Queen's Speech — Debate (5th Day) (continued)

– in the House of Lords at 1:10 pm on 3rd June 2010.

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Photo of Lord McKenzie of Luton Lord McKenzie of Luton Labour 1:10 pm, 3rd June 2010

My Lords, I start by offering my congratulations to the two new Ministers at the Dispatch Box today and indeed to the noble Lord, Lord Freud, whose areas of responsibility are covered in the debate. I acknowledge the two excellent maiden speeches and look forward to two more. I intend to focus my remarks on the labour market and benefit proposals in the Queen's Speech.

Our starting position-hitherto shared around this House, I believe, if our recent debates on welfare reform are a benchmark-is the centrality of work, good work, as a means for people to stay out of poverty, improve their self-esteem and well-being, and meet their aspiration for a fuller life. It follows from this that we support a system in which nobody should be written off and which helps people get into work or move closer to the labour market-that is, a system in which people are better off in work than on benefits; one that places reasonable conditions on individuals to take up or prepare for work when they can and supports them when they cannot; indeed, a system that is built on partnership between government, employers, local authorities and providers, including the third sector.

That is what changes to the benefits system, including tax credits, have been about since 1997, why worklessness has fallen and why the action that the Labour Government took has prevented a big increase in inactivity during the current recession. It is why fewer people are on inactive benefits now than in 1997 and why we halved the number of people on tax and benefit rates of 90 per cent plus. But you do not have to take my word for it. Indeed, it was the noble Lord, Lord Freud, himself who stated in his 2007 report that:

"The Government has made strong, and in some respects, remarkable progress over the last 10 years. The New Deals ... have been enormously successful".

Given this assessment of our approach, it is shocking to see that one of the earliest acts of the Conservative-Lib Dem coalition has been to withdraw support for the Future Jobs Fund, in breach of pre-election promises, axing some 40,000 jobs for young people this year alone.

The coalition promises us an investigation of the benefits system to simplify it in order to improve incentives to work. This is not the first such investigation and no doubt it will not be the last. No doubt we will see the re-emergence of our old friend the iron triangle. However, as we debated earlier this year during the passage of the Child Poverty Act, we need to be cautious about the simplistic application of an economic model that looks at the relationship between the level of benefits, the earnings break-even point and the rate at which benefits are withdrawn-and especially about conclusions which suggest that benefit levels have to be reduced to maximise work incentives. Simplification of the benefits system is a worthy objective, but we know that, if it is done fairly, it costs money. I would be interested to hear about the resources that have been secured from the Treasury for this end.

We have heard from Ministers about plans to reassess everyone currently on the old-style incapacity benefit according to the work capability assessment. This was already in hand with a major programme to assess 10,000 people each week in addition to handling new claims. Is it proposed to continue with this migration process at the pace originally proposed or at a different rate, and what are the resource implications? Of course it is not just a case of assessing customers in receipt of incapacity benefit. We recognised that whatever progress had been made, more had to be done to tackle long-term worklessness. That is why we proposed back in March further changes to the assessment, with new help and stronger conditions to accompany them. The introduction in 2008 of the work capability assessment and ESA marked a new beginning in how people were assessed and supported, focusing on what people can do rather than what they cannot.

Concerns have been raised in this Chamber, most notably by the noble Baroness, Lady Thomas of Winchester, about how accurately the WCA assesses individuals, and more recently it has been challenged by Citizens Advice Scotland. So I urge the coalition Government to proceed with the improvements identified following an internal review of the WCA, and in particular for there to be greater recognition of fluctuating conditions within the assessment, to expand the support within ESA to cater for those with certain communications problems and those with severe mental health conditions.

As for sanctions, we will have to unpick the detail from the rhetoric, but I had a sense of foreboding last Sunday when I thought I heard the Secretary of State say in an interview that sanctions were not being properly applied or, indeed, being applied at all. In part as a result of arguments advanced in your Lordships' House, we secured in primary legislation the recognition that good cause for acts or omissions includes the availability of childcare and a person's health conditions, physical or mental; that victims of domestic violence should have extended exemptions from JSA conditionality; and that JSA and ESA agreements and action plans must have regard to the impact on the well-being of any children. We have otherwise secured that parents with young children have the right to restrict their availability for work to school hours. I take it that all of these are sacrosanct. If not, we will look to make common cause with all those who supported and pressed us on these matters.

There is much else to keep us occupied in this agenda: the creation of a single welfare-to-work programme, the realignment of provider contracts, and progress on the DEL-AME switch. The devil, of course, will be in the detail. If the effect of all this is to make progress on ending child poverty-I welcome the commitment, and it will be interesting to see what targets are used in that endeavour; to help more people into sustained employment, and to support those for whom escaping poverty through employment is not practical, the agenda will have our support. If not, we will challenge it rigorously.

Photo of Baroness Walmsley Baroness Walmsley Liberal Democrat 1:17 pm, 3rd June 2010

My Lords, I make this speech for the first time from the government Benches, in the first coalition Government for many years. Coalitions are commonplace in local government and are nothing to be afraid of, and this one has been welcomed by at least two-thirds of the population. It is only a pity that some of the more vicious national press lags behind public opinion. I therefore congratulate my noble coalition partner, the noble Lord, Lord Hill of Oareford, on his new role and his maiden speech. He will find that we, his partners on these Benches, will play our part in helping to guide the elements of the coalition agreement through this House. In listening to one or two of the speeches over the past few days, the image has been brought to mind of the apocryphal Japanese soldier who staggers blinking out of the forest several years after 1945 under the impression that World War 2 is still under way, unaware that peace has broken out. I am not one of those; the war is over, long live the peace.

So let me start my comments on children and schools by welcoming some important policies from the coalition agreement. First, I am delighted that we will scrap ContactPoint, change the rules on collecting and storing DNA, and ensure that children are no longer fingerprinted in schools without their parents' permission. But could I ask the Minister whether the erection in public places of the notorious mosquitoes, which make a high-pitched noise which only children can hear, will also be banned unless there are very good public interest reasons for them? They are discriminatory and restrict the freedom of movement of law-abiding young people, and have been condemned by many organisations that speak for children, as well as by children themselves.

I also welcome the commitment to the overseas aid target on which so many of the world's most vulnerable children depend, and the coalition Government's continued commitment to ending child poverty by 2020. This policy was one of the best actions of the former Government. I am also pleased that the Government have stated their continuous support for Sure Start, another of the previous Government's achievements for children.

Noble Lords may recall that I have always regretted the reduction in the health visitor service. Health visitors, as a universal service, avoid any stigma for the family visited, are trusted by mothers and are a useful signposting mechanism to other services. Therefore I am delighted about our commitment to increase their numbers. However, I am keen that we get the balance right. The Sure Start peripatetic outreach workers have done a valuable job in reaching those families with multiple problems who other services have found hard to reach. I want to be sure that the new health visitors will be trained to reach out into the community, identify problems and direct the appropriate services towards families. At a time of economic belt-tightening, we need to make every pound work hard, and early intervention provides the best value for money.

One of the declarations of which the coalition can be most proud is that children will no longer be detained for immigration purposes. This was an unnecessary blot on the record of the previous Government, who did so much for children, and got in the way of this country implementing fully its duties under the UN Convention on the Rights of the Child. Every step towards full implementation of the convention is a step in the right direction.

On criminal justice, I welcome the proposal to conduct a full review of sentencing policy to ensure that it is effective in deterring crime and reducing reoffending. The rate of reoffending, in particular among teens and early 20s, is appalling. The evidence for the effectiveness of rigorous community sentences and restorative justice initiatives is compelling. So many young offenders have themselves been failed by society and need treatment, therapy and education to get them back into useful lives. I hope the evidence from these initiatives will be taken seriously in the review. I also hope it will consider the evidence for restoring the age of criminal responsibility to its pre-1998 age of 14.

In the section on the NHS I find little about children's health, apart from the welcome reference to children's hospices, which do such a wonderful job. What concerns me is the lack of any reference to child and adolescent mental health services. I am aware of the financial problems the Government have inherited but I would urge Ministers to consider the long-term financial savings that could result from early intervention for children with mental health problems and personality disorders. Emphasis on child poverty and family support can avoid some of those problems but we still need to improve what has been a Cinderella service. If we do, we will reap financial as well as human benefits.

Time does not allow me to say much about schools but I shall get my opportunity to do that on Monday. I have already pointed out the educational disadvantage of many young offenders, for example, so it is vital that all our children get the best possible education we can provide. Despite the economic problems, the Government have declared that schools will not suffer and neither will 16-to-19 education. Indeed, the commitment of my party to providing the financial premium needed to enable children from the most deprived backgrounds to overcome their disadvantage is one of which I am most proud. I am delighted that our coalition partners have agreed that this cannot be done without a commitment to that funding promise. It is for the long-term future of our country, as well as a basic human right for our children.

The noble Baroness, Lady Morgan, asks where the money is coming from. It really is breathtaking when the Opposition shoulders no responsibility for where the money went. We will be coming to the Second Reading of the first of two education Bills on Monday, so I shall not say much about academies here. However, I will be playing my part in ensuring that the objectives of the Bill are achieved without jeopardising the coalition's declared intention of providing the very best for the most vulnerable children. Their welfare as well as their education is of paramount importance-and that includes those with SEN, disabilities, those in public care and young carers. We have to look very carefully at the possibly unintended consequences of the structural reforms that are proposed to ensure that no child is left behind as we improve schools.

Both our parties have often said that we should trust the professionalism and dedication of teachers. However, there is currently excitement and concern among teachers and heads about the Government's plans and we must ensure that these concerns are taken into account. If we are to enable schools to improve, we can do so only with the commitment and energy of our teachers, and so it is vital that we listen to them.

I commend this programme of government to the House and I will work with my partners to ensure that, as usual, legislation leaves this House in a better state than when it came in.

Photo of Baroness Greengross Baroness Greengross Crossbench 1:25 pm, 3rd June 2010

My Lords, everyone in your Lordships' House will welcome the Government's intention to push forward the reform of health and social care and, in the case of social care, the establishment of an independent commission on the funding of long-term care and the breaking down of barriers between health and social care funding to incentivise preventative action. The greater rolling-out of personal budgets to both older and disabled people and carers will give more control and purchasing power, and the increase in direct payments to carers and better community-based provisions to improve access to respite care will also be warmly welcomed.

As for the health Bill, no one will argue that a sustainable national framework for the NHS which supports a patient focus on outcomes and delivers on the commitment to reduce bureaucracy by strengthening the voice of patients and the role of doctors is not a good thing. I hope that eliminating the top-down structural approach will make doctors and nurses accountable to patients and their carers, rather than to layers of NHS management. However, while welcoming this new accountability and patient focus, and supporting the reduction in bureaucracy, I speculate just how the removal of one quango layer, the strategic health authorities, and their replacement by another, the NHS board, will improve things in the short term. The expanded roles of both Monitor and the CQC should go some way to assuage those concerns, but we need more detail as to exactly how these agencies will work with the new board and I hope the Minister will be able to give us a little more information about that.

While welcoming the fact that the Government are also going to prioritise public health, I look forward to more detailed plans for this area, which I hope will emerge before too long. Whether this Government are able to tackle the economic and social determinants of poor health and reduce health inequalities will be a test of whether they can work effectively across departmental boundaries, something which, sadly, eluded their predecessors.

Often it is older people, in particular, who can find themselves on the front line of experiencing health inequality at first hand. An unacceptable variation in the quality of dementia care on general wards in hospitals across England, Wales and Northern Ireland was identified in a recent Alzheimer's Society report. Dementia patients with an accompanying physical condition are staying far longer in hospital than those people who go in for the treatment of a physical ailment alone.

Health inequalities, however, are experienced not only by older people but right across the life course. The Healthy Ageing across the Life Course programme, funded by the New Dynamics of Ageingprogramme, shows that childhood social conditions, as well as adult social conditions, have a long-term impact on physical performance. However, Professor Marmot's review into health inequalities, Fair Society, Healthy Lives, published earlier this year, reminded us that while health inequalities are traditionally regarded as a problem for the NHS, the NHS is but one player in this task. We must also address the social determinants of health, the housing and neighbourhoods where people live, education, income, standard of living, occupation and working conditions. Clearly the NHS cannot tackle these issues alone; central and local government departments, the third sector and the private sector, as well as individuals themselves, have a key role to play.

The big question is whether we are willing to invest for the future in a fairer society in which we can all enjoy a fuller and healthier life. For some people, particularly older people, the impact of the economic downturn on pension funds may mean that they will have to remain in work longer. Therefore, the proposed removal of the default retirement age must be accompanied by a concerted drive by government, employers and agencies to tackle stereotypes, to extend flexible working opportunities to all workers, and to meet the health, caring and work needs of people who are 50 and over so that they can remain economically active without it being detrimental to their health.

Most well intentioned observers would support the vision described in Our Programme for Government of a reformed health and social care system that puts people in control of their lives. While we all realise that this Government have to find radical, practical and affordable solutions to the issues that we face, the challenge will be to oversee the fair delivery of this reform in this era of new politics, responsibility and opportunity.

Photo of The Bishop of Guildford The Bishop of Guildford Bishop 1:31 pm, 3rd June 2010

My Lords, I must first express my sincere gratitude for the personal welcome that I have received from all sides of the House, especially from the Minister this morning-and especially now that our respective wives have been sorted out. To this, I add my most sincere thanks to the officers and staff of the House. I thank especially Black Rod, who briefed me just a day before his tragic illness, which I know your Lordships' House most deeply regrets.

It is, however, with a certain sense of surprise that any Bishop of Guildford stands before this House, as an examination of Hansard for July 1927 would reveal. The creation of my diocese of Guildford out of the ancient diocese of Winchester, together with that of Portsmouth, had been discussed for many years in the earlier part of the past century. The creation of a separate diocese of Guildford, comprising the county of Surrey excluding its eastern corridor but including north-east Hampshire, was aimed at what was interestingly called at the time "better shepherding" and "spiritual efficiency". The church, like the constitution of the realm, continually changes and develops as circumstances require. After its safe passage through the Church Assembly and the other place, the then Bishop of Winchester, Theodore Woods, newly translated from Peterborough, introduced the Church Assembly Measure into your Lordships' House. But an unexpected and eloquent ambush was executed by the then Bishop of Durham, Hensley Henson, which would have had fatal consequences had not the swiftest tactical action been taken by the then Archbishop of Canterbury, who successfully proposed an adjournment. Two weeks later, after a long debate and with powerful support from the Archbishop of Canterbury, your Lordships' House was "Content", but only by a margin of 10 votes, that there should be such an entity as the diocese of Guildford. I stand before you.

I begin here because a debate concerning culture should take into account the importance of knowing our history. I know that the Minister, originally a historian, will support that-in a different vein, I refer noble Lords to the earlier comment of the noble Lord, Lord Baker. To understand who we are and where we are to go, we need to know where we have come from. This is true of communities and society as well as individuals and indeed a diocese.

The diocese of Guildford includes within its boundaries two excellent university establishments, the University of Surrey and Royal Holloway College, the latter a pioneer of women's university education, with particular strengths today in the creative arts and in interfaith relationships and chaplaincy. The University of Surrey-I speak not only as a member of court but also as a personal friend of the former and present vice-chancellors-has recently rejoiced in the opening of its Surrey Sports Park with world- class facilities, not least for swimming and pre-Olympic training. It includes training and sports facilities for the disabled, including world-class sportsmen and women with disability. It is an important development. Another recent development there has seen the association of the Guildford School of Acting with the university. At the University of Surrey, we are further engaged in an innovative, multi-faith centre where people of all faiths will be able to pray in their distinct sacred spaces but also to meet together, eat together, discuss together and work together-faith and academy working together to enhance social capital and cohesion. At Woking, incidentally, also in the diocese of Guildford, we have the oldest mosque in the country. In Guildford, there flourishes a fine school of contemporary music; at Oxshott, at the other end of the musical scale, is the Yehudi Menuhin School; and at Farnham there is the University for the Creative Arts. Guildford's Yvonne Arnaud Theatre is well known, and Woking's New Vic Theatre hosts National Theatre productions and Glyndebourne on tour. Also in Surrey, uniquely for this country, is the Wintershall Passion play.

I must also mention fine museums throughout Surrey, particularly the awardwinning Lightbox in Woking-presently offering a Walter Sickert exhibition-and the Watts Gallery at Compton, where Jeremy Hunt, the Secretary of State for Culture, Media and Sport recently graced its restoration "topping out" ceremony. I particularly commend the Watts Gallery's community outreach programme, as befits the memory of the painter GF Watts, who had a very serious social conscience.

One of the most interesting observations that I made when I moved to the diocese of Guildford five and a half years ago was of the Surrey social conscience. In the cathedral there is a memorial to the Jarrow marchers of the depressed 1930s and the Surrey collection for them. In fact, Surrey and north-east Hampshire were relatively poor before the coming of the railway. That, I know, takes a little bit of believing. There was of course a vein of prosperity running through the county: the wool trade. As I stand in your Lordships' House, I am reminded that the arms of my see include no fewer than 12 woolsacks. With the railway, Surrey, in the words of Arthur Mee, became London's nearest neighbour and we became commuter-land for Waterloo and the City of London. Today, we lie between the airports of Gatwick and Heathrow, and Surrey has become a global, multinational commuter-land. This does not mean that there are no pockets of deprivation within Surrey and north-east Hampshire. Researched evidence of this can be found in the report, Hidden Surrey, commissioned by the Surrey Community Foundation, of which I declare I have the honour and responsibility to be a member.

In this debate, I would be remiss if I did not draw your Lordships' attention to that considerable heritage of which I as bishop, with the clergy and lay people of my diocese, have some responsibility for: the parish churches of Surrey and north-east Hampshire. Guildford's cathedral, by Edward Maufe, has been unduly neglected, but no longer do people speak of it disparagingly as akin to a power station-in any case, cathedrals ought to be power stations. Pevsner rightly speaks of the cathedral's interior as "luminous". In that interior sings a cathedral choir of national excellence and space is also regularly inhabited by local musicians such as the Guildford Symphony and Philharmonic Orchestras with their choruses, as well as national orchestras.

Pevsner, it has to be said, spoke of Surrey as "doubly unlucky". He meant by that its contemporary proximity to London and its ancient remoteness from anywhere else, thus its comparative paucity of grand architecture. But he rightly excepted its ancient village churches and surrounding houses. In networks today made up largely of metropolitan and global commuters, the village green and the parish church, not to speak of the disappearing pub and post office, are important icons of human continuity and community. They are for all the community. But such a precious built heritage is enormously costly to maintain-I speak now of the parish churches rather than the pubs. About £110 million a year is spent annually simply by the Church of England on keeping up listed places of worship, to which local congregations contribute two-thirds. This is a good working partnership. Nationally, as well as in Surrey, the Listed Places of Worship Grant Scheme, which refunds the cost of VAT on repairs to all such buildings, has been enormously important in maintaining the fabric of these churches, open for all. Three recent grants in Guildford diocese were concerned with additional community facilities. The scheme is due to end in March next year, with no replacement in sight, which seems like a curious blindness to the contribution of faith communities to the wider culture and well-being of society. Some years ago, the bishops in the West Midlands were invited to scrutinise a draft regional description of cultural activities. Church buildings did get a perfunctory mention, but its drafters had forgotten the Three Choirs Festival, the oldest cultural festival in the country. I urge Her Majesty's Government to avoid such partial blindness in respect of a continuation of the Listed Places of Worship Grant Scheme.

In conclusion-and speaking of seeing-I offer four ways of seeing the diocese of Guildford. There is the magnificent view of Surrey and north-east Hampshire from the Hog's Back, but do not stop too suddenly on the dual carriageway. There is the extraordinary view of the North Downs from Newlands Corner, with range after range of hills beautifully composing themselves like a Claude landscape. Alternatively, although I am not sure that I can recommend this, an excellent view can be obtained, if only momentarily, at 200 feet up on the rollercoaster at Thorpe Park. My recommended choice is from the top of the tower of Guildford Cathedral, with views over the downs as far as Epsom to the north-east and Hampshire and Sussex to west and south. This last vantage point I shall be happy to arrange a visit to, should any noble Lord so desire.

Should today's debate overrun its scheduled timing, I beg the indulgence of your Lordships' House and the Minister if I leave in the early evening to be at an engagement leading a service of worship for Corpus Christi at one of my parish churches.

Photo of Lord Colwyn Lord Colwyn Deputy Chairman of Committees 1:42 pm, 3rd June 2010

My Lords, I am delighted to be able to congratulate the right reverend Prelate the Bishop of Guildford on his warm-up from my noble friend Lord Hill of Oareford and for his interesting and informative maiden speech. I welcome him to the Bishops Benches, despite the lack of space. Many of us here will welcome his publicly declared belief that this House should be preserved as a revision Chamber for legislation and that serious thought should be given to our constitution, electoral system and your Lordships' House. He has recently celebrated 40 years as a priest and was secretary for ecumenical affairs at Lambeth Palace for the late Lord Runcie from 1981 to 1989 before being appointed a canon of St Paul's. He became Bishop of Guildford in 2004. He is a supporter of the ordination of women and is in favour of women bishops. He has been highly critical of the EU and its remoteness from ordinary people. I have a feeling that the right reverend Prelate will enjoy himself in this House. His intervention in today's debate on the Queen's speech is particularly appropriate, as he is known to Her Majesty as Clerk to the Closet. It is his task to present newly appointed bishops to Her Majesty the Queen. We shall look forward to hearing from the right reverend Prelate in the future.

I intend to speak briefly to support both my dental and my musical colleagues. Dentistry is at another crossroads. The decisions made in this Parliament to transform the delivery of NHS dentistry will be extremely important. We have been left with an unfinished reform following the 2009 Steele review. We must grasp this opportunity if we are to improve the oral health of the nation. However, the challenge of reforming dentistry-to deliver a better system both for patients and dentists-comes at a time when tough financial decisions are to be made across all Whitehall departments.

The previous Government started to clear up the mess of dentistry, much of it self-inflicted, but there remains much for the new Government to do. I take this opportunity publicly to welcome the coalition Government's commitment in their programme for government. The agreement states that,

"we will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with additional focus on the oral health of schoolchildren".

The acknowledgement of dentistry in this document is very positive and much needed. Despite an overall improvement in the oral health of the nation over the past 30 years, problems persist. As I have mentioned before in this Chamber, by the age of five, more than 30 per cent of British children suffer missing, filled or decayed teeth. In some parts of the country, as many as three-quarters of children are affected. Oral cancers, one of the conditions that dentists play a crucial role in detecting, are becoming increasingly common. There has been a 41 per cent rise in the number of cases of mouth cancer in the past decade and, in the last year for which the figures are available, 1,851 people died as a result of the disease.

