Indeed, it is pleasing to see a cross-party consensus emerging on taking forward a set of very complex issues, and I hope that the noble Lord's successor, the noble Lord, Lord Truscott, and Malcolm Wicks in the other place will continue to keep science high up the political agenda.
The skills agenda, which figured so large in the gracious Speech, has assumed an increasingly prominent position in government thinking in the past three years. It has been driven by a number of broad social and economic factors, which were neatly summarised by the Chief Secretary to the Treasury in his Written Statement announcing the Comprehensive Spending Review, to which several noble Lords have referred. In it, he set out five strategic challenges facing the United Kingdom, which the review would have to address. The first three are directly relevant to the Government's skills agenda. The first is a rapid increase in the old-age dependency ratio as the baby-boom generation reaches retirement age. I feel particularly strongly about that. The second is the intensification of cross-border economic competition as the balance of international economic activity shifts toward rapidly growing emerging markets such as China and India. The third is an acceleration in the pace of innovation and technological diffusion and a continued increase in the knowledge-intensity of goods and services.
Employers have not been slow to react. They have said emphatically that they need higher skills to compete in a global economy driven by technological change and the need for ever more effective management. According to the CBI, almost three-quarters of employers say that their employees need increasing skills. They also say that world-class education is fundamental to ensuring that young people are equipped to succeed in the world of work.
There is a real appetite for responding to this challenge right across education. I can speak with personal experience from the higher education sector, and I declare an interest as chief executive of Universities UK. There are a huge number of opportunities in higher education—from contributing to the efforts to widen participation, to increased continuing professional development, to new relationships with business and, particularly, to close partnerships with further education.
However, there are risks in this for both further and higher education. In particular, the financial risks associated with developing new provision in collaboration with employers where it is not certain whether there is either student demand or long-term demand from the employer's side is currently a barrier to development. I feel that the Government could consider providing—the Minister might comment on this—additional financial support to institutions to cushion that risk as they develop new employer-led provision, which clearly they are keen to do and, patently, need to do.
Further education will figure in legislation during this Session. Today, in an article in the Guardian, my right honourable friend the Secretary of State set out what the Government have done and intend to do on reorganisation and investment in the further education sector, including the work of the skills academies. The Government rightly wish to emphasise this work further, first, through the work being done by my noble friend Lord Leitch—we eagerly await his report, which, I believe, is due very shortly—and, secondly, with the publication of the Further Education and Training Bill, designed to develop the management of further education colleges and streamline the learning and skills councils.
I would now like to address a similar concern to that expressed by the noble Baroness, Lady Sharp. The Bill also contains measures allowing for further education colleges to be given the power to award foundation degrees. As many noble Lords will be aware, a small but significant proportion of higher education courses are run through local further education colleges, often very successfully. I know that the Government intend to consult on this proposal and I look forward to taking part in those discussions because there are some key areas where I would like to understand better their thinking. For example, will further education colleges be subject to accreditation by the Quality Assurance Agency, as are higher education institutions? I hope that the Minister will be able to provide further detail on that point later.
I look forward to seeing details of the proposed Immigration Bill, also raised in the loyal Address. I understand that that will be primarily a tidying-up measure, rather than creating any new law. Although I appreciate that this is a Home Office matter, I hope that noble Lords will not object if I remind the House of the impact that our immigration system can have on higher education. While I, and all Members of this House, clearly support the maintenance of safe and secure borders, I must emphasise the importance of ensuring that our immigration system does not act as a barrier to attracting bright, well qualified, bona fide international students to study in the UK.
As we are debating health today, I would like to ask the Minister in the Department of Health what he proposes to do to solve the current crisis in National Health Service workforce planning. A number of higher education institutions are currently grappling with the problem of strategic health authorities cutting training budgets. The consequent financial uncertainty means that, for a number of higher education institutions, education for nursing and allied health professions may no longer be either viable or sustainable. I refer to the point that I made on the skills agenda: institutions are willing to work with one employer—this happens to be the health service—but on this occasion the financial rug has been pulled out, which underlines the risk associated with the development of those courses.
The situation regarding NHS workforce planning could have dire consequences for future patient care and health services overall. Putting higher education institutions through a boom-bust cycle of funding is no way to ensure stability in the National Health Service or our higher education sector. If it means, as the noble Baroness, Lady Finlay, emphasised, a lack of opportunities for nurses and allied health professionals that is a very sorry outcome. I hope that the Minister will be able to enlighten me on his discussions with his colleagues in the DfES on this matter.
All the issues that I have covered are indicative of the range and importance of the higher education sector to the UK. Higher education institutions are worth £45 billion to the UK economy and, for every 100 jobs in a university, a further 99 are created entirely as knock-on effects. Just in terms of export earnings, it is worth reminding the House that education is already worth more than £10 billion—bigger than exports in food, tobacco, drink, insurance, ships and aircraft put together.
Finally, with the coming spending review in mind, which several noble Lords have mentioned, I should like to urge the Government to continue to ensure stability in the public funding of higher and further education by maintaining their unit of resource for teaching, and enabling them to continue to deliver the high quality teaching and learning for which they are world renowned. They are crucial to developing the skills base and innovation culture in our country. I know that the Government recognise the contribution that higher education makes to the economic, social and cultural well-being of this country, as do many Members of this House. I look forward to debating these very important issues over the next parliamentary Session.
Lord Harries of Pentregarth (Crossbench)
My Lords, the gracious Speech states:
"Draft proposals will be published to reform the regulation of human embryology".
It is this that I wish to address, but I must declare an interest as the interim chair of the Human Fertilisation and Embryology Authority, which is responsible for regulating treatment and research in this field. First, I pay a warm tribute to the Human Fertilisation and Embryology Act 1990, under which the HFEA operates, which has stood the test of time in a truly remarkable way. Based on principles set out in the 1994 report of the working party chaired by the noble Baroness, Lady Warnock, the legislation has shown itself to be robust and appropriately flexible. I am sure that its fundamental principles and approach to regulation will need to be retained in any new Act.
That said, it is only right that the Act should be reviewed and new proposals considered, for which the HFEA has asked for some time. I will just give a few examples of why new proposals should be welcomed: one is the rapid pace of scientific advance. In recent years, the HFEA has had to make decisions about developments which were not even envisaged by the framers of the 1990 Act. Sometimes we have had to consider long and hard whether a particular development actually fell within our legal remit. A number of our decisions have been challenged in the courts and taken right up to this House for a final decision; for example, cell nuclear replacement, which is misleadingly called therapeutic cloning. I am very glad to say that our original decisions were upheld in the courts. Nevertheless, these and heralded scientific advances raise questions about the legal definition of the embryo and the remit for regulation. We very much hope that any new Act will provide greater clarity in this area, difficult though it may prove to be.
Then there is the question of pre-implantation genetic diagnosis with or without tissue typing. We authorise this for certain genetic conditions but, for example, we disallow it for sex selection except where there is a genetic condition related to gender. Is Parliament happy for the regulatory authority to make decisions in this area, or are some so fundamental that they actually need to be considered by Parliament itself? After all, embryo screening does not even appear in the 1990 Act but is now fairly routine.
New proposals are necessary because the Government's review of arm's-length bodies signalled the coming together of the HFEA with the newly formed Human Tissue Authority to form a new body, the Regulatory Authority for Tissue and Embryos, RATE. We are fully committed to working towards that new body, but whatever its scope it is vital that in the future treatment and research involving embryos will be regulated with no less focus and professionalism than it has been in the past. When I had the privilege of chairing your Lordships' Select Committee on stem cells, we were all struck by the high regard in which the HFEA was held, not only in this country but also abroad, where it was looked to as a model to emulate. The tight regulation in this country has meant that public confidence in both assisted reproduction and research has been retained, enabling our scientists to become world leaders in the field. I was glad to hear the Minister emphasise just that point earlier today.
It is true that some clinics have felt over-regulated, and no doubt when we come to debate the proposals in this House we will hear that voice. Clearly, now that firm regulatory foundations have been laid, there is a case for a lighter touch in some areas. It is also true that some parliamentarians have felt that they should have been more involved in making these crucial decisions. As I have indicated, it is vital that Parliament should make fundamental decisions, as it did when regulations came before this House in 2002 allowing research on embryos not just for reproductive purposes but for serious diseases as well. New issues will continue to arise which are too fundamental to leave to clinical judgment but which, if they came to Parliament every time, would occupy not just days but weeks of its time. All this underlines the importance of having a regulatory body with a clear remit and authority.
