rose to call attention to the case for decentralisation and greater local autonomy and their effect on citizen and community vitality; and to move for Papers.
My Lords, in this debate we have a broad canvas on which to paint. In opening, I shall be necessarily impressionistic. Perhaps at this early stage in the parliamentary cycle it is appropriate for us today to be more diagnostic than prescriptive. It was partly faulty analysis of the main needs of the European Union which led to the recent debacle of the French and Dutch referenda. Earlier we had the thumping "No" in the referendum on regional government in north-east England. Evidence of political disaffection and mistrust is abundant. We politicians are not listening too well.
So I hope that we can also afford to lower our partisan guards, debate strategically and venture bold ideas without being defensive about past failings.
Forgive my shorthand if I describe the kernel of our predicament in terms of probably the most centralised democracy on earth in the midst of a rapid decline of community life; a decline which is not adequately compensated for by new networks and relationships; and a decline which, with the inexorable dilution of that identity, loyalty and all-embracing mutuality, which are the essence of community, bedevils so much else we grapple with in this place. Just think, for example, of the hatful of recent legislation combating anti-social behaviour, which provides indisputable evidence of community decay in the midst of material plenty.
Although they have claimed to uphold the virtues of organic localism, all governments of the past 35 and more years share responsibility for the relentless and clumsy centralisation of powers, and the often clumsier use of them. Perhaps the most perverse chapter of that was the Thatcher years. It suggests three awkward realities. First, many potent centralising influences are outside government. Among them are mobility; developments in communications; a metropolitanised media; disengaged transnational business and concomitant managerialism; the rapid shift in cultural patterns; changing personal agendas and morality; and, perhaps above all, rampant materialism and individualism, which shape much of the overall context.
Secondly, it is apparent that the continuing disintegration of the settled, geographically based Britain in which most of us grew up is a self-reinforcing process that it is impossible for Governments alone to counter, yet the allied temptation to try to buy voluntary-sector support for their programmes is two-edged.
Thirdly, it is now surely clear that legal regulation and intervention are no substitute for organic self-regulation, but can easily oust what is left of it. Over-legislation provides both the means of concentration of control and an equal and opposite disempowerment of local government and its citizenry. In 2003, for example, this Parliament pushed through 13,407 pages of new law, much of it barely scrutinised. Taking account of repeals, that meant a net increase of about 10,000 pages. That exceeds comparable countries by a factor two to four times. The cumulative effect is at the root of civic powerlessness and insignificance that extends well into the middle classes.
That torrent of statute law, which concentrates power in the hands of experts, is the fruit of the voting system. This delivers disproportionate majorities, which in turn encourage production-line legislation aided by a draconian whipping system reinforced by massive ministerial patronage. Labour, do not forget, has not lost a single whipped vote among thousands of votes since it came to power in 1997. God bless this unelected House, many say.
As to the general political malaise, what does one expect from an election where, on a miserable turnout of 61 per cent, Labour, with 35 per cent of the vote, got 55 per cent of all MPs, an overall majority of 66. Can one really legislate for the whole electorate with the support of only 22 per cent of it? What is the real legitimacy of manifesto pledges in those circumstances? Incidentally, having voted in 11 general elections and fought four of them, my votes have never counted, and probably never will.
Looked at from the grass roots, as Liberal Democrats are traditionally happy to do, I suggest that alienation from centralisation is related, first, to the geographical distance from the centre; secondly, to the powers of those at the periphery compared with those at the centre; thirdly, to the real degree of genuine engagement by the centre with local opinion; fourthly, to the inexperience of those devising the legislation of that which they are legislating about; and, finally, to how often Governments change policy and law.
It is not, of course, that things are necessarily done well locally, but we have all surely learnt the hard way that unless people own their institutions they will not care for them or be responsible for them, let alone give them their allegiance. Democratic ownership is a funny business, made up of as much heart as head, defying the rationalities of the mandarins and governors—elected or otherwise—who are increasingly deracinated, seeming to rely ever more on their technical superiority and cleverness. Pragmatic wisdom and real life experience are indeed in short supply.
At the moment, I suggest, we are in unthinking denial. Many of our fellow citizens—ironically, especially the rich—believe that there can be a good society without putting much back into it. Look at the professions—mine very much included—and see how far they have shifted from major public engagement to mere private acquisitiveness.