Alongside the challenges of oral health promotion and NHS dentistry, general dental practitioners face mounting challenges in the management of their practices. The creation of the Care Quality Commission, with which both NHS and private dental practices must be registered by the end of March next year, foists a further layer of regulation on dental practices. Although registration is due to open in October, the registration fee is still not announced.

Requirements for decontamination are also changing, in the form of the Health Technical Memorandum 01-05: Decontamination in primary care dental practices. The profession is seeking clarification of the evidence base for these changes and has called for a review by NICE. The question is whether the changes offer the genuine reassurance to patients that make investing in them worth while.

Pressing challenges remain, but I believe that we have the opportunity to complete the unfinished reform and change the way in which NHS dentistry is delivered in England so it is more preventive, increases access and delivers good oral health. The challenges are threefold. First, the Government must complete the unfinished reforms, learning from the mistakes of the much criticised 2006 contract-in particular, avoiding the failure properly to pilot change. The contract was so disastrous that it initially saw access fall dramatically. Only in the past six months has access climbed back to the level it was at in 2006. I am delighted that the Government have committed to pilot any changes. Secondly, we must pursue consistently high-quality commissioning of primary dental care. Some PCTs perform well, but many have room for improvement. They must be properly supported in their work, particularly by ensuring that they employ or have access to dental practice advisers and dental public health expertise. Thirdly, there must be a commitment to tackling oral health inequalities to close the unacceptable chasm which exists between those with good and poor oral health as highlighted in the British Dental Association's general election manifesto, Smiles all round. I therefore welcome the announcement in the Queen's Speech that the voice of patients will be strengthened to improve public health alongside actions being taken to reduce health inequalities. The coalition has made it clear that dentistry is a priority. The task now is to work out the detail with the profession, to deliver real change for patients and dentists.

I have a few words to say about music. I hope that the coalition will be able to make a clear statement on the situation over the Live Music Bill, which was widely supported but failed to survive the last few days of the previous Administration. A widely criticised recent DCMS live music report claimed that overall live music is "thriving", but acknowledged that this was not the case for smaller venues. However, the "thriving" conclusion was not based on any direct measure of performances, but relied instead on indirect evidence-an 11 per cent increase in live music licence applications, an apparent 20 per cent increase in the number of professional musicians, and a modest increase in self-reported gig attendance and Arts Council participation data. The last time that the DCMS surveyed actual performances in venues like bars and restaurants was in 2007. This showed a 5 per cent fall in performances after the Licensing Act came into effect in April 2005, measured against benchmark the 2004 pre-Act MORI survey which found that the majority of premises had no music at all in the previous 12 months. This did not stop DCMS from calling it a flourishing live music scene.

The Live Music Bill, which would give licensing exemption to gigs for fewer than 200 people, reintroduce the "two in a bar" rule that allows one or two musicians to play with either minimal or no amplification and exempt hospitals, schools and colleges from requiring licences for events where alcohol is not being sold should be reintroduced to Parliament as soon as possible. I believe that the Home Secretary, Theresa May, will be reviewing the 2003 Licensing Act and I urge her to consider separating entertainment licensing with an exemption for small gigs from alcohol licensing.

Grouping those two licensable activities together may have seemed a neat administrative solution, but it has seriously harmed live music in different ways, first by significantly reducing the number of places where musicians can work and radically increasing bureaucracy and, secondly, by creating the wholly misleading impression that live music is first and foremost a danger to society-as dangerous as alcohol. That is not only offensive to those who care for live music; it suggests that, as a nation, we have surrendered to petty officialdom.

Photo of Baroness Morris of Yardley Baroness Morris of Yardley Labour 1:51 pm, 3rd June 2010

My Lords, I join others in congratulating the noble Lord, Lord Hill, on his appointment. His really is one of the best jobs in Government, and as long as he can withstand the surfeit of good advice from former education Ministers who are in this House he will do very well. I am sure that he will enjoy it. I also congratulate the noble Lord, Lord Hall, and the right reverend Prelate the Bishop of Guildford on their maiden speeches. It was a delight to listen to them and I also look forward to their further contributions.

New Governments are always inevitably about change; that is what the electorate has asked for and invited, but inevitably there is some continuity as well. I very much welcome that, in what we have already heard from the coalition Government, many of the most successful initiatives of the past Labour Government-Teach First, schools supporting other schools, Sure Start, early years, federation and clusters-will still find a home under this Government. I also welcome one or two policy announcements that I have heard. In particular, on technical schools-or colleges or academies, as they seem to change their name as the policy develops-I congratulate the noble Lord on the work that he has done with our former friend on this. They are a change for good and I would certainly offer my personal support from these Benches in any way, as he knows that I have done so far. I am delighted that they, too, have found a home. I also welcome the review of the accountability framework, which is long overdue. I suspect that only a Government new in office could do that, not one who were part way through.

I want to concentrate today on the main themes of the education part of the Queen's Speech: academies, free schools and teacher control of the curriculum. Unusually, we have another opportunity on Monday to discuss the first Bill, so I shall not go into detail now. Rather, I shall look at some of the underlying principles that have been seized and which shape the education part of the Queen's Speech debate. At the start of their term in office, I suppose that every Government will have to decide what are going to be their levers of reform. In what will they place their trust to bring about the changes they want to see, and which they have promised the electorate?

This coalition Government have made two key errors-quite serious and fundamental errors-in those early decisions. From the Queen's Speech and the speeches that we have heard so far, we can see that they, like many other Governments, have seized on two things to guide their reforms. First, there is structural change, changing the legal status of schools and their governance and, secondly, embracing independence-in this case, freedom from local councils or a nationally prescribed curriculum. We have now had more than five decades of continuous change in education. We should be able to look at the evidence of what works and build on that, rather than having this pendulum which swings from one set of policy ideas to another.

There is no evidence at all that structural change leads to successful education reform yet politicians always go into structural change as a first and last refuge. You can list the types of secondary schools that we have had from 1945 onwards, from secondary moderns and grammars to communities and academies. Some of them have appeared more than once; they fade and come back. Despite what the Minister said, there is no evidence that academies are successful schools but they are not a failure, because it is not the status or structure of a school that will determine its success.

There are many good academies and I pay tribute to them. I, too, paid tribute to Mossbourne Academy, which is mentioned more than any other school in both Houses of Parliament, yet I also look at the rest of the London schools. Most of the 100 secondary schools in London that receive from Ofsted the category of outstanding schools are not academies but local community schools. If you look at Tower Hamlets, of the 15 secondary schools in the most deprived borough in our country, five are categorised by Ofsted as outstanding. Let us pay tribute to them. Not one is an academy; they are all community schools. I welcome and praise academies where they are successful, but there are failing academies. There are academies in special measures. In the south of England, there is an academy which has just been returned to local authority control because it is not successful. Changing the legal status of a school will not transform the opportunities for its pupils and the young people there.

The same is true of independence. The Government are confused about who runs schools. As Margaret Eaton, the Conservative LGA chair, has said, "Councils don't run schools"-they run themselves. Many of the freedoms that are now going to be offered to the new swathe of academies are mirages or illusions of freedoms. Many are already on offer for all schools, no matter what their status. One reason that they tend not to take and embrace those freedoms is a fear more of Ofsted than of the local authority.

It is time that we did indeed build on the evidence of what works, and every bit of evidence-none more than some research that came out of the University of Bristol in the past few months-shows that the key to individual success is the quality of teaching and of leadership within the school. The research from Bristol shows that the difference in performance between the top 25 per cent of teachers and the poorest 25 per cent can amount to 0.5 per cent of a difference at GCSE. That is why there are good and poor academies, good and poor local authority schools, good and poor church schools; it is because they are not all blessed with excellent school leaders and teachers.

When a new Government come in, they choose the levers that they will depend on to lead their reform over the following years-the flag-bearers of what they want to do. I am disappointed that this Government have chosen structural change and illusory freedom. They should have chosen to say, "The quality of teaching is what will make the difference and our policies will serve that end". The quality of teaching makes the most difference to the children from poor backgrounds and disadvantaged areas. I look forward, over the coming months, to hearing more about government policies that will help with that. So far, I am afraid that I am a little sad that this Government have almost reinvented the wheel, by seeking one more change in governance and in school status, with some more in the academies in the hope that that will bring about the reform that we all need. We should learn from research and from the evidence of what works. That does not lead us to more academies, with local authorities being squeezed out of the provision of education.

Photo of Lord Kakkar Lord Kakkar Crossbench 1:58 pm, 3rd June 2010

My Lords, it is with great humility that I beg your indulgence on this, the first occasion on which I address your Lordships' House. In the few weeks since my introduction, interrupted by the general election, I have enjoyed the warmest of welcomes from so many noble Lords and Baronesses, for which I am most grateful-as I am for the courteous, kind and thoughtful help that I have received from numerous members of staff, including the Clerks and the dedicated Doorkeepers. My happiness in making this speech is tempered by thoughts for Black Rod, who was particularly kind to my family at my introduction and whom I have had the chance of seeing, most recently yesterday evening, in hospital. I know that all our thoughts are with him and his family.

I also express my particular thanks to my supporters: the noble Lords, Lord Higgins and Lord Patel, and the Convenor of the Cross Benches, the noble Baroness, Lady D'Souza.

I could not let this occasion pass without recognising the role of the House of Lords Appointments Commission in my being here. Its thorough interrogation to which I was subjected was without doubt the most demanding and insightful of my professional career to date.

My emotions always run high as I enter the House. I never cease to be amazed by the history that attends our deliberations and the vital role that your Lordships play in ensuring that potential legislation enjoys rigorous scrutiny, so that the best possible laws may join the statute book for the benefit of all our people. That this important work is conducted in such a decent, thoughtful and selfless fashion, calling upon a wide range of scholarship, expertise and, above all, experience, makes this House truly unique.

Nor do I cease to be amazed that I find myself among your Lordships, something I could never have imagined on 7 December 1977 when, as a schoolboy, I made my first visit to this House, on which occasion I was filled with awe, excitement and a passion for our nation's democracy, debate and political discussion. The educational outreach programmes conducted by your Lordships are invaluable, and I hope to be able to contribute to these to help enthuse future generations of schoolchildren about the important work of your Lordships and about what is done in this House and how it forms a cornerstone of our much cherished democracy.

My professional life outside your Lordships' House is as professor of surgical sciences at the Barts and The London School of Medicine and Dentistry, part of Queen Mary College in the University of London, and consultant surgeon to University College Hospital. I also have the privilege to be director of the Thrombosis Research Institute in London, a world-leading centre dedicated to better understanding the problem of blood clots and how best they can be prevented and treated.

In the practice of medicine and my interest in thrombosis, I follow my father, a professor of surgery, and my mother, an anaesthetist, who came to our country in 1961 to complete their medical training. They were part of a substantial wave of immigration from India made possible because of a national consensus, long held, that has ensured opportunities and advancement for immigrant communities willing to integrate and contribute broadly to British society. What excitement there must now be among all British citizens of Indian origin on learning in the gracious Speech about the Government's desire for enhanced partnership with India, a wonderful opportunity for this vibrant community to contribute to securing broader opportunities for the entire nation.

In many ways, consensus and institutions define our national character. It is about one of our great national institutions, the one in which I continue to have the privilege to practice as a surgeon and about which I must therefore declare my interest-the National Health Service-that I would like to speak to your Lordships today. Like any great institution, the NHS cannot and must not be taken for granted. It needs to be nurtured, nourished and pruned thoughtfully and sensitively where necessary but, above all, respected.

The gracious Speech indicates the Government's desire to enhance the voice of patients and strengthen the role of doctors in the National Health Service. These are indeed important ambitions, and are made recognising the nation's serious fiscal challenge, a situation that will dominate the way that all public services can be delivered for years to come.

Time and again, Governments have felt an obligation to turn to the question of NHS reform. Why is this necessary despite substantial investment, a dedicated and talented workforce and its unique place in the nation's affections? Why is it that the care received by patients, and their experience of it, varies so considerably; that patient safety and dignity can still regularly be jeopardised; that we have not been able to define models and pathways of care that successfully cross the barriers of the hospital and general practice environment; that we are still witness to some shocking inequalities in health, none more so than those experienced by the homeless; that we have failed to develop a sustainable public health strategy; and that we are often unable to successfully disseminate and rapidly adopt innovation and the findings of medical research for the benefit of our patients? So much has been achieved, yet there is so much more that we need to do if we are to retain a sustainable National Health Service for the benefit of all. The nation's continuing commitment to the NHS offers both opportunities and important challenges to the medical profession.

All life is a journey, and in my own as a clinical practitioner and academic I have learnt so much about the dignity and resilience of human beings, but also about their frailty and insecurity. It is with this in mind that individual practitioners must deliver healthcare, at a time when both patients and relatives are at their most vulnerable. Beyond the delivery of care to our patients, however, clinicians will have to direct their current skills, and develop new ones, to help ensure that the very best possible gains in public health can be achieved, and that we facilitate the most effective use of the public funds available for healthcare to deliver maximum societal gain.

This is an impressive challenge, but one with which my own profession must fully engage, and I am sure it will, through providing clinical leadership. Indeed, in the publication of its report, Future Physician: Changing Doctors in Changing Times, the Royal College of Physicians of London recognises this to be a critical issue and an obligation for the medical profession. However, there is an important distinction between leadership and management in the NHS, a distinction that needs to be clearly understood so that the development of true leaders across both primary and secondary care can become enshrined in the way that we nurture the careers of our most able clinicians.

Leadership is never easy, and clinical leadership will require healthcare professionals to engage with difficult decisions. How can resources be most efficiently utilised? How can the delivery of care be safe and effective while always ensuring that patients are treated with dignity and humanity? How do we ensure that advances in medical research and innovation, once proven, are rapidly adopted for the benefit of our patients, communities and society more broadly?

To effect change, partnership will be essential-partnership between patient and doctor, academic and clinician, hospital doctor and general practitioner, and of course Government and healthcare professional-always focused on the best that we can achieve for our patients while working to ensure that the precious and generous funding available for healthcare provides maximum benefit.

Despite being one of our country's most cherished and important institutions, the NHS, like all healthcare providers around the world, faces immense challenges. With ever increasing costs on the one hand, and both the delivery of care and the nation's health failing to meet expectations on the other, courage will be required to secure a sustainable NHS for the benefit of our people. The forthcoming health Bill offers the opportunity to ensure clinical leadership and partnership within the NHS. The expertise of your Lordships' House will play an important role in achieving that. I thank noble Lords for having given me the opportunity to speak.

Photo of Baroness Andrews Baroness Andrews Labour 2:08 pm, 3rd June 2010

My Lords, it is my great pleasure to congratulate the noble Lord, Lord Kakkar, on an excellent maiden speech and in particular on his passionate advocacy of the NHS and patients; that is most welcome in this House. He knows that he joins a galaxy of talent among our noble medics, but we have never before had a specialist on thrombosis. He spoke about leadership, and I understand that he leads the only multidisciplinary programme in the area of cancer-oriented thrombosis.

I made the mistake of printing out the noble Lord's list of publications. Several hours and reams of paper later, I can vouch for his industry as well as his expertise. In addition, thrombosis affects us all, and he will be listened to most attentively in this House-particularly, I suspect, from the Front Bench, which spends hours sitting still. We look forward to his expertise.

The noble Lord is also clearly a man of action as well as a tremendous, internationally renowned expert, a deadly combination that puts fear into Ministers. I am sure that we will welcome whatever contribution he has to make in the future.

I also welcome the Minister for Education to the Dispatch Box, and all the maiden speakers who have spoken so eloquently today. Not wishing to be left out, I will claim that I, too, am a maiden speaker. I am speaking from the Back Benches after a long period of exile to the Front Benches; I am speaking in Opposition, which is an interesting angle; and I am speaking on a topic on which I have never spoken before but shall return to. It is a sort of cygnet song. I refer to the historic environment and the buildings and places which frame our lives, experiences and memories.

As one of the quartet of policies that we are discussing today, it is a useful and beautiful link between them all. It makes us feel better; it creates jobs and skills, and nurtures experience; and it opens doors to our history. Both the right reverend Prelate the Bishop of Guildford in his terrific speech and the noble Lord, Lord Baker, spoke about the importance of history-of knowing ourselves and knowing our country. I think here also of how we frame so much of our cultural activity in our great buildings. For example, in Belsay Hall at the moment there is a magnificent exhibition of contemporary art. This is one of English Heritage's properties. I must declare an interest as chair of English Heritage.

I want to focus on this area of policy for serious reasons. At a time when we face one of the greatest tests as a country-to rebuild our economy and protect our communities-we must realise, simply, that we must exploit all our resources: our knowledge, our skills and our wealth. In adversity nothing could serve us better than to make more of our historic assets. Sadly, those assets now face significant and new risks. If we are to maximise the possibilities of our historic environment, we need to understand the scope, source and scale of this wealth. Heritage is the main stream of our tourism industry. Four out of 10 people who come here say that they do so because of our heritage. Accounting for £2.6 billion from international tourism and a further £5 billion from domestic tourism, as an economic asset it is just below agriculture and well above motor manufacture. It creates jobs. Between them, the private and public sectors of heritage provide 270,000 jobs and they are not just in the south-east. They are also in those remote and rural areas of the country where options are so few. It has the capacity to grow and become an even greater source of national reputation and wealth.

In short, we are looking at what could become part of the national recovery programme. That is why I am delighted that we now have a dedicated Minister who will combine his responsibilities for heritage with those for tourism. Improving our world heritage site at Stonehenge, which is of global significance and requires a setting which is worthy of that, will form part of the Olympic celebration. We also welcome the Secretary of State's assurances that the National Lottery will be reformed and funds returned to the four original good causes, including the Heritage Lottery Fund. That means more strategic support for heritage, which is very welcome.

The Government have also made it clear that they want local communities and local authorities to take more control of future services and assets. In some ways they are building on what the previous Government did by putting local assets into the hands of local people to use for community benefit. There is nothing more potent, more local and more important to people than the place where they live. It does not matter whether it is the Sussex Weald or Victorian terraces. This is a Government who want us all to get involved and this is how people do so. Nothing is more evident than this in the big society. Organisations such as the Heritage Alliance and the new Civic Voice will give every encouragement to that.

I hope that, in the decentralisation and localism Bill, a presumption for sustainable development will not turn into a short cut to development at all costs. That would be simply a recipe for disaster. A third asset is the fact that our historic places are, by definition, sustainable resources-far better to invest in them than to let them decay. It is far better that the parish church of which the right reverend Prelate the Bishop of Guildford spoke so eloquently becomes a post office or shop than for it to be redundant and unused. I firmly support his appeal for the Government to maintain the VAT exemption on church buildings, which is incredibly important.

The Government need to be alert to this and to the cost benefit. Some of the best and most sustainable examples of social and economic regeneration and success in recent years-places such as Weymouth and Blackpool-have been successful because they are built around their heritage. That must continue. I would suggest that it is a good argument for why a regional funding capacity should continue, so that it can step in where national and local authorities can fail.

The case that I am making must be made now in the context where the risks to this extraordinary heritage have been increasing in recent years. The recession has had a major impact on our ability to protect historic places. Investors are more risk-averse, and owners and developers find it difficult to borrow money. Decay leads to dereliction and disaster. Once you have lost a building-think of the Euston Arch-you cannot recover it. It is not like shutting the door on a room in an art gallery. That risk is accelerating, particularly in relation to our industrial and cultural heritage. Local authorities are losing skilled staff, including conservation officers and planners-the people who guarantee that the places where we live are the best they can possibly be. That context-the financially challenging times that we live in and the accelerating risks-reinforces the case for greater heritage protection and the need for the Government now to provide time for a heritage Bill which will reduce red tape, simplify the system and increase our ability to protect buildings and places at risk. The cost of not doing that will be the huge bills of dereliction and social diminution in the next few years.

I end with this thought: this country leads the world in the care and protection we give the historic environment. People from Moscow, Naples and all over the world come to see how we have done it and to learn from us. Other countries are waking up to what they have already lost. If we do not send the signal that this matters to us, we will lose not only culturally but economically. We will also lose our leadership, which is so important to the rest of the world. Nothing could be further from the truth than that this does not matter. Failure will carry an extremely high price.

Photo of Lord Rix Lord Rix Crossbench 2:17 pm, 3rd June 2010

My Lords, it was just over 18 years ago that, during the debate on the gracious Speech, I made my maiden speech from this side of your Lordships' House, from this very Bench, flanked by Lord Allen of Abbeydale and the noble Earl, Lord Snowdon. I must say that the House was somewhat better then than it is today.

I made reference then to the labels-often unacceptable and hurtful-which apply or have applied to people with a learning disability. I was then the chairman of Mencap, but for the past 12 years I have had the honour to be that society's president. I am delighted to report that, during this time, opportunities and quality of life for many people with a learning disability have improved considerably. As an example, the closure of overcrowded, austere and remote institutions-comparable to prisons rather than hospitals-has been particularly welcome, and ensures that more people with a learning disability are no longer hidden away, out of sight and out of mind, but are able to enjoy the benefits of living in their own local communities, making friendships and forming relationships. This is a thoroughly good thing and we must build on this progress.

It would be remiss of me if I did not place on record my personal appreciation of the work of successive Governments and pay tribute to all those who have helped to make this happen. The extent of this progress is reflected in the different tone of language and terminology used with respect to people with a learning disability over this time. At the time of my maiden speech the term "mentally handicapped" was used, but the term "learning disability" is more suitable for the modern day. However, since it can be confused with "learning difficulty", no doubt the label will change yet again. But in many respects the use of language is the easy part. There is still a great deal more progress to be achieved if the 1.5 million people in our country with a learning disability, and their families and carers, are to be fully empowered and enjoy the opportunities of living independently, along with dignity and respect, and if the scourge of bullying is to be totally eliminated.

I take this opportunity to congratulate all noble Lords who have been appointed to the coalition Government and wish them every success in their new roles. The single biggest challenge facing the coalition Government-reducing the public deficit by reducing public expenditure-also poses a considerable threat to the quality of life experienced by people with a learning disability, their families and carers. I strongly urge the coalition Government to recognise this threat and ensure that people with a learning disability do not become the unintended victims of centrally driven, yet locally delivered, "efficiency" savings. Those who can afford it the least must not be expected to pay the most.

Twenty-two separate Bills were set out in the Queen's Speech, but I shall refer only to those which have the greatest interest from my point of view. The welfare reform Bill aims to simplify the benefits system while increasing incentives to find work. Many people with a learning disability want to enjoy the benefits of going to work and living more independently but, due to ever-present prejudice and discrimination, are unable to do so. Latest government statistics reveal that while 48 per cent of all disabled people are engaged in some form of paid employment, for people with a learning disability this figure is just 10 per cent. Regrettably, this figure has remained at this level for the past 10 years. I seek assurances from the coalition Government that the welfare reform Bill will be used as an opportunity to abolish much of the bureaucracy that prevents people with a learning disability from getting a job and that it will instead provide the support and assistance that will help empower them so that they can have an even greater control over their own lives.