The HFEA also believes that some other issues will need to be considered in any new proposals, such as the regulation of internet services for gametes, confidentiality provisions to allow for longer-term follow-up studies of IVF patients and so forth. To sum up, we should first pay serious tribute to the legislators who produced the 1990 Act, which has proved remarkably robust legislation in a new and rapidly developing field. However, it is now entirely right that new proposals should be considered that will not only take into account the changes since then but try to anticipate possible scientific advances. At the same time it will be necessary to have a regulatory authority which builds on the experience of the HFEA and is no less professional in regulating a field that is becoming increasingly important to a growing number of parents seeking fertility treatment and the new possibilities opening up for them to have healthy children.
Baroness Gould of Potternewton (Labour)
My Lords, I will be concentrating my remarks on the commitment in the gracious Speech which reads:
As chair of the Independent Advisory Group on Sexual Health and HIV, I, like the noble Lord, Lord Fowler, will take this rare opportunity to talk about sexual health. But I shall focus on the effects of modernisation and restructuring on the provision of sexual health services in this country.
Over the past five years there has been a devolvement of services to SHAs and PCTs, along with guidance which will revolutionise the way services are commissioned and provided. The guidance includes the introduction of practice-based commissioning, which moves commissioning to the local level, in many cases to that of the GP; payment by results, which allows for the acute sector to be paid on a case basis for its work; the introduction of the choice agenda to give patients and service users a voice; and Our Health, Our Care, Our Say, which outlines a new direction for community services. This modernisation agenda is occurring against the backdrop of extensive boundary changes for SHAs and PCTs, making the latter in the main coterminous with local authority boundaries, thus allowing planning for local populations on a larger scale to become viable. But the generic nature of these changes does not take into account the provision of sexual health services in community settings.
Having said that, I must add that where there has been investment in leadership, planning and innovation at the local level, sexual health gains can be made and money saved, but such investment is not universal with the level of provision being very different from one PCT to another. Sexual health provision has for far too long been underfunded, under-prioritised and effectively ignored. It was therefore seen as a huge step forward when the first ever strategy on sexual health was introduced in 2001, while in 2004 the Choosing Health White Paper set out clear plans and targets to improve sexual health services and committed £250 million for front line provision to achieve these ambitious plans between 2005 and 2008. This was followed by the rollout of the chlamydia screening programme and 48-hour access to GUM services being identified as an NHS health priority.
It has to be said that high quality sexual health services provide a virtuous circle of health improvement which is a model of preventive healthcare—chlamydia screening as a means of reducing future infertility, comprehensive contraceptive services as a means of preventing unplanned pregnancy, and so on. All these preventive measures are significantly cost-saving in the long term. However, in the short term financial difficulties across the NHS have had a direct impact on sexual health services. Despite the prioritisation and investment in Choosing Health, it seems that sexual health has been seen as a soft target for cuts by primary care trusts. As the noble Lord, Lord Fowler, indicated, the review by the independent advisory group revealed that almost two-thirds of the PCTs surveyed withheld some or all of their Choosing Health allocation for sexual health primarily to address their financial deficits, resulting in staff cuts and clinic closures. In London alone it is estimated that less than 5 per cent of the promised budget is reaching front line services. The possible reason for this is that none of the allocation was ring-fenced. All this information has of course been passed to the Secretary of State.
One cannot believe that disinvestment in sexual health services is occurring because PCTs do not understand the nature of the threat posed by poor sexual health. Therefore we must conclude that in the face of a number of pressing priorities, sexual health has been relegated yet again to a position of no importance. We have a long way to go before the epidemic of sexually transmitted infections is successfully tackled, before we can be satisfied with the level of contraceptive services, and before we can be sure that we are meeting the needs of patients—patients who have a very quiet voice. They are not going to sign petitions, lobby, organise or go on demonstrations. All this is taking place when we see a deteriorating level of sexual health in the UK, with increases in bacterial and viral sexually transmitted infections, including HIV.
I do not apologise for repeating the figures given earlier by the noble Lord, Lord Fowler. STI data published in 2005 by the Health Protection Agency show that while there has been a decrease in gonorrhoea of 13 per cent—a positive effect of being included in local development plans—there has also been a 12-fold rise in cases of infectious syphilis, up by 23 per cent and now at its highest level since the 1950s. There has also been a 5 per cent increase in chlamydia, with one in 10 people under the age of 25 being infected. The incidence of HIV is rising, with over 7,000 new diagnoses in 2005. The next set of STI data will be published tomorrow by the Health Protection Agency, and we can only hope that we see some improvement in the figures. There is no room for complacency, but a greater need for concentration on innovation, on the development of networks and on the redefining of roles. We need a blurring of the delineation of the functions between doctors, nurses and health support workers, as discussed at the modernisation seminar commissioned by my honourable friend Caroline Flint, the Minister for Public Health. We also have to look at the local government White Paper and the co-ordination between PCTs and local government to provide healthy communities.
A further effect is that many sexual health leads in SHAs and PCTs have lost their jobs or had them changed into a more generic function, with the loss of their knowledge and skills. Decisions around sexual health should be based on patient need and not on financial criteria. We must ensure that commissioning of sexual health services will not be compromised in areas where there is no strong lead in place, either managerial or clinical.
It seems logical to me that services which require infection control and screening need to be viewed at a national level. A proactive approach must be taken to contain infection. The recently announced campaign to encourage condom use—"Condom Essential Wear"—is of course welcome, but that campaign answers only part of the problem. For example, it is pointless for one PCT to screen and treat chlamydia if the population six miles away—in the town centre, where all the popular night clubs are located and where the campaign will be directed—are not being screened and tested. This undermines all the benefits of a national screening programme. The current investment in screening will be pointless unless all PCTs fund screening for the target population.
The inclusion of the 48-hour GUM access target in the top six NHS priorities has been helpful in keeping a focus on services, although, as I have indicated, many services are stretched in meeting that target. But when the target was announced my understanding is that it was part of the redesign of sexual health services as a whole. That may ultimately be the case but in the mean time services that cannot be replaced are being lost, particularly as there is no target for contraceptive services which are likely to be an easy target for disinvestment. There is an unclear national picture of exactly what contraceptive services exist, but we are hearing a disturbing amount of evidence of community contraceptive services under threat of closure, or closing.
Failure to invest in contraception and services appropriate for community needs, especially those of marginalised community groups, will prove expensive on a national and personal level, leading to increases in abortions, and have a negative impact on teenage pregnancy targets. Good quality contraceptive services have been proven cost effective and an excellent early and on-going way to empower and inform women. Good contraceptive providers often build long-term relationships with women and can identify and deter risky sexual behaviours. Contraceptive clinics are also ideal for the early detection of STIs and other medical gynaecological issues, all of which are cost saving.
In 2005-06, there were 2.6 million visits to contraceptive services made by 1.2 million women but, should community contraceptive services not survive the cuts, where will those women go? Not all GPs provide the range of services that are available and so many women will be deprived of personal choice. I quote one woman's view from a survey carried out on possible cuts to clinic services. She said:
"Please do not leave us to rely on our GPs—it is very difficult to get an appointment or any advice beyond putting you on the pill".
I think that absolutely sums up the need to keep the contraceptive clinic services.
But there is a further consequence: important training of future contraceptive professionals will be lost. Training needs to be captured within the commissioning framework to counter the current significant drop in training in all aspects of sexual health as PCTs decide they cannot afford the expense of releasing staff for training.
Promoting the new sexual health campaign last weekend, the Public Health Minister, Caroline Flint, stated that the nation's sexual health is a key priority. But she went on to indicate that there would be no additional funding despite the increase in sexually transmitted disease; that guidance on best practice and locally redesigned services were the way forward. She is clearly right—we have to look forward—but as we witness the NHS undergo profound and extraordinary changes, surely we want the modernisation of sexual health services to rise like a phoenix from the old order, rather than be lost in the birthing process.
The consequences of SHAs and PCTs—and our health system and the Government collectively—not putting enough emphasis on tackling the current growth rates of STIs and HIV make it possible for the figures to rise to epidemic proportions. That must be prevented. Again I refer to the growth of syphilis, a disease we considered eradicated but which is now back with us. The moment is right to make very positive changes but I fear that if we blink and fail to address the reality of what is happening on the ground, we will miss it.
The Earl of Listowel (Crossbench)
My Lords, I should like to continue the theme begun by the noble Baroness, Lady Butler-Sloss, and spoken to by the noble Baroness, Lady Massey of Darwen.
Some 135 years ago, George Eliot wrote:
"If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel's heart beat, and we should die of that roar which lies on the other side of silence".