We also need trust at all levels. We need less selfish assertiveness, less puerile reliance on competition as the modern substitute for the co-operation of yesteryear. Individualism without communal engagement, or bowling alone, as Robert Putnam put it in his book of that name, has led to a collapse, too, of community life in the United States, which in so many ways is better off than we are. He stressed the decline in social networks and investment, just as here Professor Richard Sennett of the London School of Economics has followed comparable lines emphasising the importance of actual embodied sociability rather than virtual substitutes.
Thank goodness, therefore, that many are now focusing on work-life balance. The pressures of getting and spending lay waste our powers and deprive civic life, not to mention family lives and relationships, of their fair share of our time and energy. Bizarrely, we have never been remotely as rich materially or as poor in relational terms. Public esteem, which feeds into personal esteem, is now enjoyed by few.
So when Tony Blair's wrote in a 2002 Fabian pamphlet that he,
"recognised and understood the need to let go", one might ask: where is the evidence? And although one of his early policy action teams rightly emerged with the key finding that the secret of community revival was self-help, how has that been evidenced in government policy? No doubt the noble Baroness will tell us. In saying that, I acknowledge the great feathers in the Government's cap of the Scottish Parliament and the National Assembly for Wales, as I do their work on poverty and employment.
I shall not steal the thunder of my colleagues and other distinguished speakers today by enlarging on the subject of this debate as it affects education, health, local government, local financing, and law and order. I particularly look forward to the three maiden speeches to come and warmly welcome those speakers to their first debate.
I will end with an admission and a tonic. One ineluctable feature of the decentralised state is its natural diversity. What for the centralist is disparaged as the postcode lottery is for the devolver the wondrous milky way of local autonomy. The latter means facing squarely the variety—the inconsistency, indeed—that the slaying of state giantism via the replenishment of local government powers must entail. It always amazes me that worshipers of choice in the marketplace are often monopolists in the political forum. Yet it is clear that a plethora of national criteria, targets, tables, standards and the like have, with their bureaucratic overburden, demoralised and drained professional fulfilment from those subjected to them. A succession of new initiatives and regimes in education, health, policing and local government has too often stifled rather than enhanced. As others will demonstrate, we must relinquish much of that control-freakery and teach the public to stop looking to the nanny state but rather to shift for themselves. Therein lies political renaissance.
Balancing conflicting public expectations is difficult, of course, but we desperately need a bonfire of central controls and quangos. We need, as Ed Davey MP put it, to defeat,
"the centrifugal forces of Whitehall and the national media".
Having said all that, I should like to end on an upbeat note. Our communitarian genes are deep and resilient. The voluntary sector is an everlasting source of encouragement. In my home town of Sudbury, we held a community fair last February. From a population of fewer than 20,000 we unearthed no fewer than 280 voluntary organisations, of which 153 manned stalls in the church and town hall on a cold Saturday. It was really inspiring.
Well over half the adult population is still regularly involved with some voluntary or community activity, and more than 300,000 charities still do their work, the majority of them locally and the vast majority without any paid assistance. I beg to move for Papers.
My Lords, I welcome this important debate and look forward greatly to hearing from the three maiden speakers. I wish them well. I thank the noble Lord, Lord Phillips of Sudbury, for giving me the opportunity to let off steam.
In our party's recent manifesto, we laid great emphasis on the importance of regenerating local civic pride and rebuilding local control and local responsibility. Twenty years ago, a Conservative government made mistakes in increasing central control over local councils. We accept that as a party and we have learnt from it. However, nothing compares with the manic centralisation of the past few years—the explosion of regulation; the proliferating regimes of inspection; the march of central targets; and the mushrooming of guidance notes, codes of practice, risk assessments and duties to comply with the effluent of the legislative sausage machine that has been, and still is, working overtime.
There is not a doctor's surgery, school governing body, hospital trust board, chief constable, magistrate or local authority chief executive not looking with dread at the daily in-tray for the next piece of dictation to arrive from Whitehall or its numberless phalanx of quangos. Up and down the land, head teachers are battling with Whitehall paperwork; village hall committees with mindless bureaucracy; sports clubs with health and safety advisers; and universities with politically correct commissars telling them whom they should admit. Words were the making of this Government, and I have no doubt that they will be their epitaph.