In the area of education, the gracious Speech referred to a couple of Bills: one, the Academies Bill, will introduce legislation to enable more schools to achieve academy status; and the other, the education and children's Bill, will act as a companion piece to the Academies Bill. I recognise the coalition Government's aim of driving up standards and increasing choice in education and the opportunities provided by greater freedom to be more innovative and creative in delivering education on the ground. However, I seek assurances that, as a consequence of these greater freedoms, children with a disability and their parents will also have the opportunity to enjoy the promised benefits and advantages of receiving their education within an academy or a so-called free school. Due to the seven-minute time limit, I have had to cut many of the things that I wished to say about education. However, I am glad to say that the Academies Bill, which is due to have its Second Reading on Monday, has been able to house all the notes that I wished to speak on now.

The final piece of legislation referred to in the gracious Speech on which I wish to comment is the health Bill. The coalition Government's aim is for the voice of patients and the role of doctors to be strengthened in the National Health Service. I welcome the Government's intentions to devolve greater power to patients and hope that this will lead to a reduction in the health inequalities often faced by people with a learning disability when they attempt to access healthcare in the NHS. Mencap's widely regarded Death By Indifference report and the subsequent inquiries highlighted the tragic experiences faced by six people with profound and multiple learning disabilities and the reasonable adjustments that healthcare professionals must make in order to listen to a patient's family and not make assumptions about a person's quality of life and health just because they have a disability.

In conclusion, I hope that the new coalition Government are successful in delivering their stated aim of promoting freedom, fairness and responsibility. With those guiding principles at its core-most notably fairness-I very much hope that people with a learning disability can feel that they too have a stake in this Administration and that it will help them to live more independent, free and prosperous lives. Whether that be in the fields of welfare reform, education, health or even culture, I look forward to working with the new coalition Government to improve the lives of people with a learning disability and their families and carers. For the past 18 years, successive Governments have done their best in this regard. I cannot believe that a coalition Government cannot do even better.

Photo of The Bishop of Lincoln The Bishop of Lincoln Bishop 2:24 pm, 3rd June 2010

My Lords, I welcome this opportunity to join others in paying tribute to the new Minister. I also pay tribute to the noble Baroness, Lady Morgan, with whom I have locked horns once or twice in the past. I was very grateful for her speech and for the maiden speeches of the noble Lords, Lord Hill, Lord Hall and Lord Kakkar, and of my noble friend the right reverend Prelate the Bishop of Guildford.

I speak as chair of the Church of England's education division. That is not insignificant in so far as the Church of England possesses 5,000 church schools within its family and is the largest single provider of academies. Therefore, we read with interest the coalition's programme for government and the upcoming Academies Bill. Like others, I will restrain myself from commenting in detail on that Bill until Monday when we will have the chance to address it in rather more concise detail.

The Church of England-I think that I speak on behalf of other faith communities in this respect-continues to see itself as co-operating with the coalition Government in trying to push forward education standards in this country. However, noble Lords will probably gather from what I am going to say that we are perhaps not yet ready for coalition with the new Government. We need to see a lot more detail and to tease out a little more of what is proposed in the upcoming Academies Bill, in the White Paper and in the Bill on education which is proposed for later in the year. Suffice it to say that coalitions, as we all know, entail compromises, but they also entail tensions. Tensions can be creative or destructive. In relation to the topics from the gracious Speech on which we are focusing today, I identified at least three tensions that could turn out to be creative or destructive. We must wait and see. The first of them is that I read into the programme for government, as expressed in the gracious Speech, two takes on what we mean by welfare which go to the heart of the equality issue. We have seen equality widen in our society in recent times, and so to address that issue, and to do so within the context of a debate on welfare, is vital.

On the one hand we can see welfare in individualised terms, on the other we can see it in institutionalised terms. By individualised, I mean when we adjudge that a person who is poor, unemployed or marginalised is poor, unemployed or marginalised because of the kind of person and individual they are, their character, where they have come from, their background and their context. If we individualise welfare in that way, we end up with some of the proposals which are now before us in terms of carrot and stick. You provide benefits on the one hand, and you introduce sanctions on the other, because what you are about is trying to manage individuals into better places. We see evidence of that in what is before us.

However, we also see evidence of what I am describing as institutionalised welfare; that is, when we adjudge that if a person is poor, unemployed or marginalised, it is not so much about them necessarily but about society itself and how we institutionalise equality in many of our assumptions, not to mention in much of our legislation. Therefore, if we are going to address welfare on an institutionalised basis, that is when we get into enhancing benefits-simplify them by all means, but enhance them-and you end up with a major premium placed on, for example, progressive taxation. We see in what is before us-perhaps it is the influence of the Liberal Democrats-an emphasis on institutionalised welfare and a response that needs to be systemic rather than targeted on individuals. There is a tension there. It will be interesting to see whether they cancel each other out or whether they prove to be fruitful for being combined in coalition.

The second tension that I detect is between the two takes on competition. On the one hand, we have competition that can be summed up by the well known phrase, "catch me if you can". That is when the best inspire and encourage the rest. We see evidence of that in much of the rhetoric that surrounds what is now coming our way: for example, partnering between academies and less well achieving schools. Clearly that is about catch me if you can: "I am doing well and I am going to work with you to inspire and encourage you, too, to do well". On the other hand, there is another form of competition, which is "devil take the hindmost", where the best leave the rest behind. Noble Lords will probably be familiar with the well known story of the two businessmen who find themselves in a jungle clearing and see a lion about to pounce. One businessman panics and stands there, petrified. The second calmly opens his briefcase, takes out a pair of trainers and starts putting them on. The first businessman says: "What are you doing? You cannot run faster than a lion". The other replies: "I do not have to: I only have to run faster than you". I see some evidence of that understanding of competition in what is in front of us, and what we will be discussing on Monday and thereafter. At the moment, free schools look as if they are more like devil take the hindmost than catch me if you can. Does the one cancel out the other? Let us wait and see. Perhaps they will be enriched by appearing together in coalition.

The third tension that I detect, and will speak briefly about, is between the two takes on accountability. Central control is in there. The Academies Bill-which is very short, with 16 clauses-refers to the mostly new powers of the Secretary of State no less than 20 times. That says to me that quite a lot of control is becoming nationalised. On the other hand, we have a good deal of evidence of devolution to subsidiary bodies, and local influence becoming very important, particularly in parental choices around free schools. Again, there are tensions between the two takes on accountability. I look forward to seeing whether they turn out to be creative or destructive.

There is much for the Church of England to welcome in what the coalition Government are proposing. The pupil premium is welcome. So is less micromanagement and regulation. It was good to hear from both the Minister and the noble Baroness, Lady Morris of Yardley, about more trust for teachers. We are very pleased to see the continued respect for denominational schools, which may be paid the compliment of other schools becoming more like them in ethos, values, quality and contextuality.

We have worries about where the money is coming from. If the noble Baroness, Lady Walmsley, thought it was inappropriate for the Labour Benches to ask that question, perhaps she will not be quite so offended if I ask it. Where is the money coming from? Who is responsible for strategic planning? Will the poorest areas benefit or fall further behind? What about the coasting schools that are neither outstanding nor failing? What about governance, especially in relation to protecting the religious character of schools and ensuring the role of parent governors? What does "inclusive" mean in relation to admissions? As has been said before, it looks as though free schools are likely to work best when they are least needed.

Will the tensions cited prove to be creative or destructive? We hope and pray for the former; and the Government can count on us to be reliable and constructive partners in this brave new world of new politics, new brooms and new opportunities.

Photo of Lord Sutherland of Houndwood Lord Sutherland of Houndwood Crossbench 2:33 pm, 3rd June 2010

My Lords, I add my welcome and congratulations to the new members of the government Front Bench, and look forward to jousting with them both today and next Monday at Second Reading of the Academies Bill. I congratulate also those who have given excellent maiden speeches.

A new political dawn; a new style of government; a new shape to politics; youth at the helm; old ways banished to history; the legacy of previous Administrations overcome, set to rights and relegated to the past; radical solutions called for-I could go on. I am describing 1997, not 2010. Is it the case that things only got better? In one respect at least, clearly not: in one respect, the elections of 1997 and 2010 have a depressing similarity. They both observed a guilty and impotence silence on one of the major issues of the day: demographic change. If noble Lords do not know what that is, they should look around now. We on these Benches exemplify and embody demographic change.

In the campaign, despite the fact that this is a major issue, comparable to that of global warming, there was no significant word from any major party. Noble Lords may recall that, in the early months of this year, there was a flurry, if not of activity, then at least of words about this matter. New initiatives on care of the elderly-one aspect of the problem-burst like bubbles on the surface of a simmering volcano. Much hot air was expended in this House in March, debating a late but ill-conceived government Bill on the subject; but at least and at last, we thought, the matter was back on the agenda. So we turned eagerly to the public debate during the general election that was to follow-and there was nothing. Despite all the hot air and the promises of the importance attached to the topic, there was nothing. That is the first eerie similarity between 1997 and 2010: an issue of major significance kicked into the long grass during the election.

The second eerie similarity is that apparently this is not a matter for discussion in polite hustings society, and certainly not in front of the electorate; and so we had to live with it. However, optimistic as ever, some of us awaited the proposals for legislation in the Queen's Speech: and our reward was a commission:

"A commission will be appointed to consider a sustainable long-term structure for the operation of social care".

My first, irreverent thought was, "This is a joke". My second irreverent thought was, "If this is a joke, I have heard it before, 13 years ago". The same proposal was made on a major issue: let us have a commission. Perhaps this reminds noble Lords of something. I look at the promise in the coalition document, Our Programme for Government, that the commission will report within a year. The same promise was made-and fulfilled-in 1997; but here we are, 13 years on, back at the starting line. This is incredible. It is also unacceptable.

A group of well meaning and doubtless well minded individuals will consider and report, for that is their remit. What then? There is no promise that the Government will make some decisions, or that a Bill will be presented to this Parliament. We have had groups of well meaning people in significant number over the past 13 years considering and reporting. Even the royal commission and its appendix offered two, or two and a half, solutions. There followed an IPPR report, at least two reports from Rowntree, and two, including Wanless, from the King's Fund. We have had lots of consideration; of considering and reporting there has been no shortage. Of action there has been none-at least none in England.

Do we need a commission? Probably not. Most of the main options for funding are already in the public arena. A competent civil servant could summarise and present them to Ministers within a week. However, if we are to have a commission-which seems inevitable-I will offer two or three proposals for what it could helpfully contribute to the decisions that many of us hope will come out of it. The first-this is a major task to be done in due course-is an analysis of all the streams of funding that go unco-ordinated in to this black hole. This would include the enormous sums already spent by local authorities and the health service on the needs of older people. It would look at attendance allowances, housing benefit, disability benefit and contributions to the cost of care in both cash and kind from private sources and private individuals. These are unco-ordinated and I have no doubt that better co-ordination would produce better care and a more effective use of the resources that we already spend.

Secondly, we could do with an analysis of the policies and practices of the devolved Administrations, each of whom take a different position from that taken in England. If we looked at those, we might learn something both about mistakes and about what works. We also need a plan to integrate health and social care spending across the country. This is the question that we always duck-it is too hard and the civil servants will not like it-but it has to happen if we are to have competent and efficient care. Lastly, as was emphasised in the debates here in March, we need a scheme to enable the portability of benefits from one part of the country to another.

If all this were part of the work of the commission, it would help the Government to lay effective plans to deal with the implications of demographic change. These implications have not gone away in the past 13 years and they will not go away in the foreseeable future. They have to be faced. Despite what some say, I have no illusions about affordability here or, for that matter, in Scotland. I accept that we are in different financial times from those in 1997 and 1998.

In conclusion, I ask the Minister two questions. First, will he give Members of this House opportunities to comment on the remit to be given to the commission? We want to know what it will do. Secondly, can he assure us that the commission will face the big questions and that thereafter the Government will act, whether in agreement or disagreement? We need to move forward; 13 years is too long to wait.

Photo of Lord Fowler Lord Fowler Conservative 2:41 pm, 3rd June 2010

My Lords, I congratulate the maiden speakers on their contributions, all of which were of a very high standard. I particularly congratulate my noble friend Lord Hill of Oareford on his speech. We worked together in the 1992 election, when we travelled the length of the land with John Major. We braved egg throwers on the south coast and a near riot in Bolton. Some people say that it was a surprise that we won that election and that there must have been a secret ingredient. Modesty prevents me from claiming too much about our effort in that campaign, but my noble friend certainly had a major impact. I say to him sincerely that it is very good to see him in this House. I also congratulate my noble friend Lord Howe on his appointment as a Minister. He did some fantastic work in opposition-no one was more effective-and it is extremely good to see him on the Front Bench.

In the time available for speeches in this debate, there is just the opportunity to leave a visiting card, but my purpose is to emphasise the vast importance of public health policy in fighting disease in this country, an issue that is dealt with in the coalition Government's priority programme. This country used to have a proud record in this area, but our efforts in recent years have not been so distinguished. That is a vast pity because, if you can prevent disease, not only is that good for the individual but it is also self-evidently valuable for the Exchequer, which can avoid the cost of expensive treatment.

At the weekend, I was listening to Harry Evans, the legendary editor of the Sunday Times. Talking of one his campaigns, he said: "If something bad is preventable, why not prevent it?". That is not a bad lesson. Let me give just two examples of disease and death that can be prevented. The worldwide toll for HIV/AIDS and for hepatitis B and hepatitis C runs into hundreds of thousands, if not several million. Just in case anyone should believe that this affects exclusively countries overseas, let me give some figures. In the United Kingdom, the number of people living with HIV will soon go through the 100,000 mark. There are somewhere between 250,000 and 460,000 people living with hepatitis C, while the latest estimate is that 326,000 people are living with hepatitis B in the UK. The result, in the case of hepatitis, is that increasing numbers of people are dying from liver cancer and end-stage liver disease as a result of viruses that can be prevented or treated. That is the tragedy.

Unhappily, the crucial link between all these conditions is that they are often undiagnosed. People do not know or find out after the damage has been done. The majority of people affected by hepatitis B are undiagnosed, while half those with HIV are diagnosed late, which means that that they do not get the treatment when it is ideally needed. This also means that the infection can be passed on by people unaware of what they are doing. Taken together, this represents a major public health issue.

In this respect, the position has changed radically since I was doing the health job at the end of the 1980s. For example, HIV need not now be a death sentence-we now have antiretroviral drugs that will preserve life-and the same goes for the other two viruses. It seems to me that the chief priority now must be testing, so that knowledge can lead to action. Self-evidently it is in the interests of the individual concerned to have access to treatment and it is in the interest of public health generally that disease is not spread.

We need to adopt a frank and open policy in warning the public and advising them of the position. We should not be too nervous about putting over a public message. In 1986 and 1987, we tried an entirely open approach with our "Don't Die of Ignorance" campaign. I do not say that there were not concerns about that public education campaign, which involved advertising on television and posters. I remember a reservation from a very influential figure-none less than the Prime Minister herself. In March 1986, I was sent a minute that said:

"The Prime Minister has emphasised that she still remains against certain parts of the advertisement. She thinks that the anxiety on the part of parents and many teenagers, who would never be in danger from AIDS, would exceed the good which the advertisement might do".

My private secretary was told:

"Your Secretary of State will now wish to consider how to proceed in the light of the Prime Minster's firmly held views".

I think that one can hear the authentic voice of No. 10 coming through. In the event, we went on with the campaign. We formed a special Cabinet committee to oversee it and the result was that we had very few complaints from the public. That is the significant point. The public are sensible and mature on issues of this kind. If they think that there are good public health reasons for a campaign, they will support it.

That is important when considering the issue of migration into this country from countries where, for example, the incidence of hepatitis B may be greater than it is here. I am talking about migration not just from Africa but from Asia and eastern Europe. A group of consultants wrote to the Times at the end of last month proposing the screening of people coming here from high-risk countries. That is an altogether sensible point.

Lastly, there is one other important step that we can take. For hepatitis B, there is a vaccine; it can be prevented. If only that was the case for HIV/AIDS there would be rejoicing throughout the world. Most other countries in the European Union have a policy of 100 per cent vaccination against hepatitis B. We do not. We follow a policy of vaccination of selected groups, which self-evidently is not working. In 2002, the previous Government published a paper entitled Getting Ahead of the Curve. Unfortunately, that did not happen. By 2010, the incidence of hepatitis B has not reduced; it has almost doubled.

There is a challenge here for the new coalition Government, who now have the ability to put some of these things right. It is an opportunity that we should take because a strong policy on public health is capable of delivering immense benefits to this country.

Photo of Lord Griffiths of Burry Port Lord Griffiths of Burry Port Labour 2:49 pm, 3rd June 2010

My Lords, it is a privilege to speak in this debate and to follow hot on the heels of three Bishops and three maiden speakers. The three speeches that we heard earlier offered the promise of so much more as the years go by, and I look forward to that very much.

Perhaps I may get on the bandwagon and wish the new Government well in their administration of our public affairs. We have hinted at places where there might be tensions in the future and have argued that those might be creative or destructive. We should all hope that they are creative, and I am sure that we will be responsible in siding with all good proposals for government.

When I came to your Lordships' House, I was offered the possibility of sitting on the Cross Benches or on these Benches. I did not hesitate, as I am a product of the welfare state. I am viscerally proud to take my place among the ranks here, where the very measures that gave opportunities to people like me were generated. However, when faithfully following my peers through the appropriate Lobby, I felt closest to objecting to the point of view of these Benches when I came under the influence of the siren voices of the noble Baronesses, Lady Walmsley and Lady Sharp, who sadly are not in their places right now but who, in their dogged work for a decent educational system, in their advocacy of the insights, for example, of the Tomlinson report and in many other ways, introduced commonsense notions and noble aspirations for the whole field of educational provision in this country. Now that they are no longer on the bridge but travelling steerage under the new arrangements, I hope that their voices will continue to be heard, for they stand for so much from which all of us can learn.

I speak today and declare an interest as vice-chair of the trustees of the Central Foundation Schools of London. We have a secondary school for boys in Islington and one for girls in Tower Hamlets. The Minister recently visited an academy in Hackney which is sandwiched neatly between our schools. Although our schools are not academies, they are "satisfactory"/"making good progress towards outstanding" and certainly need their own kind of attention alongside the now more fashionable academies that we will be speaking about again on Monday. Just one insight from each of those schools will suffice and then on Monday it will be to pastures new. I have already heard quite a list of speakers whom I shall see again on Monday.

With regard to the boy's school, I was not present to hear the gracious Speech, nor was I able to follow it on television, because I was locked into a conclave with five other governors of the boys' school as we reached the conclusion of a process that has given us a new headmaster.

I want to speak for governors as we view the prospect of free schools and of greater autonomy for schools and for heads and teachers to form their own curriculums and so on. We had to find seven governors. One had to withdraw because of his business commitments. All were in full-time work. We took a whole day to shortlist the candidates from 22 to seven. We had to spend the whole of Saturday morning being trained by head-hunters in interviewing-God help us!-and then two full days from eight in the morning until 4.30 in the afternoon and from 10.30 in the morning until 6.30 in the evening going through the rest of the process. I simply draw to your Lordships' attention just how much this demands of governors now. If it demands more of them in the future, then I ask that the point of view of governors and the likely consequences for them be taken seriously into account.

On this occasion, we could not have done our work without two people who sat with us throughout our deliberations. First, we have a foundation and therefore a little resource and, with a couple of schools which are voluntary-aided, we were able to pay for the services of a rather good head-hunter, who kept us on track. Secondly, we invited from the local authority an expert without whose help and wider view we could not have done our work efficiently or properly. Therefore, we must not rubbish local authorities as we find our way forward. Free schools are good in principle and they sound well, but there are lots of people on whom lots more demands will fall. Of course, in better-off areas governors able to provide that quality input will be easier to find. However, in the boroughs that I am talking about they are very difficult to find, and I hope that that figures in the calculations.

At the girls' school in Tower Hamlets, where a large proportion of our intake comes from the Muslim community-because a girls' school is very attractive to that community-we want to bring two separate sites together on to one site. A considerable amount of energy, time and money has been committed to finding a way, with the borough of Tower Hamlets, of taking advantage of the Building Better Schools for the Future programme. There have been delays, which have not been of anyone's particular making but delays there have been, and now everyone is afraid that, with a new Government, the commitments entered into will not be honoured. We are afraid to put more energy, time and money into the scheme if there is a risk that they will not be honoured.

Therefore, perhaps I may ask a very direct question, to which I hope to hear an answer today-and if not today, I shall ask it again on Monday. Will the commitments entered into by the Central Foundation Girls' School with Tower Hamlets be honoured and will the Building Better Schools for the Future programme come to pass in that borough? It will not do for the Government to say that that is asking for too much too soon because they have only just got into office or that they will set up a commission to look at it or something along those lines. I know that speed is possible. Cuts are happening at once. I know that academies can be formed this September if they meet the necessary criteria. The Department of Health already has on its website a government health warning: "Everything you read here is the previous lot's. Wait for our lot to come on and then you will see the truth". I know that speed is possible and so I ask for a speedy response. It will help a lot of people who have real angst. Will arrangements already entered into, where a great amount has already been invested, be honoured or not? I should like to hear the answer to that question.

Photo of Lord Elis-Thomas Lord Elis-Thomas Presiding Officer, National Assembly for Wales 2:57 pm, 3rd June 2010

My Lords, in following my eloquent compatriot, the noble Lord, Lord Griffiths of Burry Port-or Porth Tywyn, as it also says on the signpost-I, too, congratulate both Ministers on their appointments and, indeed, the noble Lords, Lord Hill of Oareford, Lord Hall of Birkenhead and Lord Kakkar, on their maiden speeches. I also congratulate the right reverend Prelate the Bishop of Guildford, although I am not yet sure, in our changed arrangements for sitting in this House, whether it is the right reverend Prelate and his colleagues who have joined the Liberal Democrats or vice versa. Perhaps we will find out in due course.

I read the document, Our Programme for Government-or perhaps I should say Your Programme for Government; in any case, the coalition programme-with great interest and then I went through it with increasing admiration. I particularly welcome the candid final paragraph of the foreword by the Prime Minister and Deputy Prime Minister, in which they describe how three weeks ago they could never have predicted the publication of such a document. They said that after the election,

"there was the option of minority government-but we were uninspired by it. Instead, there was the option of a coalition in the national interest-and we seized it".

I, of course, want to add that there is more than one national interest in this multinational state of the United Kingdom. However, having presided over two minority Governments and two coalitions so far in Cardiff Bay, I have no doubt which arrangements are better for Wales. I believe that this coalition will be good for the United Kingdom and the development of its constitution.