Social workers, foster carers and residential childcare workers working directly with the most vulnerable children and families expose themselves to that roar on the other side of silence. They work with troubling young people and troubling adults and often we fail to support them. To do this work properly they need to expose themselves and allow themselves a degree of vulnerability. This morning I was speaking to the manager of a children's home, a person of many years experience. In the past, such people might have been able to cuddle their children or share a little of their lives with them but, with the failure to support them, heavy bureaucratic processes are introduced and the ability to be a genuine, caring person to such vulnerable people is lost to a large degree. So if there is any goodness in us, we must do more to invest in and support people working in social care. This is especially important because we are a greying population, with more elderly people and fewer younger people to look after us. If we want to be well cared for in our old age, it is in our interest that we invest in our social care system.
For these reasons I warmly welcome the many steps Her Majesty's Government have taken to invest in social care. I refer to the recent innovation of the Centre for Excellence in Residential Child Care; the new minimum allowances for foster carers; the introduction of a three-year degree course for social workers superseding the two-year diploma course; and the registration of social workers. I especially welcome the new Green Paper on children in the care system, Care Matters, to which the noble Baroness, Lady Massey, so eloquently spoke earlier, and the White Paper on social care workforce reform, Options for Excellence. I pay tribute to the eloquent advocacy for social workers provided by the noble Baroness, Lady Butler-Sloss, in her magnificent speech.
In Care Matters, the Green Paper on children in care, the Government propose a tier of salaried foster carers to work with the most vulnerable children. This may bring about a career pathway for foster carers and, to a degree, help in retaining foster carers and encouraging more people to enter foster care. Robert Tapsfield, the chief executive of the Fostering Network has said that,
"allowing teenagers to stay with their foster carers until the age of 21 would offer massive benefits for many young people who are currently forced out before they are ready".
This is another proposal in the Green Paper.
The Options for Excellence White Paper is perhaps even more important for developing the social care workforce. In 1998 I was visiting a hostel in Kings Cross for young people addicted to heroin and other substances. I met a young mental health nurse, Gabriella Maceirras, an amazing woman. Ten months previously, she and three other colleagues had been appointed to work in that setting and, as she said, no thought had been given to the support that they would need to work with these young people. She was the last woman standing. Bowed but not broken by this experience, she was continuing to deal with the boundless needs of these young people, but her three colleagues had simply dropped out over that period. That was an excoriating experience and it kept returning to me in the days following.
Options for Excellence points out that in 2005, 49 per cent of local authorities rated their retention of children's social workers as difficult or very difficult. That does not surprise me—so often those working in social care whom I come across are in untenable situations and are not properly supported so that they can sustain their work. I can think of two excellent managers of children's homes who have moved on because they have become disillusioned with the system in which they have had to work.
I have spoken to trainers about young social workers leaving training. Their caseloads are too large and give them too much responsibility for the most vulnerable children from the start. There is a lack of good quality supervision from senior staff and of good quality placements in their training to prepare them for entering this environment. One trainer told me about a conversation with one of her most promising students two years after she entered the social work world; the student was leaving social work because she had become disillusioned with it.
I therefore warmly welcome Options for Excellence and what it says about continual professional development for social workers. I especially welcome its proposals for the newly qualified social work status and continual professional development for foster carers which, amazingly, has not existed so far. The new roles for social workers as teachers and researchers, which will enable social workers to keep practising rather than moving out of practice into management, seem a very welcome innovation. But with regard to these two marvellous documents, what priority will be given to implementing their proposals and will the Government find the funding to make these important changes?
The British Association of Social Workers has welcomed the recognition of the need to provide specific support for newly qualified social workers. However, it says:
"We believe the NQSW status should be introduced immediately. The first new graduates entering work have now completed the social work degree. They should not have to wait to receive good supervision and limited workloads—we cannot afford to lose them from the workforce".
The association emphasises that this is urgent, and that specific action needs to be taken now.
I appreciated the response from the noble Lord, Lord Adonis, a little while ago on the newly qualified social work status. He said that it had cost implications and would need to be considered in the Comprehensive Spending Review. I should be grateful if the Minister could give some indication of the likely cost of the introduction of the newly qualified social work status. I appreciate that he may need to write to me. If he would be good enough to communicate to his colleagues the strong concern about this matter expressed in the Chamber by myself and my noble friend Lady Butler-Sloss, I would be most grateful.
To return to George Eliot, social workers, foster carers and residential childcare workers expose themselves daily to the,
"roar which lies on the other side of silence".
Caring cannot be mechanical; it requires making oneself, to a significant degree, open and vulnerable to others. If there is any good in us, we must do far better in supporting our carers. Her Majesty's Government have done much to improve social care, but my concern is that we will continue to fail many young people unnecessarily unless the vital long-term changes, following decades of neglect of social care, are begun now and not deferred.
Baroness Hollis of Heigham (Labour)
My Lords, as with all public services, women are today's clients of social security. This was not exactly what Beveridge anticipated. He devised national insurance in a world of working husbands and dependent wives. Provided that the husband held on to a 40-year job and the wife held on to him, she acquired her social security as his wife. But today one marriage in two ends in divorce, one child in two is born outside wedlock, the years post-retirement have doubled and the need for carers has grown accordingly. Women, as in Beveridge's day, continue to do the caring which inhibits waged work, but now without a husband to support them in their turn. Beveridge's society has become the world we have lost.
We have sought to tweak the welfare state to fit today's society, with credits such as HRP and the disability benefits supported by both Governments. The national insurance unemployment benefit has withered to just six months before JSA is means-tested. Effectively, we have weaned the welfare state off the insurance principle for almost all its benefits. They have become either category benefits, such as children's or disability benefits, or means-tested benefits such as income support or JSA. We recognise that national insurance no longer fits our society. I am in favour of a National Insurance Fund but the conditions attached to its payment no longer work.
Only the state pension continues to use the outdated jargon of national insurance. We have abandoned it elsewhere. Even within pensions, it is largely a myth. Only 60 per cent or so of national insurance years are paid for out of wages. The rest are credits. The contributory system is a fabrication. The "something for something" slogan is therefore perverse. Why? Because national insurance—the contributory system for the basic state pension—is designed to keep the unworthy out. That is why we have it. It ticks boxes and counts numbers; that is all very well for those it fits—the working men for whom Beveridge devised it. They start work after school or college and, apart from the risk of serious disability, whatever may befall them—marriage, children, divorce, caring for an elderly parent—men can expect to carry on working, paying in their NI and drawing out when appropriate. You, we, all of us, can audit-trail their work and count it. Those who do not tick and fit the boxes become the unworthy and, of course, they are mostly women. If I may use an ugly phrase, for which I hope the House will forgive me, the contributory system is institutionally gendered. I am not saying that people are misogynist, but too many of us fail to read the system fairly because women's lives are essentially untidy. Much of what women do cannot be counted in a tick-box way, but I suggest—I am sure your Lordships would agree—that such lives are none the less equally valuable.
Let me give some examples: 1.8 million women hold jobs which pay below the lower earnings limit, yet their part-time waged work is not recognised for national insurance. Around one woman in five is a carer for someone other than children, but much of that care is informal, fluctuating and does not count for NI. She may be looking after her grandchild so that her daughter can work, but that is not counted towards NI or for childcare tax credits. Accordingly, a woman in her late 40s or 50s can have a teenage child, a part-time job, look after a granddaughter, help out her pensioner parents and even the parents of her parents, as well as run a home. She works 60 hours a week with grace and stoicism, yet none of those jobs ticks the boxes of the contributory system, so none of it will count when it comes to a basic state pension—not one penny. How many of us think that that is fair or decent?
I refuse to believe, and I hope that noble Lords agree, that what can be counted is automatically more valuable than what cannot—that his 40 hours in a garage should count but not her 60 hours of caring and coping. She is doing something; in fact, she is doing a lot of bits of "something for something"; but she gets, of course, absolutely nothing, because she does not and cannot fit in with the contributory structure. Why? Because we cannot audit-trail all the things that she does and, in any case, the bits and balance of her working life are untidy and may well change from month to month and year to year.
The Queen's Speech includes two social security measures. The measure on child support, if it can bring more money to children, I welcome. I ask my noble friend whether it will do so and whether it will have Treasury support to do so—I hope very much it will. There is also a major Pensions Bill. I also welcome much of that Bill, but it still offers a better deal for men, who already have the stronger pension settlement, than it does for women. Those women who are outside the public sector have relatively little in the pensions stakes.
The Bill continues to tweak the contributory system. I welcome the fact that there will be fewer years—I think that is great—but whereas men will come from 49 years to 30, women come down from their current 39 to 30 and as an offset lose four years of HRP. The average man would, at the moment—I appreciate that the retirement age for women is rising—gain 14 years of contribution, while the average woman gains five.