Local variety, enterprise and initiative are being stifled. We are losing colour, common sense and our sense of community. We are losing much of what made it distinctive to be British. Are we a better country because a centrally imposed system of licensing has extinguished the old right of Cambridge University to run licensing in its precincts? Will we be a better country if centrally imposed standards on school days and hours lead to the closure of a private nursery school with which parents are well satisfied? It is way beyond time to call a halt to it all, and the Motion moved by the noble Lord, Lord Phillips of Sudbury, would be a good place to start.
The basic difficulty with the way in which the Government approach so many things is that they still believe that the men in Whitehall know better and, as Mr Austin Mitchell so brilliantly put it on Tuesday in another place, the "cherub geniuses" in Downing Street know best of all.
I welcome the affirmation in the gracious Speech—a promise that, I hope, will be kept—that there should be less regulation. If any regulation is reduced, the irony will be that the Government reducing it will be the same people who introduced it in the first place. It is a real Grand Old Duke of York promise: they regulated up to the top of the hill, and they are deregulating them down again—we hope.
I do not claim that the Government alone are guilty of centralising. What an error it was, for example, for banks to take responsibility away from local branches and local managers who knew their patch and hand decisions over to remote automatic computers. It is no wonder that the reputation of banking is plummeting. We now hear cases of people being charged loan-shark rates of interest for the stopping of a tiny direct debit that an old-style manager might never have stopped in the first place. Now, most people cannot even telephone their bank branch, and, as I know from experience, if a mother is asked to help her son or a husband his wife, they are told by someone—in India as likely as not—that they cannot do so because of the Data Protection Act 1984.
Can the Minister tell the House—if she cannot, will she please write to me—what will happen with the computerisation of the NHS and the rolling out of the ID card with regard to access to public services, especially if the system ever becomes compulsory? If, as is said, it may in time be necessary to provide a biometric card to gain access to a library or to make a doctor's appointment, how will it be possible, given the Data Protection Act, for a friend to pick up a library book for an elderly person or for a wife to make a medical appointment for her husband?
Are not central computer systems in danger of breaking up family cohesion and making it harder for one person to help another? I worry about that and would appreciate specific advice from the Minister on how it will be avoided. People do not want to be numbers on a card or a computer. They want to be treated as individuals by individuals. Surely, that is the right of every person born into this free country. British people are not servants of the state. The institutions of government are there to serve them.
To give another example, how is it that the unelected head of a quango, the Passport Agency, can suddenly give an interview to a newspaper—naturally, he did not deign to tell Parliament—announcing that to be allowed to travel abroad, British citizens will henceforth have to go cap in hand to an interrogation centre to ask for the right to a passport. I ask: at what cost in time, in inconvenience, in bureaucracy and why? Who authorised that? Currently, we have a perfectly effective localised service where people can have passports delivered to them in their homes. Who decreed that to be free to travel English people should go to government centres to be interrogated? I worry about that.
We need to build up personal choice; we need to protect family cohesion; and we need to increase local diversity and accountability. I was a strong supporter of a policy in our manifesto to allow local people to elect their local police chief directly so that policing would reflect local priorities—not targets handed down by Whitehall. Do the Government have any intention of pinching that Conservative policy?
I strongly supported the abolition of unelected regional assemblies that suck power and money away from local councils. Following its rebuff by people in the north-east, will the Government consider abolishing those? I strongly back plans to restore authority to local councils over planning. It is surely intolerable that Mr Prescott can order perfectly good terraced housing to be demolished in the north or suburban gardens and green countryside to be built over in the south. It is an affront to local accountability. Will the Government think again about that?
I strongly supported the plans we had to scrap whole swathes of pointless bureaucracy imposed on local authorities from the centre, going under appalling acronyms such as CPA, BVPIs, AMPs and so on. Senior local authority executives have counted the cost of this in possibly billions of pounds. I find a certain irony in the Government talking about localism, but imposing a national straitjacket on local authorities through inspection regimes—and a straitjacket it is.