Declaring my interest as Presiding Officer of the National Assembly, I welcome the devolution health warning which appears on the final page of the document, stressing the full support of the Government for the,

"devolution of powers to Northern Ireland, Scotland and Wales", and the fact that:

"The Northern Ireland Executive, the Scottish Executive and the Welsh ... Government make their own policy on their devolved issues".

I would like to take advantage of today's debate to place on record my appreciation of the new constitutional relationships which have been established already between the Secretary of State for Wales in another place, Cheryl Gillan, and myself and the National Assembly, and my appreciation of that special relationship which has perhaps been established with the Prime Minister following his recent visit to Cardiff.

In this gracious Speech debate, I want to speak briefly on culture and media. I welcome the clear commitment to introduce measures to ensure the rapid roll-out of superfast broadband across the UK and to introduce superfast broadband in remote areas at the same time as in more populous areas. That would be of great benefit in the many not-spots that we have in rural areas throughout the UK, particularly in Wales. I was also impressed by the indication that the Government are prepared to consider using part of the television licence fee which is supporting the digital switchover to fund broadband in areas that the market alone will not reach.

However, I want to press the Government on one thing today. I am not clear how the commitment in the culture and media section of the programme to enable partnerships between local newspapers, radio and television stations to promote a strong and diverse local media industry, will apply to the situation in Wales and especially to the commitment that was entered into by the previous Government on the independently financed news consortium proposals. It seems to me that, so far, the priorities of the new department of heritage do not coincide with the declared priorities of the old DCMS and I would like to question that this afternoon. I do not speak for Ulster Television, which was awarded the preliminary agreement to develop a service, but, of course, I have been very impressed, as many of us have been, with its proposals. All of us who know the broadcasting systems in the UK were impressed by the integrated commercial newsroom delivering television, video on demand, radio and online news which UTV has in Belfast and throughout the north. We strongly support the commitment to develop something similar for Wales.

As someone responsible for communicating messages on behalf of the National Assembly, I am concerned that in a recent poll it emerged that 60 per cent of Welsh citizens in the sample received their information on the devolved Government and on the Assembly from local television. It is hardly appropriate in a pluralist context-I hope it is a pluralist context for broadcasting-that only the BBC provides such a service. Do this new Government intend to pursue this policy further, a policy which has the support of the Welsh heritage Minister, Alun Ffred Jones, as he stated quite clearly in the Assembly on 11 May?

I welcome the commitment made by the Minister in his opening remarks to investment and innovation. He will be aware that an investment of £300 million in the Welsh economy is being made by broadcasters; we want that to continue and to be enhanced. I draw to the attention of the new department of heritage a report by Ian Hargreaves, entitled The Hearts of Digital Wales: a review of creative industries for the Welsh Assembly Government, which was published in March this year and the proposals therein for a digital board and a creative industries board. Two important windows of legislation face us in this Parliament: the expiry of the current ITV licence in 2014 and the renewal date of the BBC charter in 2016. As a veteran in this House and another place, I see other colleagues here who have been involved in broadcasting and communication legislation. We must take full advantage of this opportunity to increase diversity nationally and regionally within the United Kingdom. Some of us want to see single licences for Scotland, Wales and Northern Ireland in any ITV structure.

My final request to the Government, to which I am sure they can adhere before the end of the debate, is to ask them to look at the future of S4C. In the Hargreaves report there was a proposal that there should be a review of S4C. Now is the time for co-operation between the new department of heritage here and the Ministry of Heritage in Wales. Co-operation across devolved and non-devolved areas and broadcasting is a fine example of that. I shall not follow the call made by that distinguished broadcaster Geraint Talfan Davies recently that the responsibility for S4C, including its funding, should be transferred to the Welsh Government-it is not up to me to make devolution policy on the hoof. Collaboration in future planning and a review of the role of S4C in relation to other broadcasting authorities within Wales and within the UK will be very appropriate at this time. In saying that, I wish the heritage Minister and Ministers in education and health well in the development of their policies. I wish the coalition well. From one coalition to another, albeit with a different party makeup, I wish our coalitions well.

Photo of Lord Kirkwood of Kirkhope Lord Kirkwood of Kirkhope Liberal Democrat 3:06 pm, 3rd June 2010

My Lords, it is a great pleasure to follow my colleague from Wales, a fellow Celt. He made his view strongly on coalition politics and his good wishes for the future of this coalition are well made and well received. We are grateful for that. His knowledge of such matters and the time and energy he has devoted to the development of his own community in Wales is well known and we take that endorsement from him extremely well and we thank him for it.

I endorse the tributes paid to the four maiden speakers. I look forward to hearing further from them all. I had a relationship with the noble Lord, Lord Hall, when I was Chief Whip in another place and he was in charge of BBC news. We had many ups and downs together, most of which he won, but in spite of that he will be a welcome addition to this House.

The view from the steerage seats, as the noble Lord, Lord Griffiths, described them, is different. I am very impressed by the choreography of the new coalition. In a very short space of time, it has responded to the nation's needs. Noble Lords who have spoken in this excellent debate have indicated that there are problems about trying to determine the detail. There are also problems about constructive tension, but there was no alternative in terms of the nation's needs. To someone like me who is a natural sceptic, the fact that the partnership has got as far as this speaks volumes for the people who have been putting the Government together. I wish them well and I shall do what I can to sustain them.

If the noble Lord, Lord Griffiths, thinks that people like my noble friends Lady Sharp and Lady Walmsley and myself will stay quiet, as we are sitting in the steerage seats, he has another think coming. I look forward to yelling from the cheap seats, as appropriate, and I hope to start today.

My speech is in two halves: the first half will say that we, as a country, are broke and the second half will argue for invaluable investment which the Government cannot do without. Most speakers have said that in more guarded terms. The creation of the coalition is exciting and gives a fresh look at some of the nation's problems. There is obviously frustration. I anticipated the frustration of the noble Lord, Lord Sutherland; I could have written his speech for him as I anticipated exactly what he would say because I was there with him in 1997. But we now have a commission which will take a year, and if it does as well as his did, it will be a year well spent. However, we should be further on by now.

On a broader scale, climate change and ageing are two fundamentally important challenges for our nation-never mind who is or has been in government. We have major problems. Ageing affects not just healthcare but everything. We should be planning for the eventuality that we know is coming in the next 10 to 15 years in a much more detailed way. I hope that when the coalition gets its feet under the table, it will have a chance to do that, not just expedite long-term care, on which I agree that it is essential that we act as soon as we can.

I am not an expert on climate change, but I listen to the speeches of the noble Lord, Lord Rees, and others and am frightened by what I hear. I try to look after my own carbon footprint, but as a nation we will have to learn to live differently. It is a function of government to try to provide the leadership that wins that change. If we do not do that, if we do not succeed, we will not only be poorer as a nation economically, because we will miss some of the green economy changes that are within our grasp if we plan properly, but we will find that our lifestyles are being challenged in a way that we cannot control. That may not be an integral part of the Queen's Speech, but over the course of this Parliament, we cannot ignore it.

On the deficit, we have been told: "There is no money". I do not think that the public are yet tuned in to what is about to happen. We will get a better idea of that in the Budget, but we will not know until the Comprehensive Spending Review what will be the public service changes-the extent to which things will be different. There are two ways to react to that. You can salami slice everything in front of you or you can look at things differently. The noble Lord, Lord Bichard, who has a lot of knowledge and expertise about these things, made an excellent maiden speech last week. His point was that we must start thinking about doing public services differently-not just more cheaply and with less money, but differently-and use the opportunity of the deficit. We could carry the public along with us, but it is a big job that we have not started yet.

We are not just living in reduced circumstances as a nation-that is a mild way of putting it-there is a huge amount of indebtedness in the households of the United Kingdom. Compared to our sister European nations, we have a colossal amount of unsecured debt. At the moment, 9 per cent of our households are in deep debt. That means that they have more than £10,000 of unsecured debt. More than one quarter of our households is in that category at the moment. The combination of our circumstances is daunting. We must try to use the opportunity in a creative and innovative way to get out of the hole we are in. We will not be able to determine the detail of what is facing us as a country until after the Comprehensive Spending Review in October. We must then be clear about the investments that we need to make to get long-term change. There will need to be some tactical changes to respond to the urgent financial circumstances of the moment, but we must separate what is tactical to deal with that from what is necessary in the very long-term. My noble friend Lady Walmsley and others on the Liberal Democrat Benches have shown passion about the essential element of education to get a better skilled workforce and a higher waged economy-we have a low-skill, low-base economy. That is necessary in the long run. We need to invest to save in the long run at the same time as doing the right thing tactically to deal with the deficit in the short term.

Finally-this is where the spend comes in-I turn to my area of interest, welfare reform. I say to the Front Bench of the new coalition Government that I am willing to look radically and fundamentally at welfare reform. Incentivising those who are on benefits at the moment is an essential part of early reform. I will not support anything that hurts the kind of people about whom the noble Lord, Lord Rix, was talking. The disadvantaged and dispossessed should not be expected to carry the can for those changes. I am interested in proposals that are properly invested in, because if you invest in people's success, they can trade themselves out of poverty. The noble Lord, Lord Freud, was the architect of that policy, but he needs the funds from the Treasury successfully to carry out the policy. If he does that, he will have my support. If he does not, I will be watching him like a hawk. This is an important moment for us as a nation; we cannot really see the extent of the problem until after the Comprehensive Spending Review; but I am happy to contribute to debates on all public services, which are so important, in future.

Photo of Lord Mitchell Lord Mitchell Labour 3:15 pm, 3rd June 2010

My Lords, I, too, congratulate the Minister-the noble Lord, Lord Hill of Oareford-the noble Lords, Lord Hall of Birkenhead and Lord Kakkar, and the right reverend Prelate the Bishop of Guildford. Each of them gave a magnificent maiden speech today and it is to our benefit that they join us in your Lordships' House.

My speech is on public health issues, but first I say a few words about education. My interest is that I am chair of an organisation called the e-Learning Foundation. We provide laptops to socially disadvantaged children; we have been amazingly successful in that. My predecessor was my noble friend Lady Morris of Yardley. I am stepping down this September and will be replaced as chairman by the Minister's soon-to-be noble friend, Phil Willis.

The Minister spoke about academies and, in particular, Mossbourne Academy. The late Sir Clive Bourne was a personal friend of mine, and it was his amazing energy-when he was terminally ill, I add-that enabled that school to grow. In two years, the old school was demolished and the new school rebuilt, with everything that is involved in setting up a new school. It opened in 2005; five years later, we have heard about its incredible results. His widow, Lady Joy Bourne, continues to be very involved with that school.

I know that everything that the Minister says about academies is true. It is equally true that with the use of laptops in schools we have provided phenomenal results. I encourage him to come to some of the schools using those laptops to see what has been achieved; I would be very happy to take him round.

This afternoon, I want to speak about a subject that I have raised in your Lordships' House several times, but with a new Government it is time to do it again. The subject is the labelling of bottles and containers warning of the dangers to the unborn foetus of its mother drinking alcohol. Briefly, the issue is this. Mothers-to-be who drink risk permanently damaging their babies. This occurs because alcohol in the mother's bloodstream passes to the foetus across the placenta. The foetus, because its organs are undeveloped, is unable to process this toxin, and major damage can occur. Foetal alcohol syndrome disorder is the name given to the complete range of disorders. In its mildest form, which affects one in a 100 live births, it can cause a series of behavioural attributes, such as acute attention deficit disorder. In its most acute form, which affects one in 1,000 babies, its effects are similar to acute brain damage. Simply put, the brain and other organs do not develop. Children with the most severe learning disabilities are affected. Their mental age is retarded and their cognitive abilities are limited. Often, they cannot even tell the time or find their way home. As young adults, they become disruptive and often turn to crime. Many cannot even hold down the simplest of jobs. Whatever their degree of disorder, they become a cost to society.

If today's mood is to cut costs, this is an easy way to do so without any downside. FASD is totally preventable and, if it is reduced, society gains. Knowledge among young women and, indeed, their partners of the damage they are running by drinking when pregnant is lamentably low. No one, least of all me, wants a nanny state; all I seek to do is to raise awareness of this danger. Just as was the case with the linkage between cigarette smoking and cancer, product labelling is a good place to start. Today, because of in-your-face labelling on tobacco products, few people can be unaware of their dangers. I am seeking to do the same with alcohol.

Three years ago, I introduced the Alcohol Labelling Bill into your Lordships' House. It went through the usual stages and was passed. Then, as is the case with most Private Members' Bills, it died the death when we could not persuade the Government to give it time in the other place. In summary, the Bill said that if the alcohol industry did not abide by the terms of a memorandum of understanding that it had previously signed agreeing to include prominent labelling, legislation would be introduced to make it compulsory. I cannot tell noble Lords how many well meaning Ministers I discussed this issue with. Over numerous cups of tea, they told me that they were on the case, but they needed to complete this survey and that analysis and I could be assured that there would be a successful outcome. There was not.

Go into any supermarket today and examine the bottles. A few have labels prominently displayed, but more than 80 per cent do not. Others have an illustration that the French use. It shows the outlines of an elegant and obviously pregnant woman holding a champagne glass with a diagonal strike going through it. It is very cute, very chichi and very tasteful in a rue Saint-Honoré sort of way, but it has little relevance to the culture of girls on the binge buying cheap cider and vodka at the local supermarket and getting legless as quickly as possible. We see the evidence every weekend in our city centres, do we not? There is nothing very elegant about it. What is more, the illustrations on the bottles I have seen are so small that you would need a magnifying glass to see them.

The Americans have been much bolder on this issue, just as they were with tobacco. Any bottle, can or bar in the United States has a prominent label warning of the dangers to the unborn child of drinking while pregnant. They were introduced in 1989. Here is the stark truth: the alcohol industry runs circles around Governments. It lobbies hard, like the tobacco industry before it. It throws every impediment in front of the labelling proposals. No one seems to have the strength to stand up to it. This new Government have said that they intend to address our alcohol plague. We said the same but, if noble Lords will excuse the pun, I think we bottled it.

My first question to the noble Earl, Lord Howe, who has always been a tremendous supporter of what I am proposing, is will the coalition Government take on the alcohol industry? Will they make labelling prominent, unambiguous and compulsory? If the Government really want to reverse the cult of alcohol, will they consider banning alcohol adverting, just like the Labour Government banned tobacco advertising?

Photo of Baroness Howe of Idlicote Baroness Howe of Idlicote Crossbench 3:22 pm, 3rd June 2010

My Lords, first, I offer my warm congratulations to the noble Lord, Lord Hill, on his ministerial appointment and on his inspiring opening speech. I also congratulate him and the new coalition Government on the extent to which, like their predecessor Government, they recognise the importance of education as the gateway to a better life for the individual and for the country. That is certainly the case for those from deprived backgrounds. I also commend the new Government's commitment, particularly in the almost impossible financial circumstances that they have inherited, to continue to pursue the previous Government's goal of ending UK child poverty by 2020 as well as to continue with free nursery education for pre-school children. Against that background, I shall spend my few minutes on the importance and cost-effectiveness of the earliest possible intervention and support for deprived children and children with special needs.

We should all applaud the previous Government's important and brave initiative, Sure Start. It is brave in the sense that its value cannot be fully assessed until the children who have benefited from it reach adulthood. Its value has already been seen by our new Government, and, I suspect, especially championed by Education Secretary of State Michael Gove. The Government have committed to continuing Sure Start and to taking it back to its original purpose of early intervention, with an increased focus on the neediest families.

What I particularly admired about the early days of Sure Start was the practical development of an equal partnership between the local community and professionals, whereby each different area had slightly different priorities, thus reflecting local needs. This, I hope, is what our new Prime Minister means by his emphasis on the big society, whereby the responsibility for social cohesion is left increasingly to well run local government in partnership with its own communities. Equally, however, we must make sure that sufficient extra resources and leadership, including adequately resourced third-sector leadership, are concentrated in helping to improve lives and expectations in the most deprived communities.

A commitment that should certainly help the aim of early intervention is the plan to provide more than 4,000 extra health visitors. During my 20 years' chairmanship of a London juvenile court-in the days when magistrates, probation and social services really did work together-it was always the health visitors who had that early knowledge of which families were likely to need extra support if trouble was to be prevented.

The new Government's plans to academise a vast range of schools and to increase variety and independence from local authorities are inevitably controversial, but will the Government guarantee, and if so how, that the proposed and certainly welcome significant premium for disadvantaged children directly advantages these children? I hope that the noble Earl will tell me when he replies. Today, only 27 per cent of children who are eligible for free school meals currently get five good GCSEs, compared with the national average of 54 per cent-indeed, 40 per cent of the same group currently fail to get a single grade C pass at GCSE-so the Government will need to satisfy us that those who teach such children in future will be of the necessary calibre to bring them to the required standard.

I declare my interest as president of the National Governors' Association. I note to my surprise and clearly to that of the association that the role of school governors is hardly mentioned in the coalition's programme for the government of these schools. Yet it is surely the school governors who will be ultimately responsible for whether such changes are made, and for consulting those in the locality who will clearly be most affected by this. The noble Lord, Lord Griffiths of Burry Port, made that very point rather well. One concern certainly needs an answer: will academies be required, as is clearly desirable, to have at least a proportion of governors from the local area, including some parents?

I end on my earlier theme. My enthusiasm for extra resources and early support for children from deprived backgrounds is in essence practical. First, such a young person will have a more equal opportunity to develop their skills and abilities fully and to lead a full and satisfying life in their community.

Secondly, since the cost of each prison place is £45,000, if just one juvenile can be deterred from a potential life of crime, we will save the taxpayer the considerable sums involved when such individuals become serial offenders.

Thirdly, we must hope that the cycle of deprivation which Keith Joseph emphasised some 37 years ago will at last have been broken in such families. The appalling facts are that 63 per cent of boys with a convicted parent go on to offend, and children of prisoners are three times more likely to show signs of delinquent behaviour. Of course, not all these attempts will succeed, and of course some violent offenders must be imprisoned, but the Prison Reform Trust statistics starkly remind us that, when Ken Clarke was Home Secretary in 1992-93, the prison population stood at almost 45,000. Today, it is about double that at 85,000. There are surely more productive ways of spending our money.

Photo of The Bishop of Bath and Wells The Bishop of Bath and Wells Bishop 3:29 pm, 3rd June 2010

My Lords, I, too, add my congratulations to the noble Lord, Lord Hill, on his new office and on his maiden speech. Hope is a fundamental human need. Times of election provide people with the possibility that things can be different. They hope so at least. I believe that the gracious Speech offers some signs of hope, as does much legislation in all governments.

In recent days, the Prime Minister has spoken of his desire to see people happier in this society, which is a laudable aim. But happiness can be ephemeral where hope is not. Hope takes into account reality and seeks to overcome obstacles that prevent its fulfilment. As the philosopher Ernst Bloch once put it, only when hope begins to speak does a hope begin to flourish in which there is no falseness. The role of legislators in a democracy is not to seek to play God, controlling every aspect of human life. Neither, in an increasingly secular society, is the role of government to abolish God. GK Chesterton reminded us that,

"abolish the God and the government becomes the God", and who would want that?

I welcome the commitment in the gracious Speech to end the detention of children in immigration centres. I note the answers given by the noble Baroness, Lady Neville-Jones, in her reply to questions yesterday. We simply must not allow a return to the situation of the testimony of a 14 year-old boy, Wells Botomani, who described in the Guardian his 65 days in Yarl's Wood as "hell". His plea to this Government is to,

"think of us children. We do not deserve this treatment. We deserve a future".

He concludes:

"It is my prayer that the British government shows mercy towards children. Detention for us is hell and detrimental to our fragile minds".

I believe that the Government accept that. However, turning intention into reality or hope into accomplishment may prove more challenging given the Government's priority to reduce the economic deficit.

Border police charged with the responsibility of improving immigration controls will come in contact in many cases with vulnerable children. There is a fundamental requirement that such persons should be appropriately trained in the safeguarding and welfare of children. Despite their desire, and the need to make cuts, the Government must ensure that existing and future policy is consistent with this duty, and above all that children are not separated from their families.

I welcome too, in a spirit of hope, the Government's intention to address child poverty. It remains a scandal that little has improved since the publication of the UNICEF report in 2007 on the well-being of children in rich countries. In the report, the UK ranks third from bottom in five of the six categories, including material well-being, health and safety, education, peer and family relationships, behaviours and risks, and, in particular, young people's own sense of well-being.

The previous Government set themselves the task of halving child poverty by 2010. Despite a good start to that policy, momentum was lost. Evidence seems to suggest that, while those falling below the official breadline in 2008-09 decreased by 100,000, the figures effectively rose in the three previous years by twice as much, thus creating a wider gap between rich and poor than in 1997. Again, I ask, with the Government's priority on deficit reduction, how can the fight against poverty reduction, to some extent, be ring-fenced?

There is much to welcome in the proposed national insurance and welfare Bills. But for child poverty to be eradicated within a generation there is a need not simply for parents and young people to find work, but for children to be able to grow up in households where the earnings are sufficient to lift children out of poverty. In our desire to capitalise on the nation's human resources, and to provide work for all, we must not allow either oversimplism or dogma to determine policy. I share some of the concerns expressed earlier by the noble Baroness, Lady Morgan.

There are many different and often complex reasons why people are not able to work. If vulnerable children are not to be penalised in a benefits system that is conditional, there needs to be adequate support to help adults and young people into work, with measures that address entrenched worklessness. There are real concerns. I refer, as have others, in particular, to the Sure Start programme. Anne Longfield OBE, chief executive of 4Children, said that it is important that the Government have recognised Sure Start centres as a primary means of support for children and families, and that, while of course it is important that Sure Start should target the most vulnerable families in any community, the support of children's centres is crucial for all families regardless of their social background.

Finally, just as society is more than state and families and includes charities, churches, synagogues, gurdwaras and mosques, so are our children more important than simply mini adults waiting to grow up. Neither are all childhoods the same. There are those experienced in urban and remote rural environments, from multiple families, from different cultures and much else besides. Like each of us, all children are unique. They want to make sense of their lives and be taken seriously. They do not want to be patronised or to be the subject of endless educational experiment. And when they go seriously wrong and become the subject of the law, they want and need to be treated as children, and their total experience of life to date taken into account-not subject to adult courts, however well meaning the attempts to reduce their formality.

Children need to be free to discover jouissance, that association of play and joy which offers an infinite opening out to delight and beyond delight. This means allowing for the development of children's spirituality. Dr Rebecca Nye has identified the criteria for such spirituality as space, process, imagination, relationship intimacy and trust. Children enjoy silence, with the space to think and to reflect. As Fleur Dorrell of the Mothers' Union has observed:

"It is not atypical for a child to be contemplating the stars, who made them, and wanting ice cream at the same time".

Adults may find this contradictory, but children see it as wonderfully connected. Perhaps a lighter point might illustrate this. A nun taking a class put a box of apples on the table and left a note saying, "Take one apple. God is watching you". She then put a packet of biscuits on the table, and a young person with a quick wit wrote, "Take as many as you like. God is watching the apples".