I welcome the earnings link to hold the pension's value, but it benefits most those who have complete pensions, which is currently 90 per cent of men and around 30 per cent of women. There is help for carers. But tying the proposals still to the very high hurdle of middle and higher-rate DLA would exclude much of the caring undertaken by women. The Bill proposes a national pensions savings scheme, which again I welcome, as it should benefit the lower paid, among whom are women; but, unless the interaction with the basic state pension and pension credit is sorted out—which is a crucial women's issue—we could end up, although I hope that we do not, with serious problems of mis-selling.
At the end we will still have a contributory framework, just a messier one. Yet we are told by the Government that by 2025 or so the same number of people, men and women, and at the same cost, will be covered by this reformed and revised system as we would gain from a universal basic state pension. I repeat—by around 2025 a non-contributory basic state pension would cost no more than what these reforms envisage.
Instead, if we follow the route of the basic state pension as proposed in the White Paper and the Bill, we will have added complexity by adding credits and the need to track them, so the system will remain opaque and confusing. Why should someone caring 20 hours a week for someone on middle-rate DLA get the NI contribution, but not if they are caring 20 hours a week for someone on incapacity benefit? Thousands of civil servants will track through the records to explain that caring for a disabled person on one benefit for 20 hours a week counts, and that the identical care for the identical hours for often the identical condition but subsumed under another benefit does not.
We will continue too to disincentivise savings, because people, especially women, will still not know what pension they are going to get, because that will depend on the lottery of their care as it unfolds over the next 30 years, which they cannot predict at the time that they need to start to save. If they do not know what they are going to get at the end, they will not start to save at the beginning. All this will still require substantial means-testing. For exactly the same cost, we could have a universal non-contributory system which was clean, simple, predictable, encouraged saving and valued women's lives and the way in which they lived them equally with men's.
We have a wonderful opportunity to clean up and clarify the benefit and pensions system, and I fear that we are going to fudge it again, because too many people still seem to think that "something for something" carries meaning, when it is vacuous. Company directors playing golf between the ages of 60 and 65 get a freebie NI—something for nothing. Yet women holding down three 15-hour jobs—that is, 45 hours a week—get nothing for really rather a lot of something. The unemployed lad gets freebie national insurance—something, perhaps, for nothing. The woman caring for 40 hours a week for three people who are on the "wrong" benefits gets nothing for really rather a lot of something.
I am sure that my noble friend will not tell me that the contributory system is valuable because it represents something for something. It is not, it does not and it never has, and we should stop using it to count women out. I hope that when the time comes to debate this Bill, the Government will agree to look again. The Government have done wonderful things for women, of which I am immensely proud. In our first term we made work pay for women, with the minimum wage and tax credits; in our second term we made work possible through childcare, part-time work and maternity, paternity and parental leave. We must now hope that women entering retirement will be able to do so courtesy of a pensions Act that will free them from the worry of poverty—and that could crown our legacy for women in our society.
Lord Northbourne (Crossbench)
My Lords, what an important speech that was.
I strongly endorse the Government's policy of eliminating child poverty, but I want to speak today about another form of poverty that can be equally or perhaps even more disastrous for children: poverty of attachment. I hope that at some time in this Session my Cross-Bench colleagues will give me the opportunity to introduce a debate on attachment as it affects children in families, but this afternoon I want to talk about attachment in the context of children in care. Already speeches have been made on this matter by my noble friends Lady Butler-Sloss and Lord Listowel and the noble Baroness, Lady Massey. However, those three speeches covered different aspects of children in care; I intend to cover a fourth: attachment.
The care system today does not give the children in its care enough chance to make secure long-term attachments to a responsible adult. That fact may be causally linked to the depressing statistics that show, as we have heard already, that children who have been in care are heavily overrepresented in prison and very often do not get any qualifications in school. My proposition is that a child in the care of the state has no less need of the security of long-term loving attachment than any other child—indeed, perhaps more so. The progress report for 2004-05 on the Children Act 1989, which was published this October, said:
"Children need stability in order to enable them to develop attachments and achieve the outcomes, to which we aspire, for all children".
My noble friend Lady Butler-Sloss mentioned lack of stability and said that children in care have no single point of continuity in their lives. The estimated number of children in this country looked after by the state on
Visualise the situation. For nine months a child grows up in the almost total security of his mother's womb. The relationship with his mother is secure and satisfying—unless, of course, the mother is subject to domestic violence or there are drugs in her bloodstream. It is a hugely secure environment. Then, suddenly, there is the trauma of birth, and the child finds itself launched into a strange and frightening world. Research shows that at this stage a close and loving attachment to the mother is a key factor in the baby's well-being. If the baby also becomes gradually attached to another one or two adults, that is all to the good. It is generally recognised that a stable long-term attachment to suitable adults is enormously important for every child during the whole period in which they are growing up.
Let us look at how the need for attachment of our children in care is met. First, why do we pay so little attention to the need for continuity of attachment in fostering? The kite mark that the Government have set for stability in foster placements is that a child should have fewer than three different placements every year. Thirteen per cent of all children nationally had three or more placements in the year ending
In my view, and I hesitate to say this, such treatment of foster children is simply not acceptable. I find myself wondering, though I do not know whether I dare to say it, whether some local authorities are in fact fit for purpose in looking after the nation's most vulnerable children. After all, we do not entrust our National Health Service to local authorities, so why should we entrust our most vulnerable children to them? Should the funding needs for the care of these vulnerable children have to jostle with more local issues for adequate funding? The noble Earl, Lord Listowel, and other speakers on the subject have referred to the incredible shortage of social workers, to the effect that they are often not adequately trained and so forth. Ultimately it is a question of money, which is not coming out of the local authorities to provide the service the children need.
Why do we pay so little attention to continuity in the staffing of children's homes? Perhaps the most significant emotional problem of most children in care is the lack of an early secure attachment. Do the Government feel that the relatively high level of staff turnover in many children's homes is satisfactory? Are they sure that children are not being moved from therapeutic homes to fostering in order to balance the budget, rather than in their best interests? I know for a fact that on some occasions they are. There is a difficulty: professional workers need to move on. I had an idea for the restructuring of children's homes to solve this problem. I have often wondered if there might be a role in a children's home for a live-in granny, someone who is permanently there for the children and does not change every few months or years.
This Government must be greatly congratulated on recognising that, for many children who have been taken away from their families, adoption is and will be the best solution. They must be congratulated, too, on introducing new adoption legislation. A great effort has been made to make adoption available to all children for whom it is the best solution. However, progress for younger children is disappointingly slow. The total number of looked-after children adopted has risen from 2,200 in 1998-99 to 3,800 in 2004-05, a rise of nearly 75 per cent. That is good news as far as it goes but, alas, this increase relates mainly to children between five and 10 years old. There has been virtually no change in the rate of adoptions from care of children under five.
Last week I attended a seminar on attachment at the Nuffield Foundation. Two speakers reported studies which showed quite clearly that emotional damage caused by an adverse environment in early childhood increases incrementally—that is to say, with the length of time that the child remains in the unfavourable environment. Do the Government agree that delay in arranging adoptions for younger children may not only damage children but also make it more difficult to help them later?
I recognise that it will cost more money to offer all children in care the opportunity to enjoy a secure attachment. I recognise that, in a democracy, extracting money from the public for other people's children is not easy, but I suggest that there is now enough evidence to show the links between stable attachment and subsequent good citizenship to justify more investment in those children for whom the state takes the responsibility to be their parents.
Lord Kirkwood of Kirkhope (Liberal Democrat)
My Lords, it is a great pleasure for me to speak at the end of this debate. I know it is a cliché to say that it has been a wide-ranging and interesting debate, but it certainly has for me. I have listened to a full Queen's Speech debate for the first time. I have heard the breadth of experience and corporate knowledge that is available to us, not just among our well established Members who have served the House with great distinction for many years, but also among the wide range of new talent in our ranks, particularly some of the maidens.
I have some bad news at the start, however, for the noble Lord, Lord James. The Alhambra theatre in Glasgow is being restored. I look forward to him doing his stand-up comedy routine on the public sector borrowing requirement there, and trying to get out of that alive. I think it would be a case of, "I'm no awa' to bide awa'". He is a brave man if he thinks he should discuss earnest things such as savings and the health service in the Alhambra. I will book tickets and come and listen. We have also had a brave claim from the noble Lord, Lord Bradley, a fellow refugee from another place: that he will solve the congestion problems in Manchester. Do not hold your breath, but we look forward to that with great anticipation.
This has been an interesting conjunction of subjects. The older I get, the less fit for purpose—to use the terrible cliché—are the departmental silos that we were previously accustomed to working within, perfectly properly. To be effective, modern Governments are forced to work across departmental boundaries, and a debate such as this helps to concentrate on how government should be conducted in the forthcoming year, according to the terms of the Queen's Speech.