A local council may have been elected on a platform that appeals to its residents. But it is a brave authority that says it is prepared to do badly in the inspection process because those things are not as important to its electorate as other issues and because they consume scarce resources. Far too much time and emotional energy—the greatest drain of all—are spent by senior local authority managers and members feeding the inspection beasts. Surely all that time and energy could be put to so much better use, like service improvement.
So perhaps I may address my concluding remarks to the Audit Commission. What could be more demoralising than for local authorities to jump through the hoops and then find someone changing the rules? That is what the Audit Commission is doing. I ask the Minister to look into this for it is causing wide concern at local level. After peddling one model of comprehensive performance assessment, the commission has now produced another. The new model claims to be strategic regulation, but it is not. A tremendous amount of work is asked for from local authorities in preparing self-assessments and position statements—all time that will not be spent on providing local services.
Just as scores of local councils have proved their improvement, the Audit Commission arbitrarily moves the goalposts and introduces a new, self-proclaimed "harder test". What is the consequence of a council suddenly being marked down to a low score on tests it was never set before? What does that mean for the morale of members and the residents of the area?
I used to hold the Audit Commission in very high regard, but its behaviour here is arbitrary by any measure and some of the indicators it is proposing are, frankly, absurd. It represents a serious disappointment by its high standards and makes a strong case for aspects of its own role to be reviewed. For if we do, as we all say we do, really believe in localism, why not leave the local electorate to be the judge of performance, effectiveness and value for money? That surely must be what localism really means. If only the Government and their agencies could understand the importance of that, this country would be a far, far better place.
My Lords, we should be grateful to the noble Lord, Lord Phillips, for raising this very important subject for our discussion today. The Church of England and, I believe, all faith groups in the United Kingdom are uniquely placed to make a positive contribution to any discussion on decentralisation and the importance for citizenship of the healthy and diverse local provision of public and other services and better ongoing community engagement in all aspects of modern life.
It might seem a rather hackneyed truism, but in the life of the Church, as in the community more widely, local is often what matters most—certainly to individuals and families seeking to make sense of, and the most of, their lives. George Orwell's threat of an end to diversity and the establishment of Big Brother, graphically exhibited in 1984, is not a thing of the past and community vitality, as underlined by the noble Lord, Lord Phillips, requires constantly to be nurtured and affirmed.
The General Synod of the Church of England, a body as richly diverse as your Lordships' House, meets shortly in York. The location is important and relevant to our discussion today. The noble Lord, Lord Phillips, referred to the geographic or perceived distance from the centre. Apart from acknowledging the northern province of the Church, it also acknowledges that the Church as an institution is rooted throughout England—parish by parish, urban, rural and suburban. And in terms of history and contemporary understanding, the Church is neither London-centred nor top-down in its approach to ministry and community engagement. I believe that this helps us in an appreciation of some of the issues before us today.
Way back in 1985, the Church of England published Faith in the City. The report was prepared by the then Archbishop of Canterbury's Commission on Urban Priority Areas. It was set up by the late Archbishop Robert Runcie and it was a call for action to the Church and to the nation. The report highlighted the growing number of people and places that were experiencing disadvantage and exclusion at a time when others were experiencing economic boom. Although the focus was on urban matters, the message was, and to a great extent remains, universal, and the Church has promoted similar work looking at such problems in rural areas.
The latter work enabled, for example, parish-based ministry, working with others in local communities, to respond quickly and by all accounts effectively when many such communities were traumatised by blows such as BSE, foot and mouth disease and swine fever.
The local parish-based structures of the Church and their often longstanding relationships with secular and charitable organisations working locally provides a rich source of evidence, I believe, suggesting that there is a lot to celebrate in terms of healthy communities working and living together throughout these islands. But they must be supported. Those charged with the responsibility of government, at every level, need to keep the health of local communities and all who constitute them constantly in mind, certainly in a manner in which much and such public administration is delivered to them.
The substantial body of evidence and commentary drawn together 20 years ago in the Faith in the City report, to which I referred, continue to be the subject of work and engagement right up to the present day. The Church is being invited into many new partnerships and patterns of engagement alongside other faith communities. That needs to be underpinned by both resourcing and, of course, theological thinking.
The Government say that their vision is of an "urban renaissance", one which depends on individuals and communities playing their full part. We need to think differently in the light of the changes that are affecting our urban and, increasingly, our rural communities.