In conclusion, let me plead with the Government not to risk the future of children in their desire to balance the books, and not to overlegislate or require too much too soon in the education process. Let hope be fulfilled in such a way that happiness can become possible, and above all, let us end the curse of child poverty in this nation and work tirelessly to end it throughout the world.

Photo of Baroness Massey of Darwen Baroness Massey of Darwen Labour 3:37 pm, 3rd June 2010

My Lords, perhaps I may say how much I enjoyed the speech of the right reverend Prelate. Its sensitivity and humour were very apparent. I shall speaking about education in schools. First, I welcome the Minister to his post, and I look forward to discussions with him on issues related to children's education. I chair the All-Party Group on Children. It has been a real privilege to work in focused harmony on issues related to children across the political spectrum. Much has been done to improve Bills in this House and I look forward to seeing how this will play out within a coalition Government.

I think that the whole House recognises that much good was done under the Labour Government for education: more teachers, the raising of standards, improvements in school buildings and so on. Two education Bills have been listed in the gracious Speech for this Parliament, one of which, the Academies Bill, will be considered in your Lordships' House next Monday. After a few initial comments I shall focus my remarks on academies and faith schools. Of necessity due to time constraints, I shall simply flag up today some issues for further debate.

It has been said that everyone thinks they are an expert on education simply because most people went to school. Like the noble Lord's mother, I am a former teacher and I think I know what makes a good teacher and what makes a good school. I shall echo some of the remarks made by my noble friend Lady Morris. A good school has inspiring and inspired leadership from the head and senior managers. A good school has dedicated teachers who understand children and child development. A good school has a strong and recognisable ethos. All this is in relation to academic achievement, sport, the arts and relations within school. A good school promotes discipline-both self-discipline and a respect for rules and boundaries. It does not matter what this school calls itself, it will be recognised as a good school. I visit many types of schools and the good ones are obvious.

None of this is new; in fact most of it is very clear. Governments and inspectorates have a duty to ensure that schools encourage aspiration and provide the means to entitle children to succeed in all aspects of their lives. Children are entitled to academic, cultural and social excellence. For some children, home gives a good start; for others, it does not. I hope the coalition Government will hang on to many of the entitlements set up by the previous Government, such as a guarantee of physical activity schools. I hope this Government will carry out the previous intention to make personal, social and health education a compulsory part of the school curriculum. This, of course, was lost during the wash up, and much regretted that was. I also hope that the coalition will recognise that education does not start with school and that it will support young children and families.

Let me, briefly, talk about the settings in which education may be delivered. I found curious the Minister's remarks about failing schools being addressed in due course. I would have thought that that issue was very urgent. I know that in the coalition's programme for government, reform of schools is promoted: more academies are proposed; parents, teachers, charities and local communities will have the chance to set up new schools; more faith schools will be enabled. I am deeply suspicious of all this. While welcoming some measures in the programme such as the premium for disadvantaged pupils-although I wait to see the details of how that will be worked out-I maintain that the majority of parents want a good local school where they are encouraged to feel that the school is part of the community and the community is part of the school. Such schools exist and are shining examples of what I have described as good schools.

Let us look, for example, at academic attainment, one of the stated purposes of academies. Some academies do well; some do not. Figures from 2009 show that achievement in examinations has not improved in academies. I will quote but one statistic: the Government target of 30 per cent of pupils achieving five good GCSEs, including English and maths, was missed in 2009 by 40 out of 130 academies. I have many concerns about consultation with parents, communities and schools. I also have concerns about primary schools which are part of a local network becoming academies, about charitable status and about inspections. The NUT is rightly concerned that the focus of education Bills should be about what goes on in classrooms rather than, in its own words,

"continuing with the expensive and disruptive obsession with structural reform".

I turn again, briefly, to faith schools, which are likely to increase under the proposed Bills. The British Humanist Association, of which I am a member, has gathered devastating evidence against any increase in the number of faith schools. The dangers seem to me to be obvious: people are worried about the disharmony in society which they may create. We have only to look at Northern Ireland and its history of religious segregation to be concerned. Survey after survey has shown that the majority of people agree that the Government should not be funding faith schools of any kind; that they undermine social cohesion and increase segregation. In the area of Lancashire that I come from, a report on community cohesion in Blackburn with Darwen has recently stated that schools with religious admission requirements are "automatically a source of division" in the town. There is evidence of prejudice in admissions procedures and in the selection of staff. Again, I shall be exploring these issues in greater detail during the passage of the education Bills.

I return to my original thoughts on what makes a good school. The manipulation of structures and systems through academies serves no purpose except to confuse and discriminate. I say again that what parents want is access to a good local school. Good local schools are achieved by directing resources to good leadership, good teaching, good facilities and a curriculum of entitlement for every pupil in every school. It is what parents deserve and what children deserve. I hope that we will examine the education Bills with tenacity in order to improve the lives and aspirations of all children.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench 3:45 pm, 3rd June 2010

My Lords, I congratulate the noble Earl, Lord Howe, on his new position; he is more than fitted for it. I congratulate also the new Minister and all the maiden speakers. I also thank the noble Baroness, Lady Thornton, for her hard work while in government.

I am pleased that the gracious Speech mentioned that the voice of patients and the role of doctors will be strengthened in the NHS to improve public health, alongside action to reduce health inequalities. Like me, the Minister was unhappy with the closure of the community health councils, with the appalling way in which the health forums were treated-having been set up by the previous Government and then quickly closed down-and with the ineffectual way in which the present LINks system seems to be responding to the needs of patients. How will the Government strengthen the patient's voice?

Prevention of ill health saves suffering to patients and costs for the NHS. I take this opportunity to bring to your Lordships' notice two cases which illustrate this. Very sadly, the sister of the noble Baroness, Lady Hooper, died recently. She had served her country in an exemplary way and had been Lord Mayor of Westminster. She had been nursed in one of the top London teaching hospitals, but developed a pressure sore because, as a vulnerable patient, she had not been given a pressure-relieving mattress until it was too late. I was told that this had had a devastating effect and caused much unnecessary suffering.

The other case is the brother of one of your Lordships who has had a stroke. One of his legs spasms repeatedly and he needs a splint to stop it becoming contractured. However, he has to wait weeks for an appointment at another hospital. Surely this is not rocket science. If people with stroke and other long-term conditions are kept alive, their aftercare and quality of life should be as good as possible. Delays in treatment can cause long-term problems. I know that the Secretary of State for Health has a special interest in stroke treatment, having been chair of the All-Party Parliamentary Stroke Group. Therefore, I hope that he will improve aftercare.

As nurses have not been specifically mentioned in the gracious Speech, I shall do so now. They are of the utmost importance in the prevention of infections, which is a very important aspect of public health. In some hospitals which had serious outbreaks of C. difficile and MRSA, ward sisters have been given overall control of their wards. The effect has been dramatically to bring down the rate of infections. We have seen in the past failures to take responsibility, passing of the buck and the overriding bureaucracy which stifles initiatives and costs much-needed money.

I am very pleased that public health is mentioned in the gracious Speech. Some noble Lords will remember my questions on PVL CA-MRSA-Panton-Valentine leukocidin MRSA-a potent toxin produced by bacteria from the family staphylococcus which destroys the white blood cells that normally fight infections.

MRSA infections often target elderly people in hospital who have weakened immune systems, but PVL CA-MRSA strains also affect young, healthy people and children within the community. With the Olympic Games coming along, this is an important factor. Because of this, information requires disseminating to primary care providers about the potential severity of this infection, methods for rapid and accurate diagnosis and the need to implement appropriate empirical and definitive treatment regimes is vital. The Royal College of Nursing must be congratulated on its ongoing campaigns against infections and the need for expert, specially trained nurses who can pass on the information to many other people. Information on trends of infection and the main causative organisms is crucial and requires investment in robust surveillance systems to support this work and, most importantly, to detect any reductions occurring as a result of interventions and work programmes so that good practice can be shared. I hope that the Government realise how important this is and, with the increasing problem of drug resistance, they will take note.

Tuberculosis is on the increase worldwide. What is of great concern is the multi-drug resistant TB. A prisoner in Cardiff prison died of TB this April, but Londoners now account for the largest number of cases in the UK, making up to 39 per cent of the country's total figure. In 2009, 3,376 new cases of TB were reported in the capital. There is an excellent team of professional healthcare workers who find and treat hard-to-reach people from homeless hostels and prisons. They have a mobile X-ray unit, which travels around. It is getting very old and they need two, but the funding runs out this year. I know that the Minister cannot answer all the questions today from this mammoth debate, but perhaps he can write to me letting me know if NHS London, the PCTs and the Mayor of London, who thinks that it is an excellent facility, will take up their responsibilities and fund two new units and the running costs.

I hope that the Government will put patient safety at the top of the health agenda. There are so many needs but unnecessary disasters must be avoided at all cost. At one meeting that I attended, a registrar surgeon told us that in one morning's operating list he had two cases of the wrong breast being marked for operation. Another case is that of a new mother who was given the wrong drug in a drink, which killed her. The inquest cited the chaotic drug storage at the hospital and it was fined £100,000. Everyone is a loser. There should be fool-proof systems throughout the country, and no cutting of corners.

Photo of Lord Elton Lord Elton Conservative 3:54 pm, 3rd June 2010

My noble and right honourable friends, whom I welcome to their respective Front Benches, have inherited the most appalling economic situation. We all realise, perhaps at different rates, that it is necessary to cut many programmes to save money and stop spending money that we have not got. If those programmes are counterproductive, that is a very welcome step to take. My right honourable friend Francis Maude was quite right to say in the election campaign that a system that gives someone more money for staying at home than for going out to work needs to be fixed-and so it does. In saying that, however, he evoked a large and vocal sector of public opinion. With the pressure from that, it now rests on my right honourable friend Iain Duncan Smith and my noble friend Lord Freud to reduce the flow of money going through the welfare system. Indeed, let them do so, but they must be aware that the vocal pressure contains a good many misconceptions. Benefit is not in itself unnecessary or bad; it is in fact very necessary and good when it works as it should, preventing honest people from becoming casualties of circumstances that they cannot control. Yet when it does not work as it should, it not only encourages welfare dependence but can cause the sort of casualties that the system is meant to cure.

Perhaps I may illustrate this, and ask your Lordships to put yourselves in the place of a friend of mine whom I shall report as accurately as I can. You are a retired soldier in latish middle age. Your pension is not yet in payment. Your former wife and her children have long lived in a different continent. You have a number of things wrong with you and are assessed as unfit to work. Your entire income consists of your benefits for long-term disability, housing and council tax. You live alone in a one-bedroom council flat. A good deal of your time is given to helping a solitary, handicapped neighbour to manage his dog, his flat and his shopping. You are, not unnaturally, already somewhat depressed. Suddenly, your whole benefit package-your entire income-ceases. In the past you would have asked why, but you are deeply depressed so you live off the favours from people for whom you will do small services, while brown envelopes accumulate and are binned unopened-until Tuesday, 21 May 2009, when, by the grace of God, you open one envelope. The letter inside tells you that in 10 days' time, at 9 am on Friday 1 June, the bailiffs will remove you and your possessions from your flat, breaking down the door if necessary.

My first question to Her Majesty's Government is: why, for heaven's sake, when a tenant does not reply to their letters for month after month, does a housing authority not do what an ordinary person would, in common decency, and send someone round to see if he is all right? That would have saved a huge amount of money let alone anxiety. Of course, computers do not have common decency unless it is programmed into them-we are talking of institutionalisation here.

Your first reaction to the eviction notice is to go round to St Mungo's to see whether it will find room for you and to make a small pile of essential belongings to take with you-but at last, and with encouragement, you go to your local authority customer advice centre. The lady at the desk is kind, knowledgeable and patient. Your benefit has stopped because the system shows that you are getting working tax credit. You reply that you would not qualify for it and are not getting it in any case. You are asked to prove it. Nobody explains how you can do that, even if your Post Office account had not already been closed. A second lady, equally kind and knowledgeable, joins the first and rings the Department for Work and Pensions, which says that it can only discuss it with you in person, so you speak to it directly, giving your correct address and correct date of birth. "No", it says, "That is not what we've got on our records", and cuts you off.

The ladies now agree that it looks as if somebody else is getting the money. They advise you to apply again for benefit and to apply to the court for a stay of execution of the warrant. Close to tears, you take the ladies' advice and go to the local police station to report a suspected crime. You aren't very welcome. The person receiving you, who is not in uniform, tells you from behind a plate-glass window that if there was a crime you are not the victim and sends you to an airless waiting room, furnished only with a bench. The door, which can only be opened remotely by someone else, closes behind you-and there you wait with nothing but anger and depression to occupy you for one hour and 52 minutes while other, later arrivals are called forward to interviews ahead of you.

Eventually two courteous policemen, having taken lengthy advice, confirm that you cannot be recorded as a victim of a suspected crime. This has taken a total of two hours and 40 minutes. Is that normal? Or could it be that this treatment is because you are black and your obvious accomplice, a do-gooder who wants to see what treatment you get, does not declare himself as a Member of your Lordships' House? I leave the question in the air, perhaps to be picked up by the Metropolitan Police.

With the welcome help, which I acknowledge, of the then Minister, the noble Lord, Lord McKenzie of Luton, a senior official in DWP agrees to take an interest, accepting the probability of identity theft. Meanwhile, you get and complete the application for a stay of execution and, on Thursday the 30th, less than 24 hours before eviction is due, you get it, somewhat out of breath, into the court office. It costs you £35 and, for someone with feet like yours, it is a £2 bus ride away from home. You, too, are expected to spend money you have not got.

The bailiffs are now temporarily in baulk, but tomorrow you have to persuade the court to leave them there. On that day you learn that DWP's involvement has enabled your local authority to resume paying your housing benefit. This does not give you spending money but it does pay your rent and offer the prospect of payment of arrears in due course. That is not enough for them, though-they still want you out. Luckily, unlike many, you have been able to obtain the loan of a substantial amount, interest-free, as a subordinate debt. Offered this, the local authority agrees not to object to your application for delay. That afternoon, the court gives you six weeks in which to get things sorted out. Long enough, you think.

How wrong you are. It takes all of that to get from HMRC, which pays WTC, a letter for the court admitting that it had been paying WTC to someone else. Unfortunately HMRC compounds the difficulty by confusing your identity with that of the man who stole it. Eventually, in mid-August, the court orders payment of arrears at £3.25 a week, which in your circumstances is a significant amount, and suspends the warrant. It still hangs over your head today.

I skip a whole nine-month rollercoaster ride of other difficulties till we get to May this year when, reassessed and transferred to ESA benefit, your housing and community tax benefits are automatically stopped. That is how it works. It ought to take six weeks to get them restored but, although you fill the form in at once and it is taken in over the counter at the Jobcentre where you fill it in, it somehow gets lost and the money is not there in six weeks. The suspended warrant is threatened and you are again told that you are going to be evicted.

In fact that friend of mine is still in place, and is now in receipt of benefit, but I ask my noble friend only my second question: can the Government possibly do anything about this, and will they accept any help that I can give them to get it done? I am talking not about that individual case but about the system that allows these things to happen.

Photo of Lord Patel Lord Patel Crossbench 4:03 pm, 3rd June 2010

My Lords, I congratulate the noble Earl, Lord Howe, on his well deserved ministerial appointment. When it comes to health policy, he is undoubtedly the most experienced member of the health team, having done the job in opposition for over 10 years and seen off several Ministers in that time.

On several occasions I have heard the Secretary of State, Mr Andrew Lansley, speak of his vision for better healthcare, and I have had an opportunity to discuss with him how the quality and safety of healthcare can be improved. I believe him to be concerned about the poor quality of care and to have a genuine commitment to making it better.

The gracious Speech outlined several areas where government legislation is to come. The Coalition: Our Programme for Government outlined several areas of possible health policy changes, many of which I find myself in support of, including the creation of an independent NHS board, a department of public health and a greater voice for clinicians and patients. While we have to wait for the legislative details, I hope, as a Cross-Bencher, to continue to help to improve the legislation in these areas.

While I believe reducing administrative costs in the NHS by a third to be right and possible, I am disappointed not to see mention of specific cost savings in the coalition manifesto. I hope the Government will look again at the role of strategic health authorities, their current size and budgets, and their function, particularly following the creation of the NHS board, and at the National Quality Board, the Care Quality Commission, the role of Monitor, PCTs and other organisations. There is also a need to look at the number of PCTs, which is currently in the region of 152. The number could easily be reduced to 30 or 40 and, given enhanced powers, they would bring efficiency and cost reduction.

The coalition Government's health programme outlines quality and safety of healthcare to be important in delivering better outcomes. The key driver to achieve this will be the quality of commissioning, so the first and foremost task will be to develop good commissioning for quality and safety. Currently both are woefully done. Commissioners should be expected to promote quality and safety improvement. They should ensure that provider quality accounts-published by healthcare providers-properly reflect the concerns of patients and the public, and are properly scrutinised. Commissioners should provide assurance that the services commissioned are of appropriate quality to detect early warnings of potential decline, and intervene where standards are not met. Commissioners should be responsible for improving the scope and effectiveness of quality and safety. They should also promote innovations, with financial incentives and penalties for patient-safety incidents defined as "never events", similar to those operated by Medicare and Medicaid in the United States. Poor quality and unsafe patient care is expensive. The key to delivering high-quality, safe care is good documentation, as I witnessed recently in several hospitals in the United States.

The Government also intend to bring in GP-led commissioning and to improve the quality of general practice. I hope that, in doing so, account will be taken of lessons learnt from previous experience of GP-led commissioning to ensure that the prime purpose of commissioning will be to deliver benefits to the patients and efficiency savings; and to ensure accountability of public expenditure. Can commissioning GPs be accountable officers, as CEOs are in NHS trusts and PCTs? Does the Minister agree that greater clarity is required in the respective roles of regulators, commissioners and the National Quality Board in promoting and ensuring quality and safety?

The Government's commitment to tackling health inequalities is very welcome. However, the key determinants of poor health are economic and social. To succeed will require effective working across several government departments-a key test for the coalition Government. There is in the Government's programme for health a distinct lack of any mention of public health and preventive health measures, apart from the creation of a department of public health. Could the Minister comment on which policies the Government will bring in to reduce harm related to alcohol, tobacco and nutrition? Increasing obesity, related to the high sugar and fat content of foods, now affects nearly 30 per cent of children. The high salt content of ready-made foods accounts for significant health problems in the older population. What is the Government's strategy in these areas?

I finish on a positive note. I find nothing wrong in the ambitions of the Government's health programme. I hope we will now have appropriate legislation and policies to deliver it. Cutting bureaucracy and useless administration, and delivering safe patient care in a safe environment, with more of the care delivered by competent professionals, will-to borrow a phrase that the Minister may well recognise-deliver,

"some of the best health in Europe".

I hope the Government commit themselves to that.

Photo of Baroness Sharp of Guildford Baroness Sharp of Guildford Liberal Democrat 4:09 pm, 3rd June 2010

My Lords, I shall concentrate my remarks on education. The opening words of the gracious Speech state:

"My Government will seek to build a strong and fair society".

As the noble Lord, Lord Hill, reminded us in his opening speech, that fair society depends a great deal on education. I was rather surprised at how well the coalition of the Liberal Democrats and the Conservatives managed to put their two education policies together. The noble Baroness, Lady Morgan, referred to the pupil premium. Some years ago, I travelled with Nick Clegg to Holland to look at the way in which the Dutch funded education. We found that disadvantaged children were given special extra funding which they carried with them as they moved from school to school. The pupil premium was based very much on the research work that we carried out on that expedition and I was delighted to see that it plays a substantial part in the policies which the coalition is putting forward.

I am also pleased at the emphasis that we are giving to rolling back bureaucracy. Both parties agree that schools and colleges-and universities, for that matter-are overwhelmed by bureaucracy. Last year a seminal report was produced by the Merits of Statutory Instruments Committee, which found that each year the average head received well over 700 pieces of paper comprising directives and guidance. That is roughly three for each working school day and is an impossible amount to manage. When I inquired of a local comprehensive school head how much time he allocated to interpreting the bureaucracy that he received from the centre to his staff and parents and governors who needed to know about it, he said that on average he thought it took him roughly half the week, which is an astonishing amount of time. The more that we can roll back that bureaucracy and allow our school leaders and teachers to give time to front-line services, the better it will be. It is important that we, as a Government, practise what we preach. It is too easy to talk with one breath of freeing up teachers from bureaucracy and then to declare with the next that they must use synthetic phonics to teach reading.

I confess that I am also somewhat worried at the thought of Ministers laying down the law on what the history curriculum should be, even if they call in eminent historians to advise them. We were very worried by what Stalin and Hitler did to the history curriculums of their countries. I am not suggesting that democratic Ministers would behave like that, but it is important to beware of too much political influence over the curriculum.

The flagship measure of this Government that we shall see within the next week is the Academies Bill. It will not surprise noble Lords on all sides of the House to hear that I have reservations about the Bill as it stands. However, I shall leave my thoughts on the proposals in that Bill until its Second Reading on Monday. I echo the point made by the noble Baroness, Lady Morris of Yardley. If we are looking to create a fair society, it is very important that we concentrate not on structures but on process. Taking the issue of process somewhat further, one aspect of lessening bureaucracy that is agreed is to change the role of Ofsted. The schools that consistently perform well will be inspected less often and, as the Minister mentioned, the Government are proposing to reduce the number of performance indicators. But in that case it is vital that we use the right measures of performance and it is difficult to know what they are, because any school's performance is also closely linked to its socio-economic profile. Our high-performing schools are predominantly in middle-class areas with middle-class intakes. Poorly performing schools serve disadvantaged populations. It is this gap in performance that both the coalition and the previous Government have sought to close, and will seek to close, so that there is genuine equality of opportunity.

It is no good just whipping the schools to produce better SATs and GCSE results. First we must find a way of compensating those coming from disadvantaged homes for the disadvantages that they suffer; hence the importance of programmes such as Sure Start, and the children's centres frequently associated with Sure Start, which combine education and parenting. Programmes such as Every Child a Reader are crucial because they provide one-to-one tutoring for six and seven year-olds who are having difficulty in mastering reading. At secondary school level, it is very important to find and provide a curriculum that excites and motivates those who at present are often turned off by the overacademic approach of GCSEs. Diplomas were supposed to be the answer to this problem, but I worry that, as currently developed, they are too much of a hybrid, satisfying neither the vocational nor the academic side of education. This is why I am very excited by the prospect of university technical high schools that the noble Lord, Lord Baker, spoke about. They would combine first-class vocational training with dedicated equipment and teachers, but keep open the door both to jobs and to higher education. That seems to be a much better way forward than shunting pupils around from school to college for the odd half day here and there.