This year's Queen's Speech is interesting, as is its political context. I have never known the situation where the Prime Minister launches a great parliamentary programme for the year, safe in the knowledge that he will never see it through. It is a bit rich for the noble Lord, Lord Warner, to talk about this being a vibrant programme; the only vibrancy we will see in the next year is Gordon Brown's pager going off when he is summoned to No. 10. That will be a seminal moment, when the political terms of trade will substantially change. We are all, in considering the Speech today, in a bit of a hiatus. We do not know who will step up to the plate and when, and what difference that will make. Government is about more than a programme of legislation and a list of Bills; it is about personalities and delivery, and we heard some strong speeches earlier in the debate. I look forward to seeing how the programme pans out.
This institution, important as it is—and the House of Lords is an important part of Parliament—now has to share power much more with the devolved legislatures in Scotland and Wales, and with Brussels. The encroachment of some of the international dimensions of policy-making is new. It is all very thrilling to watch, as I did, the ceremonial pageantry of the Queen's Speech and the Blues and Royals riding on 17-hand war horses. Actually, however, we do not run the world as much as we used to. We have to share power. The legislative power that we are bringing forward this year cannot be entirely controlled by us. We have to bear that in mind in future as well.
A number of themes came through powerfully in the debate. Many speeches concentrated on front-line delivery—not policy programmes or legislation but how the legislation is delivered at the front line, whether in drug and alcohol rehabilitation centres, dentistry or care homes. All those are very important parts of public programme delivery. However, the Ministers who set the policy are not always in control of how it is discharged at the front line. We should think very carefully when we are creating legislation about how it can be translated and implemented. It is an important part of its successful implementation.
On delivery, I was reminded by the noble Lord, Lord Fowler, that, as a spokesman in the other place, I was a beneficiary of his excellent approach to AIDS. I am by academic training a pharmacist, and I was baffled by the disease when it first appeared in Edinburgh through a drug route. The noble Lord stimulated a Friday debate that I remember well. The difference about that debate was that he invited all the spokesmen, and anyone else who was passing and interested at the time, to come and talk to the Chief Medical Officer of Health. That completely changed the tone of the debate. It became less confrontational and less about people scoring points off one another. Everyone realised what was going on—or perhaps they did not understand in the early stages.
I pay tribute to the work that the noble Lord did then and absolutely agree with him that the public advertising programme which he put in place was unique in western Europe. It was a model that has been used since. It perhaps demonstrates not only that there is a need for a fresh AIDS programme in order to protect our children—another powerful theme of the debate—but that there is a role for sensible, sensitive public advertising policy. This is an age of the image. If we can get cleverly done programmes on television it will attract young people's attention, which is a hard thing for politicians to do. I pay tribute to the noble Lord's work and entirely support what he was saying earlier.
The importance of children came through very strongly, not only from my two distinguished colleagues behind me, who have a daunting record on the subject. As I think the noble Earl, Lord Listowel, said, children are an investment for the future. The demography is changing. If we are to have a workforce that can generate wealth to pay my pension and the noble Earl's pension, we have a self-interest in that. But so does the nation. It is wrong to consider children as capital assets—I am not suggesting that for a moment—but if we cannot make the best use of everyone we have, we will be doing ourselves no favours and cutting off our political noses to spite our faces. That serious message in the debate came through strongly to me. I hope it came through equally strongly to the Minister.
The issue of children in care, which came through strongly from three or four colleagues, is immediate and must be attended to right now. I have in my library all the law reports of the noble Baroness, Lady Butler-Sloss, who highlighted the importance of social workers. I also have the pamphlets of the noble Baroness, Lady Meacher. I would not be without them because I read them late at night when trying to get to sleep. There is a difference between meeting the needs of children right now, whether in care or with social workers, and the arguments of my two colleagues behind me about the need to invest in the longer term.
I am, if anything, a social security person—interested in social security. I think that the Government can meet the 2010 child poverty targets, if that is what they are trying to do, only by making immediate short-term increases and changes to the benefits system. However, I am absolutely convinced that, by 2020, dealing with child poverty will be not a social security problem but an education and training problem. The only way in which we will get anywhere near abolishing child poverty by 2020 is if we seize the initiative and deal with the generation that is five years old right now, get them educated and give them life chances that will enable them to support themselves and to trade their own families out of poverty. Otherwise this cycle of intergenerational inequality will continue and worsen every time that it comes around. I absolutely agree with all the important points on early years provision and about part-time education being the poor relation. Further education and skills are part and parcel of that.
Another important theme of the debate was mental health. Mental health comprises two parts; it is not just mental illness. People often think that people who are mentally ill are not really compos mentis. People who are mentally ill are perfectly capable human beings, but their illness has to be treated and there is a clinical dimension to that. An intermittent pattern of some mental illnesses prevents people working, because of how the illnesses rub up against the personal capability assessments. The noble Baroness, Lady Meacher, referred to that very powerfully. She is absolutely right that the benefit-linking rules are completely out of kilter with anything that can begin to assist those suffering from intermittent mental illnesses which prevent them going into work. She is also absolutely right that the benefit rules are substantially deficient in other ways as they affect mental health.
The noble Lord, Lord Low, in a powerful speech, made the point much more eloquently than I could. It defies belief that people who have challenged sight cannot get extra transport assistance. He referred to a slightly different problem of which I am personally aware—that only the lower rate of mobility allowance is available to people with challenged sight. That is a scandal and runs completely counter to the grain of the Government's active labour market policy of trying to get the one million people who are on the incapacity benefit lists at the moment—"the stock", as it is rather inelegantly called—into the labour market. Many of them could be traded off.
I have some hopes and I think that the Government have made some changes. Lisa Harker's work on child poverty looks at more flexible use of pathways to work and condition management programmes. It looks at families as a whole and at giving them more flexible support and sticking with the support. Part of that has to be providing transport and increased mobility allowance. Why people who are partially sighted do not receive the higher rate of disability living allowance completely defeats me. The department should take the issue on board. I know that money does not grow on trees but, in the current day and age, against the background of the Government's active labour market policy, it is completely indefensible to let it rest as it is.
I come from south-east Scotland, a very rural and slightly provincial—in the best sense of the word—part of the world, but I visit some of our biggest cities in pursuing social security interests. I am struck by the diversity in places such as Birmingham and Manchester and by how we need to respond better to that diversity. I think it was the noble Baroness, Lady Verma, who made the point that we need to embrace that properly and to provide better role models for young people. In my work in the Social Security and DWP Select Committee in the other place, I was struck by the spatial concentration of poverty in some of our ethnic communities, particularly in London. There is a lot of poverty—real, abject poverty—in London right now. A lot of it is in minority-ethnic groups. I think that that needs to be attended to. That theme certainly came through to me in the debate. A lot of the speeches will repay careful study, and I propose to do that myself. I hope that the Front Bench ministerial team will do the same.
If there is one overarching difference between what the Government are proposing and what has been said this afternoon, it is that the Government are much more interested in and focused on national security, and we seem to be talking about social or personal security. They are not mutually exclusive but, for my money, if there is a limited public purse and if you are trying to enhance people's lives in the United Kingdom in the upcoming 12 to 18 months and beyond, I would deal with some of the important social gaps mentioned this evening on both sides of the House just as urgently as I would deal with terrorism.
My noble friend Lady Walmsley said it for me: if you do not get into this subject at a social level at an early stage with the citizens of this country you will never win the argument, because it is a hearts-and-minds argument as much as it is a cops and robbers, MI6 and people-in-tanks argument. That came across very strongly to me. You do not need to be interested in social security to know that. I am particularly worried about the increasing conditionality of benefits. There will be a time and place for this during the Welfare Reform Bill, which is subject to a carry-over Motion. It will give us a chance to look at some of the ways in which conditionality is creeping into benefit entitlement all over the place, which creates uncertainty. It certainly does so for people with a mental illness claiming incapacity benefit. That is increasing uncertainty. Pension uncertainty is not helping people to sleep more easily at night. Under the Stern report proposals, the poorest will get hit first and hardest when the additional 2 per cent Stern-assessed contribution to deal with climate change comes in. They will be on the front line facing the consequences. That creates uncertainty.
We have not spent a lot of time on immigration this evening, but it affects people's judgment of their employment prospects in a way that the Government are ignoring. I am in favour of immigration. It can be done; it should be done; it needs to be done; we need to talk about it more and we need to be less frightened about tabloid press reports, which are inimical to the development of proper public policy. We need to address it not just in labour markets but in the housing implications of immigration in some of our disadvantaged communities in inner cities.