In many ways these changes become apparent in the events that make our news headlines: the eruption of violence back in 2001 in northern cities; the low turnouts, already referred to, in general and local elections; the crisis—or at least the severe and real dislocation—in the relationship between urban and rural populations. All point to a time of critical opportunity and challenge for all of us—for faith groups, tiers of government and, importantly, within and around the diverse communities we are all trying to serve.
A greater awareness of regional identity and relationships has, of course, been fostered through the creation of the regional development agencies and an enhancement of the role of regional government offices. The former is now expected to take the lead in the allocation of resources for area-based regeneration. Regional performance is considered vital in the context of Europe, where many nations have cohesive regional economies and more regular distribution of resources and population. But, as a Bishop, I remain concerned about increasing regional disparities in economic performance, employment, house prices and, indeed, media profile, as well as the treatment and inclusion of faith communities in regional strategies.
London, of course, continues to stake out its place as a global city in a context that places other British cities in a completely different league. Significant questions exist concerning London's ability to develop appropriate strategies for regeneration and redistribution within itself and its relationship with other places in the United Kingdom and abroad.
We are all increasingly aware of the European and global dimensions to issues of employment, corporate culture, migration and notions of belonging as well as identity and home.
The Church is uniquely placed to provide an overview of regions from outside the business and local government perspectives. The interests of rural and urban communities, and often the poorest members of those communities, can be advocated by the Churches and other faith communities. There is, however, a need for greater liaison between those engaging with regional government bodies within and across the regions. It is vital that this level of engagement is undertaken in an ecumenical context which acknowledges the interfaith dimension.
Twenty years on from Faith in the City, the Church of England, working closely with other United Kingdom faith groups, continues to celebrate the local and national partnerships that must succeed so that citizenship is enhanced and community vitality affirmed, and, indeed, Big Brother kept at bay.
The Commission on Urban Life and Faith was launched at a meeting in this House in February last year. The Commission on Urban Life and Faith is a group of experienced practitioners on urban issues drawn from different communities around the country, all of whom have a commitment to improve life in disadvantaged urban areas. The commission's aim is to promote a realistic and positive vision of urban life and the contribution of people of faith, based on an analysis of tension, delights, injustices and the needs of contemporary city and urban living. As a key part of that work, the commission has rightly spent time looking at issues of concern to young people—the local communities not just of today but also of tomorrow.
In conclusion, I pay tribute to the reverend noble Baroness, Lady Richardson of Calow, for her work as chair of the commission and to the noble Lord, Lord Phillips, for initiating this interesting and vital debate. Like other noble Lords, I look forward to the maiden speeches of the three new distinguished Members of the House.
My Lords, I am delighted to be able to make my maiden speech in a debate that goes to the heart of the health of local democracy and to the heart of the debate about trust and politicians.
At the outset, I have a confession to make. In 1975, together with everyone else who attended the Labour Party conference of that year, I voted to abolish your Lordships' House. On that occasion, we were all gently chided by one of my mentors, Lord Shinwell, who reminded us that he had voted to abolish your Lordships' House in 1929. After a very long and very distinguished career in another place, he said, "I had nowhere else to go". I leave it to your Lordships to judge whether I have nowhere else to go, but if that is the case I can think of no better place to go.
I used to chide my younger colleagues in the other place that they were not proper politicians if they could not speak for 10 minutes without engaging the brain. Again, I leave your Lordships to judge whether on this occasion I have taken my own advice.
I came into politics 33 years ago, the son of a shipyard worker in Sunderland, who had been unemployed for seven years during the 1930s. It is not surprising that I had one or two small matters on my agenda when I entered politics, such as abolishing poverty, abolishing unemployment and abolishing educational inequality. My commitment to those objectives has remained firm over all those years and my noble friends on the Front Bench espouse those objectives too. Over the years some progress has been made.
I had another objective, which was to prevent too much power ending up in too few hands. Perhaps it was the nonconformity that I learnt at my mother's knee. I leave your Lordships to speculate how someone who was a nonconformist to his finger tips ended up as the agent of conformity for 10 years in the other place. How that happened I cannot tell. Because of that nonconformity or for some other reason, I have always been a decentraliser and a devolver, both by instinct and by experience.