Education remains the key to unlocking our potential. The UK must raise its game, both to maintain international competitiveness and to help to build a society that is fair and more at ease with itself. This is recognised within the coalition agreement by the priority given to education, and the ring-fencing of the schools budget. There are real savings to be gained from reducing bureaucracy and concentrating managerial resources on the central tasks of teaching and learning; but let us not waste these gains on fruitless restructuring. Rather, let us give our teachers and school leaders space and time to innovate and excel.

Photo of Baroness Murphy Baroness Murphy Crossbench 4:17 pm, 3rd June 2010

My Lords, I, too, warmly welcome the noble Earl, Lord Howe, to his role on the Front Bench. I am sure that he will forgive me for saying that he has been practising diligently for this role for more than 10 years. We now have a Secretary of State and a Minister leading in the Lords in health who have a solid understanding of health policy. That is a great good fortune for those of us who work in this area. While I suspect that parts of the policy are still a work in progress-social care is probably the fuzziest at present, and I hope that noble Lords were listening to the noble Lord, Lord Sutherland of Houndwood, on this point-I welcome strongly the direction set down in the gracious Speech, and the indication that we shall now speed ahead to reverse the unhelpful dithering and procrastination of the past two years.

I declare an interest as a member of the board of Monitor, the NHS foundation trust regulator, and chairman of St George's Hospital Medical School, University of London-although not for long, as I am retiring this summer from both roles. The future agenda is exciting, both for improvements in healthcare and for the impact that such policies are likely to have on health sciences education. I welcome and will support the intentions of the forthcoming health Bill. The coalition agreement, based on pre-existing Lib Dem policy and the Conservative Party publication NHSAutonomy and Accountability, is entirely welcome.

First, I will highlight the news that research into the dementias has become a government priority. This is music to my ears, as it is my specialty, and makes economic as well as clinical sense. I look forward to seeing how it will be effected in reality, given the inevitable pressures there will be on research council funding.

I welcome strongly the intention to complete the shift to a health system where decisions are made locally by patients and professionals rather than centrally, to complete the separation of commissioning and provision, to get all hospitals to foundation trust status, to improve the information available on the quality of care so that better decisions can be made and to put the setting of incentives in the system on a more professional basis by establishing an independent economic regulator of health care. For a system of tax-funded healthcare to be sustainable in the long run, we need better incentives and more local decision-making and innovation. These changes will be very helpful for that.

There is now incontrovertible evidence that competition between hospitals and between service providers improves both innovation and health outcomes if the system is well regulated to ensure a financial level playing field and the quality of care is subject to rigorous monitoring and improvement. Too often in the past, the internal market was left to its own devices and subject to central interference. It worked to keep down costs but did not necessarily improve quality. The BMA and other professional bodies have been rightly critical of it. However, recent evidence from the Centre for Economic Performance at the LSE and other independent studies by US-based researchers of health outcomes in heart disease treatment in English hospitals have confirmed that a properly regulated market has a positive effect on outcomes, including saving lives-about 400 lives in heart disease treatment. This is especially true when clinicians are in real and powerful leadership roles.

I am sure that we will have many happy hours scrutinising the details as the Bills come before the House. We do not yet know what some of these details will look like. In particular, I do not really understand what the relationship will be between a national commissioning board and local GP commissioners. Finding the best way of organising how we spend £100 billion on healthcare continues to be the most significant unresolved question in the reforms. Commissioning decisions need to be made at a sufficient scale to support the right level of analysis and expertise but also close enough to the clinicians who actually make the spending decisions to influence their behaviour and to reflect local circumstances. How will we prevent groups of GPs from delegating their commissioning to junior administrative staff, as they consistently have done in the past? The benefit of small-group GP fundholding has proven extraordinarily difficult to replicate on a larger scale and I look forward to hearing how that can be done.

How will we get all hospitals to foundation trust status? Only half the acute hospitals and three-quarters of mental health services have so far managed to demonstrate that they are sufficiently financially robust and well governed to stand on their own feet and to operate independently. Strategic health authorities have truly struggled in preparing applicants, so we will need a better approach to help the remaining trusts to get up to the required levels of competence. FT status is not about achieving some label; it is about putting the management and finances of the trusts on a sound footing for the challenges ahead.

Will FTs be subject to Treasury spending controls? If so, this will significantly reduce their freedom from central interference and undermine the intention of the Bill to allow more local decision-making. A way of preventing that would be to adjust the FT regime sufficiently to allow the trusts to be taken off the Government's balance sheet. We could have, as an alternative to Treasury controls, strong regulation and a clear failure regime to ensure sound finances.

I am challenging the Government to show the kind of bravery that will really move the health service forward. When the Blair Government took office, they had some very good ideas and it is not surprising that the new Government are trying to improve on those good ideas. However, the Blair Government did not implement them quickly enough-it took them five years to get started-and latterly the policy sank into the doldrums, besieged by old party slogans. Although this Government now have the opportunity to act, they must truly get on with it. They cannot improve care directly; only front-line clinical staff can do that, as the noble Lord, Lord Kakkar, said in his maiden speech. However, they can provide the structural context in which improvement of care is likely. I disagree that all structural change is unnecessary or unhelpful. Sometimes structural change is necessary to ensure that something completely different is delivered. In this case, I think that we should continue the structural changes that have been begun but do so more quickly. Therefore, I urge the Government to go as fast as they can; it is our health and our lives that are at stake.

Photo of Lord Warner Lord Warner Labour 4:24 pm, 3rd June 2010

My Lords, it is a great pleasure to follow the noble Baroness, Lady Murphy, with whose speech I largely agree. The Government would do well to take heed of many of the remarks that she and the noble Lord, Lord Patel, have made.

I shall speak today on adult social care and the NHS but, first, I congratulate the two Ministers on their new appointments. As one of the Ministers that the noble Earl, Lord Howe, has seen off, I congratulate him on his strong grasp of health and social care. Even when he was skewering me as a Minister, it was always done with elegance and with a sense of doing so in the best interests of the NHS.

I greatly enjoyed the maiden speech of the noble Lord, Lord Hill. It reminded me that it was one of his former boss's ideas on GP fund holding that I pinched and turned into practised-based commissioning. I have never owned up to that publicly but this seems an appropriate occasion to do so.

I begin by congratulating the Government on administering a speedy coup de grâce to the ill-conceived Personal Care at Home Act. This has removed an important roadblock to achieving sustainable long-term reform in this area. Unlike the noble Lord, Lord Sutherland of Houndwood, I welcome the idea of an independent commission to look into this. I think that we need to dig quite a few people out of rather entrenched positions on some of these issues, and a commission of independent mind might help us to do that. However, it is important that it focuses quickly on the considerable amount of common ground that exists among different shades of opinion in this area. A few of us identified this common ground in March in a pamphlet produced on a cross-party basis with Sir Derek Wanless. I know that Ministers have seen that pamphlet but when we were writing it, it was very clear that there was a large measure of agreement on many issues in this area, and that is something on which the commission needs to build.

It is clear from the public debate so far that total funding for adult social care has to be increased significantly to cope with demography. It is also clear that there has to be a larger contribution from individuals and families who can afford it, rather than from the taxpayer. It is equally clear that risk-pooling through some form of insurance has a key role to play. These points are all well documented and well settled, and we need to build on them. We need to do more-and I hope that the commission will do this-to engage the insurance industry in ways forward in this area.

Before leaving the subject of social care, perhaps I may say a few words about the idea of a national care service. Like all parties, the Government rightly want to achieve more integration of health and social care for the benefit of service users. No one could disagree with that. However, I suggest that a better starting point for improved integration is the local commissioning role, rather than just concentrating on the provider side. This will particularly be the case if GPs are to be more powerful service commissioners in the future. We now need joint commissioning which supports more personal budgets and user choice and which creates greater diversity of service providers. It seems to me that the rather statist-sounding national care service is not self-evidently the best way to achieve this, and we need to look at that idea very carefully before we take it too much further forward.

I turn briefly to the subject of dementia, which has been raised a number of times today. I support and welcome the Government's decision to prioritise dementia research but I would encourage them to think more widely about whether the current allocation of service and financial responsibilities for dementia between the NHS and social care is right. After all, dementia is very much an illness; it is a disease, and I wonder whether the NHS is bearing its full proportion of the burden in this area. Another look at that might change some of the calculations that the independent commission might have to make in adult social care. I do not have a strong view on that, but it is an area that we should look at again.

Turning to the NHS, the Labour Government's record on investment in the NHS was outstanding. We recognised that that needed to be done after almost two decades of parsimony in the 1980s and 1990s. I shall not recite all the figures; many in this House have heard me recite them from the Front Bench many times. However, I emphasise one point: the independent evidence from the Nuffield Trust shows that the much maligned targets did a lot to improve services, however much NHS staff disliked them. Before we ditch targets we should consider whether, in a democratically parliamentary accountable system like the NHS, we have a few levers in Richmond House that enable us to satisfy the public that taxpayers' money has been spent reasonably well.

Latterly-the noble Baroness, Lady Murphy, put it very well-my party lost its appetite for NHS reform and certainly lost its appetite for some of the agenda that was promised in the 2005 Labour election manifesto, particularly those parts about more competition and greater diversity of providers to give patients more choice. I am a little hesitant about asking the coalition Government to help to implement that Labour Party manifesto. I notice in the new health Bill that this Government are to make Monitor into a proper economic regulator, a move which I have long supported. This is a good opportunity to ditch, once and for all, the rather misguided idea of the NHS as a preferred provider. A good start could be made by starting with market-testing PCT provider services, which the Department of Health has already said are inefficient and lacking in good productivity. I wonder whether the noble Earl can say whether there will be a review of some of the mergers that have quietly taken place or are in prospect of some of these less than efficient PCT provider services.

There is not time for me to go into any other areas of the NHS. As the new Government tackle the very difficult financial challenges ahead, which the NHS has never faced in its history on this kind of scale, I hope we in this House can settle down and discuss all these changes, which would have been inevitable whoever had won the election, and start doing so in a constructive and non-partisan way.

Photo of Baroness Emerton Baroness Emerton Crossbench 4:32 pm, 3rd June 2010

My Lords, I, too, welcome the noble Earl, Lord Howe, to the government Front Bench and offer him my congratulations on his appointment as Minister for Health. I am sure that his experience, knowledge and wisdom will be invaluable in taking forward the five priorities set out by the Secretary of State for Health and the long list of proposals within the health section of the coalition programme for Government. I also congratulate the noble Lord, Lord Hill, on his appointment and his mastery of the subject in his opening and maiden speech. I welcome my noble friend Lord Kakkar to the Cross Benches and congratulate him on his maiden speech. I am sure that his expertise in the area of medicine will be of great benefit to the deliberations of this House.

As I read the coalition Government priorities in the health section, I could not resist casting my mind back to 1953 when I started as a student nurse. At that time the ward sister reigned supreme and the matron was to be obeyed not only by the nurses but also by doctors and administrators alike. In my time, I have experienced six major reorganisations of the NHS, all of which had good points. I agree with my noble friend Lady Murphy that changes of organisational structures are sometimes good, but there are also things which are not so good. The one that stands out and disappoints me is the lessening of authority and accountability of the ward sister and the community sisters through to the director of nursing, both in hospitals and in the community. Therefore, I am delighted to read that:

"We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration ... We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line ... Doctors and nurses need to be able to use their professional judgment about what is right for patients, and we will support this by giving front-line staff more control on the working environment".

It important for us to note that professional judgment and working with more autonomy and higher levels of the critical thinking and problem-solving skills are core elements at the heart of the Nursing and Midwifery Council's review for pre-registration education and the move to the degree, under which the Nursing and Midwifery Council register will from 2013 require all registrants to have a degree. All those standards have a clear synergy with the Government's vision of the role of the future professionals in the NHS. The proposals all echo the recent recommendations of the Burdett Trust for Nursing in Leadership and the Business of Caring, the RCN's recent work on strengthening the role of the ward sister and the most recent recommendations of the Commission on the Future of Nursing and Midwifery Professions.

I very much hope that the coalition Government will grasp this opportunity to develop and enact those policy statements with the benefit of improving the quality of patient and client care; ensuring that there are clear lines of accountability and authority well-defined and understood from the patient, the client and the public level through to the board level, including enhancing the role of the nursing voice at board level; and being knowledgeable of the wider context of the NHS, conversant with modern nursing practice and measuring clinical outcomes both in hospital and in the community.

It is also important to note that the announced cuts in finance will not exempt the multi-professional education and training budgets and that the current £4.8 billion will be reduced by 10 per cent, most affecting undergraduate and postgraduate education in medicine and dentistry. The £0.8 billion which is used for continuous professional education and national innovations is the most vulnerable. That raises concerns about the Government's ambition to raise quality of care standards and the future shape of the workforce. Balancing the necessary cuts to meet the overall deficits will require the highest quality of medical and nursing professional management skills to ensure a workforce that will protect the safety and well-being of patients, together with the priority to raise the profile of public health, which will require knowledge and expertise so that clinical outcomes of patient experience and safety are met, as well as meaningful health promotion and prevention of disease being developed further.

I refer to two other important issues. The Government have said that they will seek to stop foreign health professionals working in the NHS unless they pass robust language and competency tests-a crucial policy requiring action to change the current interpretation of the EU legislation, the professional qualification directive 2005/36. This prevents regulators from assessing the language competence of EEA professionals before admitting them to the registers. Currently, assessment is left to employers, not the regulators, and ignores the fact that many health and social care professionals are independent practitioners who practise outside the NHS and formal management assessments. The Nursing and Midwifery Council exists to safeguard the health and well-being of the public, and all nurses and midwives on the register should be safe and effective in practice, but the regulator is not permitted systematically to language-test trained applicants, therefore undermining the integrity of the register and presenting a risk to the public. The situation is also confusing to employers, applicants and the public, leading to a potential risk to the health and well-being of the public.

I ask the noble Earl to ensure that the 2012 review of directive 2005/36/EC on the recognition of professional qualifications reflects these concerns. Health and social care professions from outside the UK make a significant contribution to healthcare in this country, but patient safety must always take priority over free movement of labour.

While I share the concern of my noble friend Lord Sutherland about the delay in the introduction of long-term care and the suggestion of a commission, I hope that the Government will quickly take forward the commission and bring forth a sustainable structure of funding for long-term care. The part played by nurses and social care workers will be crucial in establishing the three Ps: prevention, personal and partnership. I should like to add the three Cs: care, compassion and communication, which are all essential ingredients that the public are looking for, especially in the light of the recent inquiry about Mid Staffordshire that demonstrated so clearly unacceptable levels of care. It pointed to the need for a highly competent workforce, high levels of supervision and management within a culture conducive to demonstrating compassion and communication with the flexibility to cross boundaries from health to social service and other partners. There is no doubt that there is a formidable list of proposed policies and I wish the Government well in taking them forward.

Photo of Baroness Knight of Collingtree Baroness Knight of Collingtree Conservative 4:40 pm, 3rd June 2010

My Lords, it has been a delightful and somewhat unusual experience to sit here hour after hour today hearing a deluge of praise and kindness showered upon my noble friends on the Front Bench. Every word was said with such meaning. I appreciate it very much and would like to make it clear that we on this side of the House are just as delighted to see my noble friends on the Front Bench in government as members of the Opposition have kindly suggested.

The stated aims of the Government's new health Bill are excellent. There has long been a crying need to improve basic healthcare for our citizens. I thoroughly approve of doctors and patients being given greater control. There should be devolution of power and responsibility in the NHS. We all understand that there must be management of the hotel side of our hospitals-the laundry, the cleaning and the cooking-but people who know nothing about medicine are not the ones who should be the captains of the hospital ship, as they often seem to be.

Administrators are not the best people to improve bad standards. They are far more likely to sack a whistleblower than to listen to the complaint and try to do better. Even when I have complained about the disgraceful treatment of patients, the reaction has invariably been outrage that I should dare to criticise and flat denials that anything at all is ever wrong with the treatment of patients rather than what I would have far preferred: an apology and a promise to investigate and do better. I have always been very careful to report only cases where I can give names, dates, witnesses, addresses, ages and the hospital where the incident occurred. Your Lordships will have often heard me speak in this House of such cases. Many have been of patients who have been given neither food nor water, or-and I find that this is extremely common-whose food has quite deliberately been placed too far away for them to reach and has then been whipped away untouched with not even the slightest offer to try to help them with feeding. Those who have no one to watch out or speak up for them are in terrible trouble. Some time ago, an elderly man in exactly that situation was actually filmed on TV as he starved and died.

There are many, many cases of patients being treated without care or compassion. Relations often fear to complain, in my experience. Sometimes they say, "Well, he's dead anyway, we can't bring him back, and if I complain I will really be in trouble because that complaint will go down against me and my care may suffer when I need it". One instance has been cited a number of times by many different sources. A patient begs, even screams, for help to get to the lavatory, but is completely ignored and given no help at all. Eventually, helpless, they let loose in the bed, and what happens? They lie in the mess sometimes for hours before anyone comes to wash and change the sheets. Sometimes the excuse is that there is a wait until the next team comes on in the morning, but often no notice is taken at all of their predicament, which is appalling. I have absolutely no doubt that there are still angels among the nursing fraternity-we have some of them in this House-but I am afraid that they are a lot rarer than they used to be.

Only eight days ago, one major newspaper reported two quite separate examples on two quite separate pages of the lack of the most basic standard of care: one in a private home, and one in the NHS. The former was an 84 year-old man who was placed there because his wife could no longer care for him. He had Alzheimer's and was both deaf and blind. After only one day, the first family visitor to see him found him on all fours, wearing only a nappy and covered with bruises and dried blood. When he was admitted, he had three bed sores. A few days later he had 18, all of which were covered with dirty dressings. He died six days later as a result of no proper treatment for the sores. The noble Baroness, Lady Masham, spoke of a similar case. Sadly, she knows as well as I do that there are many of them. One can only imagine what agony that poor old gentleman must have endured. As his inquest, the coroner ruled that he had,

"died for want of care by those charged with it".

In the same newspaper on the same day, a journalist wrote of her treatment in an NHS hospital. She had had surgery on her back and had no complaint about that. The surgeon was excellent and the operation went well-that was all absolutely fine-but the standard of nursing care afterwards was abysmal. "On the ward", she writes:

"I was treated like a malingering bed-blocker ... When I asked for pain relief, it was refused. When I asked for help in moving, it was refused".

One can imagine that after a back operation she had great trouble trying to move. She went on:

"When I asked for a second pillow so I could sit upright, it was refused", even though every other bed had two pillows. She asked for help with another extremely painful condition from which she suffered. That help, too, was refused, although by then she was hallucinating and crying from the extreme pain that she was in. I will draw a veil over the rest of her account, and report only the last words that she wrote. She said:

"what happened to me had nothing to do with money and everything to do with mindset".

I always came to the conclusion that the previous Government believed that the excellence of care could easily be measured by the number of millions of pounds spent on the health service, a point which has been touched on in this debate. That is wrong-I repeat, wrong. It is not how much money is spent, but how that money is used which is so important. That yardstick took no cognisance of the standard of care a patient received.

Our new Health Minister promises that his Bill will focus on quality and the needs of patients, which we have wanted for years. It seems that new Ministers have watched and learnt. How pleased we were to see only yesterday that details would be made clear about how many patients have died from MRSA. I was staggered to see a report that the number was 8,000. Whether that is accurate or not, we shall soon know. Whatever is or is not done, and however many millions are spent on the health service, if the patient's well-being is not the first priority, the service fails. That message should be framed and placed on the desk or a nearby wall of every Health Minister.

Photo of Lord Mawson Lord Mawson Crossbench 4:51 pm, 3rd June 2010

My Lords, I should like to add to the deluge of praise. I congratulate the new Government on their success and wish them well in the coming years as they try to develop a working partnership and deliver their programme. I also want to take this opportunity to wish the Minister, the noble Lord, Lord Hill, well in his new job and to thank new colleagues for four excellent maiden speeches. I also congratulate the noble Earl, Lord Howe, on his new appointment.

As a result of many years of bringing disparate groups of people together to deliver practical results, I know that the key to partnership is to focus on relationships and not just on new structures, processes and strategies. Focus on the relationships and everything will follow. Ignore them and you will face serious difficulties. My colleagues and I have spent more than a quarter of a century bringing together partnerships to modernise public services so that they are more responsive and fit for purpose in our modern enterprise culture.

I thought that it might be helpful if I shared with the new partnership Government a few lessons that my colleagues and I have learnt at the coalface. It might also help them to put some flesh on the bones of what the big society might look like in practice. Many people are wondering what this piece of marketing means. We all know that it is crucial for a new Government to lay solid foundation stones on which real change and development can grow. Real change is elusive and may not come to fruition until a Government have left office. Effective innovation can take a generation and requires committed individuals to champion it. It is rarely captured in a policy document, written by what my colleagues affectionately refer to as "the bright, young things". Real change has to be grown and deeply rooted in communities, otherwise, as I suspect that new Labour is discovering, it will be blown away like the sand when the first gust of wind comes along.

What are the lessons? How do you create a big society and lift the game in education, health and welfare? First, I would suggest that this Government support organisations that already have a successful record of reforming public services. Do not reinvent the wheel, but build on what works. They should back success and learn from their many years of detailed practical work. Do not, as new Labour so often did, take their best ideas, pass them to the Civil Service machine and exclude these experienced innovators. Let them take the wheel. Support them and enable their efficiency. Do not think that it is now the Government's job to take control. It is not. They should take the long-term view.

Secondly, we need to question what the overused term "fairness" means. The question to ask is: fairness for whom? If you are seeking to achieve fairness for Karen and her children on housing estates across the country and to improve their educational opportunities or access to health, you must back the best providers with a proven record. It is irrelevant whether they come from public, business, social enterprise or voluntary sectors. However, if you are seeking to be fair in dishing out grants and resources to the voluntary sector, you will do something quite different. Who are you trying to be fair to and why? Life is not fair, and where we began to challenge and question this thinking in east London and embrace not equality but diversity, a thousand flowers began to bloom. "Fair for whom?" is the exam question I leave with the Minister. It is not possible to be fair to everyone.

Thirdly, if fairness is about creating opportunities for employment and improved services, the future must be about enabling environments where business and social entrepreneurs can do business together. These are the new relationships that will reform public services and they are already showing significant success, but this means that some of our cherished ideology will need to be examined and probably dropped. For the last decade, bureaucrats have fed a bureaucracy monster and it is now very large indeed. Often, contracting out has transferred a large government bureaucracy to private sector companies with large contracts-prisons, for example. Then the civil servants have migrated from one large organisation to another. The contracting process seems designed to stifle innovation and risk taking. The role of the new Government needs to be to create a level playing field where new relationships and networks can grow, particularly between business and the social enterprise sector.