Government is hard. None of this is easy. The Government have done a lot; they have been running very hard to try to make progress on child poverty, and a lot of progress has been made. There are some problems in the list of Bills. Regarding the Child Support Agency, if they really are going to write off the debt of £3 million or so, that would cause me to quail, as it would a lot of other people who anticipate getting hold of some of that money eventually. For a Labour Government to be in power for so long and do absolutely nothing except top up slightly the Social Fund is puzzling. I do not understand why more use is not made of loans to keep people out of the indebtedness levels that we see and to protect them from loan sharks. It has long been necessary to address that. Rehabilitation has not been mentioned, but some interesting work has been done at Cardiff University by Mansel Aylward on getting a biopsychosocial model of some of the personal capability assessments. That is much more focused on the Welfare Reform Bill that we will talk about later, which is important to me and, I hope, to the Government.
It has been a very good debate. I hope that the Government will listen carefully to what has been said about the delivery mechanisms and the need for targeted investment. More than anything else, my message to the government Front Bench this afternoon is that if they are really looking to tackle the underlying causes of insecurity, they cannot ignore investment in social policy. Plenty of ideas have been put forward in this excellent debate. It would be a shame if the Government did not go away and think carefully about some of them and implement them as soon as they can.
Earl Howe (Shadow Minister, Health; Conservative)
My Lords, the noble Lord, Lord Hunt of Kings Heath, has the unenviable task of summing up this extraordinarily rich and wide-ranging debate and, although I have no doubt whatever that he is up to it, this is one occasion when I am rather glad that each of us is located where we currently are. Indeed, I am quite sure that the noble Lord would not have things any other way.
I cannot remember when the House has had the privilege of listening to as many as six maiden speeches in an afternoon, but it can certainly never have heard so many of such a high order of excellence. In every one of them, we found ample evidence of the way in which this House is enriched by its new Members. I recall to your Lordships' minds the noble Baroness, Lady Meacher, who made important observations on the benefits system in the context of those with mental health problems. The noble Baroness, Lady Butler-Sloss, commented on children in care and social work, born of her unrivalled experience as a very senior judge. My noble friend Lord James made a perceptive analysis of NHS funding issues. There was an extraordinarily impressive speech from the noble Lord, Lord Low, about blindness and disability. There was the stirring celebration by the noble Lord, Lord Bradley, of Manchester and all things Mancunian. The noble Lord, Lord Morrow, spoke uplifting words about the youth of Northern Ireland and the example set by Northern Ireland's schools and colleges.
The debate as a whole has taken us into all sorts of policy areas, from pensions to the HFEA, and from dentistry to rural health services, but there have been some distinct and recurrent themes: the disabled and care of the elderly; vulnerable and looked-after children; education and skills in their various dimensions; and sexual health. I hope that the Minister will be able to give time to all those themes when he winds up the debate.
Perhaps the oddest thing about the gracious Speech is what it did not contain. Earlier this year, the Government published a landmark White Paper, Our Health, Our Care, Our Say. It was not unreasonable for some of us to expect that a number of key measures might emerge from that—widening the scope of direct payments, creating individual budgets and unifying the complaints system across health and social care. In July, the Department of Health published A Stronger Local Voice, which outlined the latest proposals to remodel patient and public involvement in health—a much talked-about and much heralded set of changes that we expected to be set out in a Bill. On the same day, it published another document setting out a commissioning framework, from which we believed we would see all sorts of new legislative proposals designed to carry through the Government's reform agenda on commissioning, patient choice, provider regulation and the extension of foundation trusts.
As long ago as November 2004, Ministers announced that they wished to merge the Healthcare Commission with the Commission for Social Care Inspection and the Mental Health Act Commission. We expected to see those changes set out in a Bill. In July, the Audit Commission made a number of recommendations relating to the governance and accounting systems in the NHS, not the least of which was the need to develop a clear failure regime to deal with situations in which NHS trusts found themselves in financial distress. We could perhaps have been forgiven for thinking that the gracious Speech might have made some mention of those matters as well.
But on all those issues, disparate as they may be, there has been a strange and unaccountable silence. No Bill has been announced. What can we read into that? Are we really to suppose that the Department of Health was unsuccessful in bidding for parliamentary time to legislate on so many key planks of its health agenda? Have the Government had second thoughts about any of them? If they have not and if the proposals are still on the table, can the Minister enlighten us on when we might expect to see a Bill? I ask that question in a sprit of genuine inquiry. If the best answer he can give is, "When parliamentary time permits", I shall be greatly disappointed. The Government have made a raft of announcements; they have raised expectations, and indeed fears, on a wide scale about the changes that appear to be in prospect and they have left us dangling. The Minister cannot remain inscrutable on all this.
It seems a long time since the gracious Speech of 2005. Numerous Bills have passed through your Lordships' House; indeed, the wide and flowing river of government legislation is still in spate and has in no degree abated. But one Bill announced successively by Her Majesty and by the noble Lord, Lord Adonis, in May last year that never reached us in the last Session was the Mental Health Bill. First, there was a resounding silence and then a full year later, in May 2006, the Minister of State, Rosie Winterton, announced that the Government, after all that had gone before, had abandoned their plans to replace the 1983 Act and would instead seek to introduce a much shorter Bill designed only to amend the existing legislation. Another six months down the track and that amending Bill has been published.
It may just be me, but it hardly seems credible that, having begun as long ago as 1998 the task of constructing a new and updated legislative framework for mental health, having promised that that framework would replace altogether the Act of 1983, which itself is based on legislation passed in the 1950s, and having set themselves that worthy objective, the Government could reach the point of saying, eight years later, that a brand-new Bill was all too difficult and complex and that they were going to settle on a repair to the old jalopy instead of a bright new model from the showroom. There were, as we all know, extensive criticisms of the two draft Bills of 2002 and 2004, but we hoped that whatever finally came forward would represent a clean start for this area of legislation.
The Second Reading of the Mental Health Bill takes place next week and I do not want to pre-empt that debate today. However, I would like to make a couple of broader points about this area of policy-making. The first is that changing the law relating to mental health inevitably takes us into very sensitive territory. There are proposals in the Bill to change the definition of mental disorder, to change the criteria for detention and to legalise compulsory treatment in the community. I am not going to comment this evening one way or the other on the merits of those proposals; I simply observe that they are potentially very far-reaching. They profoundly affect service users, health professionals, voluntary organisations, carers and many others. Unless those groups are signed up to them, the proposals will simply not be workable. Parliament has to listen with more than its usual care to the concerns and views of interested parties, because to fail to do so will let down the single most important interested party—the patients. For that reason, I believe very strongly that the Bill should be the subject of at least some form of pre-legislative scrutiny. Even at thislate stage, I appeal to the Government to give pre-legislative scrutiny serious thought.
My second point is that, before considering any legislation that would allow certain groups of adults to receive medical treatment against their will, we have to be clear why we think that it is right to make an exception to the rule that in all other circumstances is regarded as sacrosanct; namely, that medical treatment may be administered only with the active consent of the patient. We need to be clear what it is about people with a mental illness that makes them different from people with a physical illness. In my view, the Government have not adequately explained that, and they will certainly need to do so by Second Reading. The rationale cannot be that mentally ill people lack the capacity to take decisions. The vast majority of mentally ill people have perfectly good decision-making capacity—a point made very well by the noble Lord, Lord Kirkwood. The difficulty arises with certain individuals whose decision-making capacity is in some way impaired. However, if that is so, we need to define whom exactly we mean and why compulsion is the best and only way of addressing the difficulty that they present. I sometimes think that, in their general pronouncements on the Bill, Ministers are too inclined to take as read a proposition that in any other area of medicine would meet with the most vigorous challenge.
It is time to bring the noble Lord, Lord Hunt, to his feet. This has been a varied and fascinating debate, and I await with more than my normal degree of fascination the response that the Minister is to give us.
Lord Hunt of Kings Heath (Parliamentary Under-Secretary, Department for Work and Pensions; Labour)
My Lords, we have certainly had a very wide-ranging and first-class debate covering six Bills and three government departments. It will be difficult for me to do justice to every contributor but I want to congratulate our six maiden speakers on their excellent contributions.
The noble Baroness, Lady Butler-Sloss, commented on the inconsistency of the colour of our carpets. I do not know whether she has yet encountered the Pugin Room, which will confuse her as it is red. It belongs to the House of Lords, yet we cannot use it. If she can find a way through that, we shall all be very grateful.
The noble Baroness, Lady Meacher, comes very well qualified to talk to us on mental health issues. She has a long record in this area and is also the current chair of a mental health trust.
My noble friend Lord Bradley, who has perhaps returned to Manchester, promoted the city with great skill. As a Birmingham resident, I was rather squalling when he seemed to try to track yet more government money towards Manchester, but certainly all of us who went to that city in the autumn acknowledge the tremendous developments that have taken place there.