Perhaps I may be allowed to refer to my former constituency, the town of Bishop Auckland, by way of example. Perhaps the only thing for which Bishop Auckland is known throughout the world is its superb amateur football club. In the 1950s and 1960s the team regularly ended up in the final at Wembley playing in front of 100,000 people. The people of Bishop Auckland are rightly proud of that great football heritage. They are also proud of the fact that the town has been the home of the bishops of Durham for 800 years.
A few miles down the road is Shildon. In 1825, slightly before my time, Timothy Hackworth began to build rail rolling stock in the town of Shildon. The building of that rolling stock went on until 1983, sometimes employing 2,600 people. The people of Shildon tend to celebrate their railway heritage now because of the efforts of Shildon Borough Council and the National Rail Museum at York where they have Locomotion, a rail museum with 60 rolling stock, which has attracted approaching 150,000 visitors in the short nine months since it opened.
A few miles in another direction, in Spennymoor, people are immensely proud of their mining heritage. I will be marching behind the Spennymoor town band at the miners' gala as I have done every year for the past 15 or 20 years. The gala is a great celebration of mining. It is such a moving occasion, when you watch 30 bands coming over Elvet Bridge with banners flying and stopping in front of the hotel in the centre of Durham.
All of those are sources of immense pride in my communities but I am even more proud of the miners' settlements in Spennymoor because they have nurtured many painters among former miners who are of regional significance—and two who are of national significance; Tom McGuinness, who worked for 50 years in the mines in Bishop Auckland, and Norman Cornish, who was also a miner in Spennymoor.
I have only Teesdale left to mention out of my former constituency—almost 600 square miles of the most glorious countryside in the whole of the north of England. Barnard Castle boasts the national gem of the Bowes Museum under its very able young director, Adrian Jenkins, which is chaired most ably by the noble Viscount, Lord Eccles, who I am glad to see is in his place.
If we are to regenerate further these communities we can only do so by building on their already established sense of civic pride in their history. That cannot be done by central government from the top. Of course, there has to be a strong strategic centre. If we had nothing but centralisation, I fear that we would end up with chaos. We need a strong strategic centre voting on policies and allocating the money to allow interesting things to happen at local level. However, we can regenerate communities only by releasing the skill, commitment and creativity of local people.
Local government, as well as national government, can be centralising. Our message ought to be directed at both central and local government. No regeneration of communities can take place without engaging the skill and creativity of local people.
We are not only talking about the health of local democracy this morning; the matter goes to the reform of the public service. We have tested to destruction the view that you can micromanage the health service from the centre. We have learnt that you have to release the skill and creativity of people at the sharp end. We have all learnt that, but I am not certain that we have learnt the mechanisms by which it can happen. Perhaps that is because there are echelons of managers who have been brought up in the command-and-control culture and find it difficult to learn that managing these days, both in business and in public service, is a matter of releasing the skill and creativity of the workforce. I look forward to the Government pursuing that agenda with even greater vigour.
I am very pleased to have been allowed to make a small contribution to this debate, and I hope that other opportunities occur.
My Lords, I warmly congratulate the noble Lord, Lord Foster of Bishop Auckland, on his eloquent and thoughtful maiden speech. I first met him when he was a Member of Parliament, and I visited Bishop Auckland as part of a small group representing the Commission on the Future of Multi-ethnic Britain, in 1999. It was a most revealing and helpful visit, to see the disparity of those who were very poor living side by side with those who were very affluent—and the lovely countryside of north-east England.
After a long and illustrious career in local councils in the north-east of England, and 26 years in the other place, I have no doubt that the noble Lord will make very important contributions in future debates, particularly in the fields of economic development, employment and the environment. He also has very interesting and broad-reaching contacts; for example, he is a member of the Salvation Army and has a tremendous interest in youth affairs. I am delighted that he is here and look forward to his valuable contributions in future debates.
I also congratulate the noble Lord, Lord Phillips of Sudbury, on securing this debate on a topic that particularly affects service delivery and the well-being of all citizens and communities. I shall focus on health and social care-related issues, drawing on my experience in Merseyside, which is an area where significant pockets of socio-economic deprivation are located close to affluent communities.