Fourthly, I would ask the Minister how he will practically encourage new environments where people "learn by doing". Will he get his hands dirty by planting the seeds of enterprise in the fertile soil outside the comfortable but dry world of theory? If this new generation of politicians is to gain any understanding of how the real world works in practice, and not hide in the bubble of Westminster, I would humbly suggest that each Member of Parliament should become involved in one project in their constituency to play their part in building the "big society". Do not pontificate about it: do it. Legislators might then begin to understand the relationship between legislation and practice because attempting to deliver a new school, health centre or service is a practical nightmare nowadays, given the number of contradictory hoops laden with half-baked ideology that practitioners like me have to jump through. The confusion that exists between delivery and democracy is a minefield. The micro is the clue to the macro. Learn from it and gain the public's respect in the process.

If this Government are serious about empowering communities, Ministers will have to get involved in messy detail. For example, one of the difficulties we face in giving people more professional independence in health is the awkward fact that often doctors do not want to innovate. They have not been trained to think like entrepreneurs and so resist change because they have an entrenched view and an expensive biomedical model of health to protect. This is not just my view, but that of the doctors I have worked with. Can we leave commissioning with doctors? Will they be responsible? It depends on the mindset of the individual doctor.

Finally, the idea that devolving power to local authorities will deliver a plurality of outcomes is not always correct either. Local authorities are not neutral when commissioning services. They often have an aversion to selecting innovative approaches because they do not understand them. Many of their staff have only ever worked in the public sector. They do what they have always done, but change the wording on the forms to please the Government of the day. Look carefully and you will still see the same bodies under new clothes. Local authorities are often the least likely to choose an innovative approach to service delivery, so why are the Government looking to them alone? Could the Minister tell the House what criteria will be used to choose these authorities? How will he select the sheep from the goats? Or, like doctors, are they all as good as each other? Not in my experience.

I wish the Minister well in this time of opportunity. Partnership is a great thing and the present financial crisis is the time to embrace innovation. Never miss the opportunity presented by a good crisis. If you are to deliver, I would humbly suggest that you do not rely on structures or theories, but on people. Back the best people, be they in the business, public or social enterprise sectors, and, funnily enough, you will be fair to everyone.

Photo of Baroness Wall of New Barnet Baroness Wall of New Barnet Labour 4:59 pm, 3rd June 2010

My Lords, through a very croaky voice-my voice box has just given up, forgive me-and after more than 30 previous speakers, I, too, welcome the noble Lord, Lord Hill, and congratulate him on his maiden speech. However, I particularly want to focus on the noble Earl, Lord Howe, and say how delighted I am that he has received the reward we all hoped he would receive by becoming a Minister on the Front Bench. It has been an absolute joy working with him over the six years that I have been here. So I say to him, "Well done", and look forward to working with him again in the future.

More importantly, I look forward to him coming to my hospital. I declare an interest as chair of Barnet and Chase Farm NHS Hospitals Trust, which is a two district general hospital trust serving the community in north London. On his appointment, the Secretary of State, Andrew Lansley, picked out my trust as the first one he should visit. From his interest, particularly in our A&E, and the questions he raised with us about the rest of the trust, it was obvious that he had gained a real insight into the services across our two hospitals. We greatly welcomed the opportunity to see him and to have his support.

Shaping the future of healthcare that is safe, of high quality and responsive is a vital component for any government reform in the NHS. In fact, it is enshrined in the NHS constitution that patients must receive the best care possible when they come into contact with our services. Patients, in consultation with their GPs-much of this has been referred to already today-have a choice about where they can receive their care or treatment, and we in Barnet and Chase Farm welcome that. I agree almost totally with the comments of my noble friend Lord Warner about the independent sector because the fact that people have the opportunity to use it makes our services better. I strongly believe that when a choice is offered, people will make sure that they are the ones who are chosen. We certainly do that in my hospital. The decisions patients make are the driving force behind my trust working hard to become the provider of choice, whatever the competition. If the Government are going to work on that principle, all I ask of the noble Earl is that we have a level playing field. That is very important.

We are committed to ensuring that every patient is treated with dignity, compassion and respect while receiving high-quality clinical care. Every time I follow the noble Baroness, Lady Knight, in a debate, I wish that I had said to her the last time, "Please come to my hospital" because the things she tells the House-which I am sure are true-are so heartbreaking. She will remember that we spoke in the House about the red trays. I shared with her our experience of the equipment we use in Barnet and Chase Farm which ensures that people who cannot feed themselves are drawn to the notice of everyone and receive support from either the nursing staff or volunteers; that because their red tray indicates, "I cannot do this by myself", someone goes along and helps them to do it. We now have red jokes which I am sure the noble Baroness, Lady Knight, will be delighted to know. Although we gave patients food, sometimes the water was too far away, and so we remedied that as well. I extend an invitation to the noble Baroness today and I shall make sure that I follow it up.

In my trust, we believe that greater ease of access to healthcare will improve patient outcomes. There is no mention in the gracious Speech of whether the coalition Government will continue with the four-hour A&E access target, from which our patients benefit and which they value. In my trust, in order to achieve the four-hour A&E target we had to go back to the drawing board and redesign the patient pathway so that patients are seen as quickly as possible but by the right clinician. This, too, is much better for patients and, thank goodness, the 12-hour trolley waits are a thing of the past-certainly in my trust. It is interesting that whenever patients talk to friends or relatives when they have come out of hospital, they comment on the quality of their treatment-about their operation being successful, we hope-mostly very favourably, but one thing they are quick to talk about, in the pub or wherever they go, is how long it took to be seen. No matter how good the quality of care was, if they were kept longer than they thought was appropriate, if it was longer than four hours-and four hours is not appropriate any more-they still remember that bit: "It was great but I had to wait". The focus of some kind of incentive for people to work on that is really important.

We in Barnet and Chase Farm regard the fact that we have achieved "green" on the "traffic-light" indicator for our access targets for so long-together with being "green" for just as long in our quality targets-as a key factor in patients choosing to come to our hospitals. Seeing those quality targets being met, they know that our hospitals are places where they will get both the treatment that they need and the performance that they are entitled to. Perhaps the noble Earl will tell us when responding that the value that patients place on this system is important also to the new Government. I put all the caveats around how we make sure that that happens.

One speaker today has talked about removing the Care Quality Commission. I would plead with the Government not to do that. It is a great improvement on the Healthcare Commission; it is much more proactive; and it makes our trust feel that we will be challenged and that we will be superb in the way we go about our work. Let us combine timely access with high-quality clinical care and sound financial management, which is equally important.

I make this plea for targets not because they are about being achieved at any cost-they are not-but because they are about treating patients well. People who benefit from really good access along with absolute professional care get seen more quickly. In my trust, the introduction of MRSA reduction targets-there has been much discussion of them today-has led to a reduction in MRSA bacteraemia cases every single year. The noble Baroness, Lady Knight, mentioned very high figures. Last year, we had 16 cases in our trust, which we thought was awful. This current year, we have had four cases, with no more than seven predicted by the end of the year. That is a result of the care that we make sure is given to patients. All the nightmare stories that one hears will happen again if people do not take care of their patients. This is another example of how appropriately set targets can provide better care and improved outcomes. It is good for patients. We again urge the coalition Government to hold us all to account in this way.

During this time of change, might I be so bold as to say that we must take care in making any decisions about changing or removing targets? They can and do benefit patients as long as we always have the patient and the quality of the service at the front of our minds, which is absolutely essential.

I conclude by sharing with your Lordships a case study made by a Department of Health on delivering same-sex accommodation, which was a flagship policy of the previous Labour Government. We hope that the new coalition Government will hold on to this policy and push all hospitals into delivering this environment which is so valued and appreciated by patients of both sexes. That is what dignity and care are about.

Photo of Lord Addington Lord Addington Liberal Democrat 5:08 pm, 3rd June 2010

My Lords, coming in at number 35 in the batting order, I am surprised to discover that I have something to say which has not been covered already. That does not often happen in a debate such as this; you usually have to quote everybody in front of you.

I shall refer first to the education aspect of the debate. Before doing so, I welcome the noble Lord, Lord Hill, to the cross between Alice in Wonderland and Gormenghast which is how I have always regarded the House of Lords. He is welcome as a noble friend-something that I did not expect on 6 May to be saying. I hope that he will carry on in the same vein as that in which he started.

The coalition document refers to assessment for all pupils with special educational needs, which most people involved in the field have concluded is absolutely necessary. It will be important to make sure that we hit targets for improved literacy, for example. The previous Government, to give them their due, did throw resources at this problem and found out that we were not getting to the group of people with such things as dyslexia, which is a special interest of mine. Too many people were still not being identified or treated properly when they got through. The other hidden disabilities are as bad. What usually happens here, as the noble Lord will discover, is that the most extreme cases are dealt with first, provided that you have an articulate parent behind you. That is the absolute iron law. The organisations that do the work behind this are driven by those articulate parents. Dyslexic people from working class backgrounds, who often have dyslexic parents and dyslexic children, end up with people with dyslexia in prison. That would be roughly what I would say about it. We need to ensure that the assessment works and is given the time, place and energy and is made to cover all these conditions. The assessment may be a complicated one that takes several days or weeks, but it must be done in that way. If you miss this target, you will miss an opportunity. I shall come back to this at a later date-probably on a lot of later dates. I think noble Lords are nodding their heads in agreement. It is something that we must look at, and I encourage the noble Lord to engage fully with all the organisations out there. I hope that we can make a good fist of it. There is no right answer, but there may well be a better one in this field.

I turn to the link between culture and health. The noble Lord will not be surprised if I say that the linkage between the sports and physical activity and health is absolutely obvious, but government has never really got hold of it. The idea is there, but we do not really correlate the two properly. The coalition document mentions helping sports clubs; something has been done, but not enough. I recommend the Bill that I brought forward on amateur sports clubs, and would like to take credit for all the drafting, but the CCPR would have my hide if I did. We do not give enough support to those taking sport outside school, in encouraging them to take it on after that.

I am worried by one of the other comments in the document that refers to school sports. One thing that we know about sporting activity is that it drops off at 16, 18 and 21. Those happen to be the dates at which people leave educational institutions. If you are fit as a flea at 15 and a fat slob at 22, the NHS ain't going to get a great deal of benefit. How do you encourage people? I asked the previous Government and the Government before that. The noble Earl, Lord Howe, and I have been noble friends and allies and noble opponents in this House. What is the best form of recruitment devised by all the sporting bodies supported by Sport England to keep people involved? I have had long and in-depth replies but I have never found out the best answer. How can we keep people engaged and active in sporting activity? People will then turn round and say that people can be healthy without playing a competitive sport. One in several thousand may have the motivation to do the 2.3 miles of jogging two to three times a week to keep their weight at the recommended level over a long period of time, but nobody else will. You need an incentive and a reason to get yourself involved; even if it is only to look good on the beach, you need a reason. It is easier to eat chips. The answer will not always be found in eating healthier food. You can get fat eating healthy food and watching TV. It might take slightly longer, but you can still do it. We need to give people an incentive to get involved. Will the Government ensure that the Department for Culture, Media and Sport and the Department of Health have regular meetings and discussions about how they can marry these two things together to ensure that there is some real interaction? I know that effort was put in before, but it seemed to disappear somewhere behind the Chinese walls. I do not doubt that many Ministers tried-they probably ended up wasting a great deal of time with my pushing to get this on-but please can they make a move through with a linkage that goes slightly further than Ministers saying occasionally, "Oh, we must do something". It happens that things fall away occasionally between Ministers who are supposed to meet each other.

If we are talking about protecting school playing fields in this document, please can somebody also address the fact that that battle might have been lost? It took 10 years for the previous Government to reverse their sell-off of school playing fields. Maybe they could have acted sooner, but they did not. They slowed it down, but did not reverse it. I think there was a great announcement, after about 10 years of asking this question, saying, "Finally, we've got two more than we had last year". Can we have a real addressing of the facilities available across the board for people to take on sport? Can we also look not just at school playing fields but at local authority and private playing fields? I asked that several times and it was never measured. Can we look at this in the round?

Finally, on the Department of Health, if we are encouraging people to play sport and take exercise, can the noble Earl, Lord Howe, tell me whether we are doing more about making better sport and exercise medicine available? That is because soft-tissue injuries which are not dealt with properly become chronic, leading to the person becoming less active-indeed, often, to them becoming disabled. It is an absolute fact that this happens. The process is slow; physiotherapy is slow to acquire. Instant treatment often solves problems overnight. Leaving them for several weeks means you have major problems requiring major involvement; I have case studies on that by the barrow load. I will not bore the House with those tonight, but unless something is done to bring these facets together, all the activity around the Olympics and other great sporting events will not achieve anything like it could. I would hope that, on my two questions, both noble Lords will go away and remember that they must talk to their colleagues and to the rest of the House to maintain pressure for this.

Photo of Lord Morris of Handsworth Lord Morris of Handsworth Labour 5:17 pm, 3rd June 2010

My Lords, I, too, pay tribute to the gracious Speech and to those noble Lords who have delivered maiden speeches today-in particular, the noble Lord, Lord Hill, who delivered his from the Dispatch Box.

Unlike previous years, in order to explore the true intention of the Government's programme it is necessary to read not only the manifestos of the two parties in government but the important document The Coalition: Our Programme for Government. The Government, and indeed the gracious Speech, say that the legislative programme will be based on the principles of freedom, fairness and responsibility. Reflecting on what the coalition's programme commits to in respect of the National Health Service, I find it to be long on expectations but somewhat short on commitment to its users.

For example, as the noble Baroness, Lady Wall, who has just left her place, pointed out in her question, where is the commitment to guaranteeing maximum waiting times for hospital treatment-the commitment to a maximum wait for an urgent cancer treatment referral, or while in accident and emergency? In the context of the debate in your Lordships' House, these commitments might sound somewhat pedestrian, but if you are on the waiting list they are vital. Indeed, for some it could be a matter of life or death.

Today, though, I will examine the bigger picture, letting the notion of "freedom and fairness" pass. I want to focus on the principle of responsibility. Tucked away on page 25 of the coalition's programme for government is a paragraph on the NHS. It says:

"We will establish an independent NHS board to allocate resources and provide commissioning guidelines".

That statement raises questions and gives no real answers. The creation of an independent NHS board, as set out in that programme, challenges the very principle of political responsibility and political accountability. In essence, the coalition Government are proposing the creation of a superquango to run the National Health Service. What, then, of the promises over a number of years of "no more pointless reorganisations" of the NHS? What of the promise in the coalition programme to reduce the number and costs of quangos? In fact, the proposed NHS board will be the biggest, most expensive quango in the history of the NHS.

The coalition Government will argue that their proposed NHS board will prevent "political interference" but, to many, what has been loosely labelled as such is actually political accountability. Ministers will no doubt say that they want to devolve power, but there is a qualitative difference between devolving power and abdicating responsibility. Ministerial responsibility for the NHS cannot be outsourced or subcontracted to unelected quangos. Ultimately, it is the Government who must be held accountable for the funding and service decisions that shape, influence and affect the healthcare of the nation. Democratic accountability demands that Ministers, as we have seen today, come to the Dispatch Box to be questioned about their decisions on the running of the NHS.

The NHS is a public service that spends more than £100 billion of public money each year. It is an essential front-line public service that makes a difference to the quality of our lives, and we are all stakeholders in it. That is precisely why it is with Parliament that the buck must stop, not with some superquango that does not have to face the electorate or stand at the Dispatch Box.

The proposed NHS board raises a number of fundamental questions, and I hope that the Ministers will give us some answers. Will the board both commission and provide services? Who will own the assets of the NHS? Who will have responsibility for managing and monitoring those assets? How are taxpayers' interests to be protected and safeguarded? What will the relationship be between foundation trusts, primary care trusts and GP services?

If Ministers really want to improve our NHS and devolve decision-making, I am sure that the best way of doing that is to empower NHS professionals-our doctors, our nurses, our front-line healthcare workers. What the NHS does not need is the creation of a superquango that is unelected, unaccountable and unnecessary.

Photo of Baroness Howarth of Breckland Baroness Howarth of Breckland Crossbench 5:25 pm, 3rd June 2010

My Lords, it is an absolute delight to see the noble Earl, Lord Howe, across the Chamber on the Front Bench. He and I have exchanged views for many years. Sometimes we have disagreed but he has always replied with grace. I also look forward to getting to know the new Minister. I hope he does half as well as the noble Earl; he will then do pretty well indeed.

It is in times of economic constraint that the services to the most vulnerable get lost. It is the most in need-the least vocal-who are diminished. I am sure that this Government will not want to lose sight of those who require our care. Recognising their commitment during the election, in the manifestos and in their speeches, I am particularly grateful for the concern already expressed. Before I move on, I specifically mention the ending of detention of children for immigration purposes. After many years' service in social care, I recognise that this is a complex issue, particularly since children must not be separated, as the right reverend Prelate said, from their families. The previous Government did much to end this practice. We now look to this Government to complete the task.

Unlike my noble friend Lord Sutherland, I welcome the commission to consider a sustainable long-term structure for the operation of social care. As chair of Livability, a charity providing services for severely disabled adults and young people, I recognise the challenge of delivering excellent opportunities to give individuals maximum choice and freedom with the balancing of cost. I hope the Minister will reassure me that looking for value will not lead to the lowest level of care and quality. People who need our services deserve the best that we can give. That is why the commission is so important in taking a broader look at all those in the social care system. I also hope that during this review the Government will look at simplifying some of the structures that we now have. The uncertainty and additional bureaucracy associated with assessment and care support planning under the personal budget programme-which has led to an industry of people set up to manage people's individual budgets, taking a top slice-is just one example of added complexity.

Linking this commitment to improving public health and reducing health inequalities, I expect the Government to see the close link between health input through hospitals and medical facilities and practitioners, and the community care provided by those in social care in local authorities and voluntary organisations. For example, Little Hearts Matter is a small charity dealing with children who experience the most severe surgical interventions in heart conditions. I pay tribute to those specialist doctors who have given these children a life through brilliant intervention techniques. However, the children will spend most of their lives in the community, not in hospital, needing support services and follow-up care. I anticipate that the Government will see these interventions on a continuum, rather than as incidents, and support the whole, including the part played by the voluntary sector.

As noble Lords would expect, I now want to focus on children and children's care services. I am not speaking of education, important though I see it is, because many of your Lordships here will do so. However, I say to the Minister that without emotional stability and family support, children will fail to learn. Again, the two are interrelated. The previous Government said, "Education, education, education", and I said to them often on the Floor of this House, "Welfare, welfare, welfare, if children are to learn". As yet there seems to be no clear decision about the long-term plans for children's local authority services-children's trusts-but stabilising them is absolutely vital. They are working in a time of unprecedented pressure. Social workers need to know that they are as valued as teachers, nurses, economists and the rest. I did not hear mention of them in the introductory list of the noble Lord, Lord Hill, but perhaps he would like to learn more about their work. I would be delighted to inform him. Why is that? It is because we entrust them with the safeguarding of our children. We leave them with the most difficult decisions. They are damned if they remove children, damned if they don't and damned to hell if they get things wrong.

Is it any wonder that there is a shortage of these committed individuals? The tragedy of Baby Peter and the media treatment have overwhelmed the service. The workforce is demoralised and service provision is at its tightest. In the Children and Family Court Advisory and Support Service, where I chair the board, the numbers of referrals are higher than at any time in the life of the service, and we are a barometer of what is happening outside in the community. Despite this our unallocated cases continue to be held and reduced, so CAFCASS is doing better than ever through innovative work practices, partnership with judges and the support of the new president of the family courts. Much can be achieved through partnerships and finding new ways of working so long as the children and their families are central to our thinking. However, we, like local authorities, are still failing against our key indicators because our resources simply cannot match the demand. At the heart of all this for all social care services is the serious shortage of skilled social workers.

The one bright hope on the horizon is the report of the Social Work Task Force giving a once-in-a-generation opportunity to rise to these challenges. They are not challenges unknown to the government Benches. When in opposition, the Conservatives held their own review and were positive in their approach to social work. Where is this now? There has been no mention of the Social Work Reform Board and its plans to implement the recommendations of the task force. Can the Minister say where this stands in government priorities?

For many working in social care there is pressure, uncertainty and, for some, low morale, but I do not want the picture to be totally bleak. Social workers, volunteers, carers and others continue to give of themselves day in and day out, and it certainly is not for the pay. New ways of working are being developed. What we need are ways of sharing experience and building on strength. We require a Government with a national vision that can have local implementation. The work needs to be integrated with health, housing and DWP to get the best out of public sector resources and reduce duplication and waste in the processes. It is needed now because the work simply does not stop for a change of government. We look to the Government for a better future for those in need.

Photo of Baroness Warwick of Undercliffe Baroness Warwick of Undercliffe Labour 5:32 pm, 3rd June 2010

My Lords, I will focus my comments on the impact of the Government's programme on higher education. I, too, welcome the noble Earl, Lord Howe, in his ministerial role for health. I cannot think of anyone better qualified in terms of knowledge, commitment and sensitivity. He is also pretty good behind the footlights.

Although I am no longer chief executive of Universities UK, my passion for higher education remains undiminished. I am anxious that investment in higher learning should not be an unintended casualty of the Government's determination to reduce the deficit. Several proposals in the Queen's Speech have a potential impact on higher education. Among them are the Academies Bill, the education and children's Bill and the health Bill. The Government also propose to put a cap on non-EU immigration. I also wish to touch on the dismantling of the system of regional development agencies.

Universities have invested considerable effort and resources into building closer links with schools in order to break down the social barriers that act as a barrier to participation in higher education. This has been supported by the previous Government's commitment to measures aimed at increasing social mobility. We must take care that the close links between schools and universities are not damaged by the administrative changes that the new Government are bringing forward.

Similarly, not everyone will be aware of the extent to which changes in NHS structures can have a major impact on higher education. Education for nursing and allied health professions in England is provided through contracts with strategic health authorities and universities. The proposals to establish an independent NHS board to allocate resources and provide commissioning guidance will directly affect this link. I urge the Government to ensure that this is borne in mind as the proposals are developed.

On the issue of migration, I understand that the non-EU cap will not apply to students. I warmly welcome this decision. A quarter of a million international students studied at our universities last year. Of course, they make a substantial contribution to the financial sustainability of universities, but their economic impact is a great deal wider than that. They will go on to become the economic and political leaders of the future, taking with them established links to the UK.

Higher education is an international market where the UK can be proud of its leading role. Eighteen UK universities are in the top 100 in the world. The ability of our universities to recruit the best researchers and teaching staff from around the world is a key factor in maintaining this leading position. Any moves that make it more difficult to recruit the best staff can only limit our ability to compete in this global education market.