The noble Lord, Lord Low of Dalston, brings considerable experience and expertise to your Lordships' House. He made the point very strongly that it is wonderful to see the achievements of many blind people. But, as he suggested, we also have to reflect that many blind people suffer deprivation and social exclusion. Whatever system of social or benefit support, we have to ensure the continuum of care and support that is needed. I look forward to debating the Welfare Reform Bill with the noble Lord when it arrives in your Lordships' House.
I noted with interest the analysis of the noble Lord, Lord Morrow, of the current situation in Northern Ireland, and particularly his acknowledgement of the successes of the education system. He rightly pointed out the problem of low achievers and referred to the potential of schools and teachers and particularly the FE sector. I very much agreed with his comments on the role of employers in the skills agenda. That is of course a matter for my department, and it is a vital consideration in achieving the objective of an 80 per cent working-age population over the years.
The noble Lord, Lord James of Blackheath, in his non-controversial way, started off on the issue of Lords reform. He said that if something is not broke, we should not fix it. I think that many noble Lords would agree with that, although sadly, I suspect, not his own Front Bench—or, at least, not his own leader. None the less, the one thing that I can guarantee is that he will have many opportunities to talk about Lords reform in the months and years ahead. We look forward to all our maiden speakers making further contributions. They have shown tonight that they have very much to offer your Lordships' House.
The noble Lord, Lord Kirkwood, said that government is hard. It is, but it is better than opposition, even in winding up our debate tonight. Has a theme come through what we have heard? I think so. The over-riding theme that I commend to your Lordships, because I believe that it goes to the heart of what this Government stand for, is to seek social justice and fairness for all as the essential basis for helping people to fulfil their own potential, where economic efficiency and social justice are not opposites but partners, where aspirations and compassion are reconciled, and where excellent public services are delivered. I believe that we covered all those aspects. Nowhere is social justice and fairness more important than in pensions policy.
I shall respond first to the noble Lord, Lord Fowler, and my noble friends Lady Turner and Lady Hollis. The first aim of the Government on pension policy was to alleviate the inheritance of pensioner poverty. That is the importance of the introduction of pension credit, winter fuel payments and other measures, and the essential foundation on which we wish to build a long-term pensions settlement. It is why we have the desire to uprate basic state pension in line with earnings; to reduce the number of national insurance qualifying years, so that many more people will benefit from full basic state pension; to encourage people to enrol in personal accounts and so secure a better pension for themselves; and to meet the tremendous pension challenge over the next 40 or 50 years.
My noble friend Lady Turner referred to the financial assistance scheme. I have written to her with details of the extension of that scheme, and obviously we hope that more payments will be made in the future. If the noble Lord, Lord Oakeshott, were here, he would ask me how many payments would be made. The current number is 508 with a total of 1.8 million. The noble Lord, Lord Fowler, mentioned in passing the ombudsman's report. Our decision was a reluctant one, but we believe that the information was not inaccurate or incomplete and that no causal link between the information provided by the Government and scheme member losses has been demonstrated.
My noble friend Lady Turner asked me why it has taken so long to restore the earnings link. It would be preferable if we could restore that as soon as possible but, as I said earlier, the Government's aim was to tackle the immediate issue of pensioner poverty, which is what we have done through the introduction of pension credit. Our aim is to restore the earnings link, and the decision will be taken in the first year of the next new Parliament. Clearly, in terms of building a settlement for pensioners in the future, this will be a very important measure but in the interim period, there is a serious affordability issue.
I know that the uptake of pension credit causes concern. My noble friend Lady Turner and the noble Lord, Lord Skelmersdale, referred to that. The current figures that I have suggest that 61 to 69 per cent of eligible pensioners take up pension credit, but that 70 to 80 per cent of those eligible for the guarantee credit, which is available only to the poorest pensioners, do not claim it. We have run big campaigns and many visits have been made to help pensioners make those claims. It is clearly more challenging to reach those entitled to either smaller amounts or to just the savings credit, but we will continue to do everything that we can to achieve a bigger uptake.
My noble friend Lady Turner thought that the intention to raise the retirement age could be unfair to lower socio-economic groups and perhaps some other employment groups. I understand the issues she raises. It is difficult to set a state pension age for which you can take account of the causes of health inequalities. The Turner commission looked at this issue and suggested different S2P and basic state pension retirement ages, but that would be complex. It is worth saying that if current differentials remain the same, men in the lower socio-economic group would not experience any reduction in length of life after the state pension age was raised to 68.
My noble friend Lady Hollis was even more eloquent than usual in talking about national insurance issues and the impact on women. She is, of course, right that society has moved on since Beveridge, and she analysed the role of national insurance in society and conditions for payment, suggesting that it is an institutionally gendered fabrication. I hear what she says, but national insurance is in the psyche of the nation. My noble friend says that it is in the psyche of men rather than women, but we believe none the less that the contributory principle is important now and will remain so. By our proposals to reform the contributory system, we are making it work better for women: first by reducing the number of years of contribution required to 30, then by giving greater recognition to the role of women as carers.
My noble friend is of course right that women's lives are messier. It is hard for them to tick the boxes, but the measures we have taken will make it possible for many more women to receive full basic state pension. The corollary is that were one to take a different route from the citizen's pension, there would be issues of immediate cost, as well as some practical issues because of how long it would take to base it on residency. I know that my noble friend will always have an answer to that, and I suspect that we will have many interesting debates during the passage of the Pensions Bill.
The noble Lord, Lord Skelmersdale, and my noble friend Lady Turner referred to the second part of pension reform. If I can put it this way, it has been trailed in the Queen's Speech that we will bring forward proposals for the personal accounts delivery authority in the first Pensions Bill. A number of issues that arose tonight will be best addressed when we publish a White Paper, which I hope will be done shortly. There are clearly some interesting issues.
On levelling down, I say to my noble friend Lady Turner that we have done some research and analysis of the views of 2,500 employers whose costs would increase. Only just over 1 per cent of those who are now contributing 3 per cent or more say that they would level down. Only 2 per cent report that they might close their scheme. The evidence shows that the critical importance of employers making that contribution is that it is a clear incentive to employees to take part in the scheme.
There is a Bill in another place on welfare reform, and I hope that it will not be too long before it is received in your Lordships' House. The debate has mostly concerned the impact on people with mental health issues, and that is absolutely right. The noble Baronesses, Lady Meacher and Lady Barker, made some telling points. The employment rate for disabled people as a whole is about 47 per cent, which is an increase of about 8 per cent since 1997, but for people with depression it is 23.7 per cent and for people with serious mental illnesses it is 11 per cent. Therefore, everything we do to reform incapacity benefit must be focused on the experience of people with mental illness, or we will not increase that employment rate or be able to get 1 million people off incapacity benefit.
It is essential that we ensure that the approach is sensitive to the needs of people with mental health illnesses. I recognise the contribution that cognitive behavioural therapies can make and I accept that the National Health Service has an important role to play. Fluctuating conditions are a fact of life, and the system will have to respond to that. In relation to the linking rules, the aim is to provide safeguards, but if the noble Baroness, Lady Meacher, cares to let me have details of specific matters that she has encountered in east London, I will be very happy to look at them.
The noble Lord, Lord Skelmersdale, briefly mentioned benefits simplification. We will debate those matters, and we are committed to simplification. The welfare reform proposals will lead to simplification, but there is always a trade-off between simplification and sensitivity. I hope that when we come to consider the numerous amendments that will be made when the Welfare Reform Bill is before your Lordships' House, we will remember that Parliament has a key role to play in ensuring that there is a simplified system.
The noble Baroness, Lady Butler-Sloss, made some important points about the life outcomes of looked-after children. We know that they are very poor: poor educational attainments, poor work records and poor life outcomes in general. I accept her view that part of the foundation of doing something about that is to improve the capacity and confidence of people working in social services. I agree that we need to do more to improve the image and self-esteem of social workers and to encourage people into the profession. I know that the Department of Health is very exercised about this matter and that the Minister is concerned to do what he can to raise the image of social workers. I accept the more general point made by the noble Baroness, Lady Greengross, about demographics and the need to ensure that social care is in a good position to deal with those enormous challenges.
My noble friend Lady Massey and the noble Lord, Lord Northbourne, emphasised two things about looked-after children: first, that there needs to be cross-government action; and, secondly, that we need to do what we can to encourage local authorities to improve their performance. There is cross-cutting working together, and I assure noble Lords that our wider programme to tackle poor outcomes and social exclusion will mean that the position of looked-after children must be given every consideration. That must include the issue of local authority performance. I very much take the noble Lord's point about fostered children and the continuity of employment for those employed in children's homes.