To provide services for the needs of those two distinct population groups with very different needs would require careful local planning. However, quality of services is best regulated through standards set at the centre. That arrangement is to be found in healthcare: standards are set by the centre through National Health Service frameworks, treatment guidelines provided by the National Institute for Clinical Excellence—NICE—and supported by agencies such as the National Patient Safety Agency and the National Clinical Assessment Authority.
The performance of local primary care trusts and hospital trusts is self-assessed by the local trust's audit committee, corporate and clinical governance groups and the finance committee, all led by non-executive directors. Here I declare that I am a non-executive director of Birkenhead and Wallasey PCT; I also serve on a steering group of the National Clinical Assessment Authority.
Good policies do not guarantee improved service delivery, because delivery depends on effective implementation of policies locally. In the past four years, the Government have directed healthcare services from the centre by setting numerous targets for primary care trusts to achieve annually in order to be awarded star status, ranging from zero to three stars. Rewards worth £1 million each have been given to three-star primary care trusts every year—and I am pleased to report that mine is one of them.
This system of centrally led healthcare delivery has produced limited improvements in patient satisfaction and in the health of communities. It has also caused staff to become frustrated with having to work to targets that do not necessarily improve the health of patients. Not surprisingly, the second phase of the NHS Plan announced six months ago emphasised a moving away from national to local initiatives. This new phase has been labelled the patient-led NHS. It is based on patients' choice through information and involvement with greater influence of primary care and GPs through local staff leadership and motivation.
Before we become excited by the prospect of local autonomy I inform your Lordships' House that more changes are envisaged in the work of PCTs and hospital trusts. A system of listening to patients and local residents is still rudimentary. One excellent example of this is the National Patients Survey (NPS) programme introduced in 2001 by the Department of Health. Listening to Patients is the collaborative annual survey of PCT patients first surveyed in 2003. Every PCT pays its share towards the commissioning of that survey.
A significant finding was that in 2004 some 70 per cent of those surveyed were content with the information they received about side-effects of medication prescribed for them, which means that 30 per cent of them were not. As a result PCTs on Merseyside are changing their contracts with community pharmacists to ensure that pharmacists will speak with every patient collecting their medication to discuss any medication issues. The report states that when patients were asked whether they had asked a pharmacist for any advice on medicines in the past 12 months, 26 per cent said that they had. Of this group 82 per cent said that the pharmacist's advice was definitely helpful and 4 per cent said that it was not helpful.
Clearly, eight out of 10 of patients on Merseyside do not speak with pharmacists. Therefore, it is important for the community pharmacist to initiate conversation with patients and ask them if they have any concerns regarding their medication, how they are to take their medicines and how to reduce side effects. If that were to take place, it would reverse the high proportion—about 70 per cent—of patients on Merseyside who do not complete the course of medicines prescribed by their GP or hospital doctor.
Computerisation of GP clinics is being developed so that primary care doctors may send information on their patients to hospital specialists through secure systems. If I may be provocative, an alternative system of sharing patient information would be for all users of the NHS to carry identity cards holding personal information about their health to share with GPs and hospital doctors.
Another example of local autonomy that will rapidly improve public health is that of having smoke-free workplaces. On Merseyside local authorities and NHS trusts have been more focused on achieving smoke-free workplaces that include shopping malls than the Government have been on their proposal to allow smoking in public houses where no food is served.
Public consultation on Merseyside has demonstrated that the majority of smokers also support smoke-free workplaces, public houses and shopping malls. The importance of this finding is particularly significant when we realise that Merseyside has the highest rate of lung cancer in England. Local autonomy on Merseyside has led to very sensible decisions on improving public health. Therefore, I hope and trust that central government will support local authorities and local groups on this most worthy decision to promote smoke-free workplaces, public houses and shopping malls especially the Bills for a smoke-free Liverpool and London.
The Government have made health and the NHS a priority. Spending on the NHS by 2008 is set to double that which was given in 2000. To achieve the maximum benefits the Government must trust local people who care and who are dedicated to improving the health and well-being of local communities. Appropriate services, whether provided by public or private sectors, should seek to meet the needs of people where they live. To be relevant and effective, service provision and delivery must be locally determined. I look forward to hearing the Minister's views.