The noble Lord, Lord Northbourne, made some very supportive remarks about the new adoption legislation. He said we had made progress but that clearly there were challenges ahead. I very much agree. In the same vein the noble Earl, Lord Listowel, talked about the need for more investment in social care workers. He will know that resources for social work have increased over the last few years. He raised the cost issue of newly qualified social workers. I do not have that information to hand but I will ensure that he is written to.
That conveniently leads me on to the Child Support Agency. What can one say about it? We are making progress. The CSA under its new chief executive is implementing an operational improvement plan. We are beginning to see some progress. I say to the noble Lord, Lord Skelmersdale, that the contracting out of the collection of debt began in August this year. By the end of October the agency had transferred over 7,000 cases and over £180,000 has already been collected. Perhaps even more encouraging is that before a case is given over to the private company, a warning letter is sent by the agency to inform clients that this is about to happen. This resulted in a quarter of a million pounds being collected before going out to the agency.
We are beginning to turn the culture of enforcement around, building on the tremendous work of my noble friend Lady Hollis. It is early days to say how successful this will be, but the signs are encouraging. My noble friend raised the point about the contribution that a reformed and redesigned child support system can make to deliver more children out of child poverty. Basically and bluntly, that depends on the size of the disregard. We have committed ourselves to a higher disregard. I am not in a position to disclose that today but, as she will know, we are always engaged in constructive discussions with our friends in the Treasury.
Let me turn to education. My noble friend Lady Warwick is right about the skills agenda. On the challenges of a global economy, as she described it, the skills requirement of employers is increasing all the time. We have 75 per cent of the working-age population in work. We aspire to get that up to 80 per cent. We need that to meet the demographic challenge and to respond to the global economic challenge; but that means that we must equip our people with higher skills. I am very hopeful that the Bill that will come before your Lordships is one way to deal with that. I say to the right reverend Prelate that I am advised that there can be consultation through a wide range of bodies that may well include faith groups, local authority schools and community groups.
On the ability of colleges to award degrees, of course close collaboration will continue between universities and colleges. The requirements for gaining degree-awarding powers from the Privy Council will remain stringent. The new powers will in any case have an impact only on a small number of large colleges which will be able to respond. All foundation degrees are based on modular principles. The role of the QAA will be as for other degrees. The Secretary of State will set the criteria that institutes will have to meet to award a foundation degree. The Government will consult on the criteria. The QAA will continue in its role of advising the Privy Council on the application of those criteria robustly and fairly, and its role will be as robust and fair on foundation degrees as it is for any other degrees.
I turn to the Mental Health Bill. The noble Earl, Lord Howe, expressed some disappointment at its shape. The noble Baronesses, Lady Finlay and Lady Barker, and my noble friend Lord Morris of Manchester all commented on its importance. I certainly recognise that it has had a long gestation. There is no question but that it has been a very difficult process. We are seeking to find a way through some very difficult and controversial areas. The noble Baroness, Lady Barker, asked about our engagement with stakeholders. The very fact that the Bill to be brought before Parliament is different from the original proposals shows the impact of our engagement with stakeholders. An adapted supervised treatment order is being introduced. We decided against a separate condition for patients at substantial risk of causing harm to another person and against the policy that anyone should have the statutory right to request an examination by the relevant authorities against the first four criteria—and so on and so forth.
The Government have talked and listened to stakeholders. We will continue to do so. I know that my noble friend Lord Warner is eager and anxious to talk to noble Lords about any issues or concerns that they have. Surely it must be recognised that the status quo is not an option. Surely we are aware of the detrimental revolving-door cycle of discharge, relapses, readmissions, and the misery that that causes people whose mental health lacks stability. Surely we should recognise that supervised community treatment addresses that cycle by providing a framework for community living with powers to tackle problems before the crisis occurs.
I hope that when the Bill comes before your Lordships' House, instead of there being a knee-jerk reaction of opposition, the matter will be given genuine and fair consideration. Of course I accept the comments made by the noble Baronesses, Lady Finlay, Lady Barker and Lady Meacher, about the state of mental health services and the need to develop them, but since we came into power, the Government have done a tremendous amount to make mental health a priority.
I refer noble Lords to a comment made by Matt Muijen, a former director of the Sainsbury Centre for Mental Health, who is enormously admired by many people in the field of mental health and who now works for the World Health Organisation. In an article, he explained that mental health services in Britain are better funded, better structured and better supported than anywhere else in Europe. We cannot be complacent; there is much that we have to do; but the Bill soon to come before your Lordships' House is one of the foundations on which we will take the matter forward.
I pay tribute to the noble Lord, Lord Harries, for his work with the HFEA and for the work that he did chairing the Select Committee following the great debate that we had about the order concerning embryonic stem cell research. He was very persuasive in arguing that the legislation should be reviewed. He gave some examples where greater clarity is required. I know that some noble Lords expressed concern about the decision to create a merged authority. That will be subject to pre-legislative scrutiny and the Government will be very interested to hear the comments of noble Lords. We believe that that will produce a more co-ordinated system of regulation, building on the tremendous work of the HFEA and of the Human Tissue Authority, which has more recently come into being.
I conclude by talking about health issues. There have been many comments and questions about the National Health Service. I did not recognise the pessimism that seemed to emanate from some noble Lords about the condition of the National Health Service. I ask noble Lords to consider the past nine years and the resources that have gone into the health service, the waiting times that have been slashed, and the extra number of doctors and nurses. Of course the health service faces challenges at the moment, and of course there are reconfiguration issues. Those issues should have been tackled many years ago, but it is this Government who have had the courage to get to grips with these critical strategic and structural problems. The overall condition of the NHS, however, is very much to the good. The response from members of the public who use the NHS shows that time and time again.
On dentistry, the noble Lord, Lord Colwyn, is no longer drilling and filling, but he is sedating, although not, I suspect, on a treadmill. As he knows, I was responsible for the first discussions with the BDA some time ago on developing the new contract. What has been produced follows the nature of those discussions, which were about getting dentists off the treadmill. The great majority of dentists, representing about 96 per cent of NHS services, signed new contracts in April 2006, and PCTs are commissioning more activity in NHS dentistry than was delivered last year. We do, of course, need to keep these matters under review. We want to keep dentists with us. We also want members of the public who want NHS dentistry services to have access to them. There are positive signs.
The noble Lord, Lord Fowler, and the noble Baroness, Lady Gould, referred to sexual health issues. I pay tribute to both of them for their tremendous record in this area. There is no room for complacency, although fortunately we have a relatively low prevalence of HIV. There has been a large drop in the number of people diagnosed with AIDS, and a 70 per cent drop in the number of AIDS-related deaths following the successful uptake of highly active anti-retroviral therapy since the late 1990s. But sexual health remains very much a priority. As my noble friend Lord Warner said earlier this afternoon, we have made it clear to the NHS that it is one of its six priorities. I understand the concerns about funding and why my noble friend Lady Gould would prefer there to be ring-fencing, but we think that the NHS must be free to take its own local spending decisions. We do not believe that ring-fencing is the right approach, but, by making this a key target, we demand that PCTs show what they are doing to improve waiting times and to reduce infections. We are introducing a national support team for sexual health that will intensively support the 10 to 20 per cent of areas that are finding it the most challenging to meet their targets. There is no complacency here. This matter will be kept under close review.
The noble Baronesses, Lady Greengross and Lady Finlay, made very important points about the end-of-life experience which I shall draw to the attention of Health Ministers. I have noted the very interesting exposition by the noble Lord, Lord Cameron, of rural access and funding. We do believe the formula to be the best approach. It is a very serious approach, and an advisory committee, made up of managers, academics and GPs, continually oversees the formula, but I will draw the noble Lord's remarks to the attention of the Department of Health. I certainly understand the importance of rural-proofing NHS services. Indeed, the Department of Health has funded a rural-proofing toolkit, which was developed by the Institute of Rural Health.
I do not, I fear, have time to refer to patient forums and local involvement networks, although we intend to seek an early legislative opportunity. This is the same answer that I would give to the noble Earl, Lord Howe, on the regulatory system and the merger of the regulatory bodies.
Overall, this has been a splendid debate. It has been a privilege to answer or attempt to answer so many important points raised by noble Lords. I very much look forward, as do my noble friends on the Front Bench, to debating these important issues in the months ahead. In so doing, I thank very much all noble Lords who have contributed.
On behalf of my noble and learned friend Lord Falconer of Thoroton, I beg to move that the debate be adjourned until Thursday next.
Moved accordingly, and, on Question, Motion agreed to, and debate adjourned accordingly until Thursday next.