I turn to the future of regional development agencies. Often, universities are among the largest businesses represented on the boards of RDAs. The economic impact of universities at a regional level is substantial. In my region of Yorkshire, for example, there are almost 28,000 full-time-equivalent jobs in higher education, and a similar number that have been created by secondary means elsewhere in the economy. Universities' research and innovation can pay enormous dividends in terms of future economic development. I share the concern of university vice-chancellors that we risk damaging the capacity for cross-regional collaboration if RDAs are replaced with bodies that cover much smaller areas, and which perhaps will focus on more parochial concerns.

Beyond the measures outlined in the Queen's Speech, I will address the wider issue of the future funding of higher education. Many arguments that I would put were made by speakers across the House in the excellent debate on higher education initiated by the noble Lord, Lord Baker, on 25 February this year, and I commend these points to the Government. They reflect my concern about the sustainability of our hard-won excellence if higher education faces again, as it did two decades ago, relentless underfunding.

The new Government face a difficult job in navigating the UK to sustained and sustainable economic growth: all noble Lords in this House have acknowledged that. I hope that the Government will recognise the vital role that higher education can play in securing economic recovery. The higher education sector already faces £1 billion-worth of cuts announced last December. The Chancellor's statement of two weeks ago added a further £200 million to the tally. Against this background, the noble Lord, Lord Browne, is conducting a review of future higher education funding and student support. This is the elephant in the room for the coalition; and, given the length of the Session before us, it could become a very restless elephant indeed. We know from the coalition agreement that the Liberal Democrats have an opt-out should the noble Lord, Lord Browne, propose an increase in tuition fees. This is hardly surprising, since virtually all of their Members in another place-including the Deputy Prime Minister and the Secretary of State for Business, Innovation and Skills-signed the NUS pledge not to support an increase in fees. However, is it credible to imagine Dr Cable abstaining on legislation sponsored by his own department?

My fear is not the immediate cuts to universities, tough though they will be, but that in the June Budget and the autumn Comprehensive Spending Review, higher education will find itself cut back further in ways that will undermine the teaching excellence that produces the highly qualified people that we so desperately need, and will undermine the world-class research that will give us the best advantage in emerging from the economic doldrums.

I do not know what the proposals of the noble Lord, Lord Browne, will be. He is charged with finding a sustainable way to fund universities. If the Government will not fully implement his proposals, universities will not have the freedom to respond to the increased financial pressures that they face, and higher education will not be able to play the role that it could in securing our economic future. I hope that, in replying, the Minister will be able to reassure me on this vital point.

The new Minister for Higher Education, David Willetts, knows the university sector well and is widely respected within it. I, with others, welcome the noble Lord, Lord Hill of Oareford, to this House and to his education role. He adds a further formidable brain to the two that Mr Willetts is said to have. All three will need to be applied to the task if they are to steer our universities through the challenges ahead so that they maintain their world-beating position.

Photo of The Earl of Listowel The Earl of Listowel Crossbench 5:40 pm, 3rd June 2010

My Lords, I join others in congratulating the noble Earl, Lord Howe, on his new post as Parliamentary Under-Secretary of State. I also thank the noble Lord, Lord Hill of Oareford, for his maiden speech. I shall speak about young people in care and care leavers, but I should like to raise a few points before I do so.

The principles behind the Queen's Speech were freedom, fairness and responsibility. The noble Lord opened the debate by talking about the need to free up professionals at the front line to do the job that they understand and know how to deliver. That is crucial. A general theme in this debate has been that professionals and users on the front line can make the most difference. We can deliver freedom, fairness and responsibility through teachers, social workers, foster carers and all those other workers.

Listening to the noble Baroness, Lady Morris of Yardley, I recalled that two months ago the former Secretary of State, Ed Balls, said in Church House that if he regretted one thing from his term in office it was that he did not do more for social workers early on. No matter how often we say that we need to support and develop teachers and social workers on the front line, somehow they manage to slip off the agenda. I pay tribute to the Government's excellent work in raising the status of teaching, but there is still a long way to go. The noble Lord will recall that, over several years, Finland has been the highest performer on the PISA tables. It is so demanding about who should teach its young people that it rejects 90 per cent of those who apply to become teachers.

The noble Baroness, Lady Howarth, talked about social work training and the social work college. I look forward to hearing information about the future of this important new institution. The National Centre for Excellence in Residential Child Care has over several years provided excellent support to a sector that has very little capacity in working with children with the most complex needs. Paul Ennals, the director of the National Children's Bureau, started out as a residential childcare worker. Jonathan Stanley, the director of the National Centre for Excellence in Residential Child Care, which is based at the National Children's Bureau, was director of the well respected Caldecott Foundation, a therapeutic community for children, of which my noble friend Lord Northbourne was once a trustee. The institution has a great deal of experience in residential childcare, so the Government's decision to switch funding to another organisation caused some consternation. That may be quite the right thing to do, but I am glad that there is a second opportunity to look at the contract and I hope that the Minister can provide further information on why the decision was made.

I do not believe that we have spoken this afternoon about early years. I remind the Minister that research by Professor Melhuish at the University of London highlights the fact that, working in particular with disadvantaged communities, if one provides good-quality pre-school education, pupils will still be doing well at the age of 11 whether they have gone to a bad primary school or a good primary school. I hope that the Minister will take thorough note of that. I am sure he is aware of the importance of early intervention. There has been much progress with the early years workforce, although there is still a high turnover of staff and the work is still regarded as low-status and is poorly paid. Much more attention needs to be given to it.

The noble Lord referred to unruly children. I hope that soon he will consider meeting exemplary charities, such as The Place2Be, which provides much-needed mental health support to children in primary schools, to the parents of those children and to the teachers in those schools. It has a very good track record in this area and I hope that the Minister will decide to meet its staff soon to discuss their work. Volunteer Reading Help is a charity that provides support to more than 1,000 primary schools, helping children to read. Volunteers trained by the charity work, over a year, with children who are identified by their teachers as having a particular need for support. Over that period, the children benefit not only from improving their literacy but from developing a relationship with an adult. I have visited the organisation's training sessions and have noted that many of the volunteers are men, so boys who are experiencing life without a father have an opportunity to develop a relationship over the period of a year.

I declare my interests as vice-chair of the All-Party Parliamentary Group on Children and Young People in Care, and as a trustee of TACT, the largest voluntary adoption and fostering agency operating in England, Wales and Scotland. I am also a trustee of the Michael Sieff Foundation.

I see that I am running out of time, for which I apologise, but perhaps I may take this opportunity to thank Her Majesty's Opposition for their huge commitment over many years to young people in care. I recall the Quality Protects initiative, which ring-fenced funding for children in care. I also recall the legislation, including the Children (Leaving Care) Act, which introduced new duties on local authorities to support young people, sometimes up to the age of 25, providing them with a personal assistant. There was also the Children and Adoption Act, which introduced a right for children to have an advocate when making a complaint-something that was very much welcomed in the sector. In addition, there was the Children and Young Persons Act, which introduced a duty on local authorities to secure an appropriate range of placements for these children. I am very grateful to the noble Baroness, Lady Morgan, and her predecessors for the commitment that they showed in that role.

I ask the Minister how the Government will build on those achievements. I know that there has been some concern that, despite all the investment, the outcomes for these children have not improved as we would have wished. Professor Jackson was the academic who first alerted us to the way in which we had, over many years, failed these children in terms of their education. Two weeks ago, she told me that the admission rate to university for these young people has moved from 1 per cent to 9 per cent-an increase of 900 per cent. Although that is far below what we would want and what is acceptable, clearly progress has been made. Indeed, although these children's GCSE results are still not where they should be, they are at last beginning to follow the rate of improvement experienced among the general population. Therefore, the work invested in the past is beginning to pay off, but how will the Government build on that?

The previous Government introduced two pilots to enable young people to stay with their foster carers past the age of 18. Will the Minister consider how that might now be progressed and how such an arrangement might be made available to all young people in care? There is a shortage of 10,000 foster carers in England and Wales. Perhaps the Minister would care to write to me about how that will be addressed.

Many Peers among the Opposition have been strong champions of looked-after young people over the years. I shall briefly speak of the work of Timothy Loughton MP who, fortunately, has been shadow Minister for children and families for several years. He has built relationships with NGOs working in this area; he is well respected; he has visited Denmark and seen children's homes there and the excellent model of social pedagogy operated in that country; and he has several children's homes in his constituency of Brighton and Hove. It is reassuring that he now has an office within the children and families section of the Department for Education. We cannot expect too much given the budgetary constraints, but it is encouraging, especially as he chaired the committee on the excellent report on social work,No More Blame Game, to which my noble friend Lady Howarth of Breckland referred. I am encouraged that the Government are talking about freeing those at the front line to do their job. Of course, they need to be equipped to do that job. Through teachers, social workers, foster carers and early-years' workers, fairness, responsibility and freedom for our citizens will be delivered. I am grateful to the Government for taking these matters so seriously.

Photo of Lord Inglewood Lord Inglewood Conservative 5:51 pm, 3rd June 2010

My Lords, this time of the day is not the moment for long introductions. However, I endorse the remarks previously made about my noble friends on the Front Bench and I congratulate the coalition for having put them there.

This afternoon's debate could perhaps be politely described as a bag of liquorice allsorts. I intend to confine my remarks to the culture bit of the package. In so doing, I declare an interest as chairman of the Reviewing Committee on the Export of Works of Art, although I shall draw on some of my other interests which are declared in the register.

As your Lordships will know, this country is one of the world's cultural centres; and as such it is not only a great cultural bonus for all of us who live here, it is also an extraordinary generator of inward spending from abroad and a raiser of revenue for the Government. In that context it is interesting to note, as some noble Lords may know, that a number of the Gulf states are building up large museums and cultural centres in anticipation of the end of their oil riches, to encourage visitors in the future and to generate income.

In this Chamber, as everywhere in this country, there has over recent weeks and months been much debate about public expenditure. We sometimes seem to overlook the fact that, in certain circumstances, public expenditure is a kind of clearinghouse between those who enjoy something and those who actually produce it. Let me give an example. I live near the English Lake District, and I am both a hill farmer-among other things-and president of the Cumbria tourist board. Visitors come to the Lake District to look at the fells. If the fells were not grazed by sheep they would be covered in birch trees and the visitors would not come. If there is no money in farming, the land will not be farmed, and that in turn would destroy the tourist industry. Of course, in practice, it is impossible for those who come to visit the locality to pay the producers of the landscape they come to see directly. The paradox that emerges is that the by-product has become more valuable than the principal output of the underlying activity.

In many ways, the same can be said of museums. It goes without saying that we are living in economically difficult and hard times, and we have to recognise the problems that that poses. However, it is also important to recognise that our museums and-particularly, but not exclusively-our national collections in London are enormous generators of public revenue. How we as a society respond to the cuts and the way in which the Government impose them must recognise that.

Another paradox is that you cannot successfully set out to create a good attraction, in precisely the same way as you cannot set out to make yourself happy by deliberately trying to achieve it. That became apparent to me when I was doing some work for Carlisle cathedral. People do not go to Carlisle cathedral because it is an attraction; it is an attraction because it is Carlisle cathedral. The way to underpin that important economic part of our society is to ensure that it retains its level of excellence, to ensure that it remains the best.

Part of the way to achieve that is to ensure that acquisition budgets do not simply evaporate. There are two reasons for that. First, our national institution collections are permanently evolving. If items leave this country, the chances are that they will have gone for ever. If the money to prevent that is not to come directly from the public purse, we must find other ways of leveraging that money. That is why I and my committee very much welcome the emphasis on philanthropy in this area, which was first raised and debated more widely by the outgoing Government and has been emphasised by the new Secretary of State in the past few days. In parallel with that, there is the evolution of the Heritage Lottery Fund, which will have increased funding. In order to make philanthropy work in this country in the way that will be essential for our institutions in the years to come, it is important that the tax reliefs available for those who support those institutions are extended-particularly to capital gains tax and, I suggest, to income tax. The douceur to encourage people must be extended in the same way.

Secondly, the rules about reserved benefit need to be changed. If anyone else was to, say, build a new wing to the Tate Gallery at a cost of several million pounds, it would be galling to find that if you wanted to hold a party there once it had been completed, you would have to pay tax on any value which happened to have been conferred on you over the sum of £500. That is not the way to achieve philanthropic giving. We must ignore the sirens who say that this is all some kind of "toys for toffs". In society, you have to decide what you want. There are and will continue to be rich people in this country. If you think about it carefully, the point about being rich is that you have more money than other people. If you have more money than other people, you can spend it the way you want. We should aim to achieve a system which encourages rich people to spend money on things which are in the public interest, rather than to be merely self-indulgent. In that way, we can have our cake and eat it.

I am fully aware that to an economist, some of my remarks may sound rather flaky and woolly, although I rather doubt whether JM Keynes would have shared that view. That does not alter the fact that if you look at national institutions and museums from a bean-counting perspective, I dare say that the monetary investment in our national collections is one of the best investments that the country has ever made. "Ah!", you may say, "but of course they will never be sold". That is probably true, but equally an awful lot of money is spent by the public sector on things that no one else would ever buy-such as the IT system in the Rural Payment Agency.

In the economic predicament that we now face, difficult choices have to be made, but I believe that on our national collections, we must take the long view and concentrate on ensuring that when again we reach the sunny uplands of economic prosperity we do not find that we have debased our inheritance and relegated ourselves to the second division. Acquisition and maintenance are the two long keys to sustainable excellence. It is important that they are not subsumed to shorter-term, more populist claims sung to more populist tunes. As I say to my children, the easy solution is almost invariably the wrong one.

In conclusion, to go back to Keynes, who, you will remember, said that in the long term, we shall all be dead, I add my rider that the collections will still be alive for future generations.

Photo of Lord Macdonald of Tradeston Lord Macdonald of Tradeston Labour 5:59 pm, 3rd June 2010

My Lords, as the financial crisis grinds on, noble Lords on all sides of the House now accept that public spending must be reduced, but today many of us plead for our favoured causes. Following on from the noble Lord, Lord Inglewood, I will also argue that public spending in support of Britain's cultural sector is a sound economic investment.

Over the past two decades, the rapid growth of our creative industries has been one of the UK's proudest achievements. The creative sector is driven by imagination and flair-from architecture to advertising, across the media, from fashion to computer games-and Britain has undoubtedly got talent. Most of that talent works through small companies, and their artistry is often combined with an unabashed entrepreneurial zeal. An outstanding example of this is in television where government policy in the 1980s helped to create hundreds of independent production companies. I trust that the Minister can assure us that the public service output of our television channels, which is so widely admired abroad and enjoyed at home, will be protected by the coalition Government, particularly in areas such as regional news and current affairs in England and, most crucially, in the devolved nations of the United Kingdom.

Over the past decade, our creative industries have grown almost twice as fast as the rest of the UK economy. The sector employs about 2 million people, and the UK's creative exports total £16 billion a year. The contribution made by our creative industries to the UK national economy is now greater by proportion than that in any other country. We are world leaders when it comes to creativity. London, in particular, benefits from being an entertaining, edgy cultural capital. Its creative industries employ about 800,000 Londoners, and Mayor Johnson asserts, with regard to tourism and job creation more broadly, that:

"London's cultural environment has become a significant factor in its competitive advantage".

Cities outside London have also flourished in our cultural renaissance. In Brighton, where I now live, May is a month-long festival and music, theatre, arts and media, along with a lively club scene, attract the tourists and keep Brighton buzzing throughout the year. Since the incomparable Edinburgh Festival was founded some 60 years ago, the growth of festivals in small towns and every large city has been quite remarkable. Today, the largest creative cluster outside London is in Manchester. Back in the 1980s, Granada Television set about transforming the derelict warehouses around its television station by the River Irwell. The wonderfully anarchic Madchester phenomenon transformed the local music scene. The Commonwealth Games regenerated another run-down area and left Manchester City a world-class stadium in which to compete with Manchester United. In addition, we now have an excellent Manchester International Festival, as the noble Lord, Lord Hall, highlighted in his splendid maiden speech. There is also the Lowry arts centre. Mostly importantly, MediaCityUK in Salford is now nearing completion. It will become the BBC's new production centre in the north, with 2,500 staff jobs being transferred from London.

As the metrocentric BBC strives to make itself more British, Glasgow too is benefiting from the transfer of BBC production to Scotland. Scotland at last gets a fairer share of UK programme-making to match its licence fee contributions. I hope that the Minister will confirm the Government's support for the BBC's policy of creative devolution. Noble Lords may recall that in 1990 Glasgow was the least likely candidate for the role of European city of culture. Like most Glaswegians, I was pretty sceptical. However, in the 20 years since, cultural activity has been a key element in a remarkable regeneration. Glasgow still has its legacy of industrial and social problems, but they are eased by its 3 million tourists spending £700 million a year. That success was repeated in Liverpool in 2008 when, as European capital of culture, it attracted 10 million visitors and had a reported income of £750 million, which was a very welcome boost in these hard times.

Three years into the current financial crisis, cultural budgets are obviously under increasing pressure. Private sponsorship has held up better than expected, but it fell about 5 per cent in 2008 and is likely to have dropped again last year. The budget of the Department for Culture, Media and Sport is now also under pressure. When the Chancellor announced his £6 billion of public spending cuts, £88 million was lopped off the DCMS budget. It was just 4 per cent, but it might be only the start. The Arts Council of England's budget is a central concern for that most important funding engine, encouraging creativity up and down the country. It is a respected and well-run organisation that has sensibly trimmed its own administration costs in recent times. The Arts Council, like other bodies, suffered when the income from the National Lottery was diverted to fund the Olympic Games, and I would welcome the Minister's confirmation that the lost shares of lottery funding will be restored to the arts, to heritage and to sports sectors post-2012.

Many in the creative industries were encouraged by the enthusiasm for the arts which Jeremy Hunt, the new Secretary of State at the DCMS, and his junior Minister Ed Vaizey expressed in opposition. Will the Minister therefore assure us that the new team at the DCMS will do its utmost to protect our highly successful but inherently fragile creative industries from further damaging cuts in public support?

Photo of Baroness O'Neill of Bengarve Baroness O'Neill of Bengarve Crossbench 6:05 pm, 3rd June 2010

My Lords, your Lordships' House is extremely fortunate in the two Ministers who have arrived on the government Front Bench. We all know that the noble Earl, Lord Howe, has for many years followed health matters with scrupulous and impressive attention to detail. No one could be better qualified, and it is marvellous to have him in his post. It was also a great pleasure to hear the maiden speech by the noble Lord, Lord Hill, from the Front Bench this morning. I think that we can look forward to serious engagement on a wide range of extremely difficult topics.

I will make one undertaking at the beginning of this speech; I will not plead for the protection of a particular area of expenditure. I have my favourites and my interests, and I have a long university career behind me, but I am not going to plead for those. I looked at what would be at the head of the queue, and it is of course the Academies Bill, so I decided that I would focus on the issues that legislation in that area will raise. We expect to hear, and a first reading of the Bill suggests that we will hear, quite a lot about governance. I strongly support better governance and more independence for schools, with the caveat that we must all realise that more independence means that some will do a less than ideal job. We cannot expect greater independence to have uniformly good effects, but it will have better effects, and that is its justification.

The topic on which I want to say something today is not directly about governance but about the concepts of accountability and assessment that are ancillary to governance. Rather too often, systems of accountability undermine the independence that governance supposedly secures for institutions, and systems of assessment can undermine our educational aims for pupils. Of course accountability and assessment are both needed, but we need intelligent accountability and intelligent assessment, and in these matters more is not always better. That is why I have a suggestion for noble Lords on the Front Bench as to where savings might be made.

I will give two examples of defective accountability. When at breakfast I mentioned the theme on which I would speak today, my son, who is a governor of a very poorly performing primary school in Tower Hamlets, remarked that the governors of that school are accountable for 98 school policies that run to 100 or so pages of A4. He commented that if they did nothing but review those 98 policies every two years, as they were required to do, they would do absolutely nothing else. That is a reasonable example of a defective form of accountability. Requirements of this sort seemingly delegate but actually confer a quite illusory independence that obstructs other activities. The test in taking forward academies is that we do not undermine their independence and the education that they might offer by imposing forms of accountability that obstruct them.

My second, and unfortunately far from local, example is the system of assessment by which pupils, teachers and schools now find themselves held to account. Pupils and schools are judged on the scores achieved in SATs, at GCSE, at AS and at A-level. These are used not solely for educational purposes, which might be their proper use, but to construct league tables with very heavy implications for the futures both of pupils and of schools. This form of assessment becomes a rigid and educationally distorting form of accountability.

We hear that academy status is to be available to the best schools. Behind that phrase "the best schools" lurks of course a system of accountability and in this case perhaps a system of accountability that is in part based on pupil performance and league tables. But if merit is to be judged by pupil attainment, schools will continue to be hyper-incentivised to push limited forms of educational attainment. Gaining academy status will not lead to real independence for schools.

I remember talking to the head of an independent school which was very close to the top of the league tables when AS-levels had been introduced a few years before. I asked her whether it had had benefits for pupils. In her judgment, it had not. It had reduced the educational attainment possible in the lower sixth by cutting into teaching time and requiring a relentless focus on less demanding-indeed, quite often terminally boring-examined content. More generally, the system incentivises schools to push those subjects where A grades are more easily obtained.

I rather naively commented that, given the position of her school, she could refrain from entering pupils for AS-level. Her reply has stayed with me. She said, "With parents like mine, I can't. They want every point that is available". Systems of assessment can undermine the independence even of independent schools. If they are used for ranking schools in the future, the independence which the coalition Government seek will be undermined because all schools will be driving their pupils across the same hurdles. Even if those hurdles are not very high, there are a lot of them. More passes is always regarded as better. Another generation will be subjected to Stakhanovite quantities of exams, rather than being given plenty of teaching and an interesting and thoughtful education in which skills are assessed by exams and by examiners who are permitted to use their judgment and are trusted.

For too long the assessment tail has been wagging the education dog. I hope that the Government can be bold enough to see that serious judgments of quality cannot be based on test scores. If schools are to have greater independence, they must be free to teach more and to examine less, to emphasise skills, including skills in academic subjects, more. I greatly welcome the comments of the noble Lord, Lord Baker, who is not in his place, about technology colleges for 14 to 19 year-olds, but we need to free schools to concentrate on skills in academic subjects, not merely on the imparting, memorising and regurgitation of information-you may say factoids. We need better skills in languages, maths, science and writing. At A-level, pupils deserve to be offered an exam system in which reading beyond the syllabus is valued and celebrated, and not penalised as it has been by the examination system. There is a long way to go and I wish the Government well.

Photo of Lord Rea Lord Rea Labour 6:14 pm, 3rd June 2010

My Lords, like all other noble Lords I welcome the appointment of the noble Earl, Lord Howe, as Health Minister. I am only sorry that he did not get the top job. He certainly deserves it and he would have done it very well. I also welcome the noble Lord, Lord Hill. I am gratified to hear his support for professional independence.

The main problem facing the National Health Service is how to keep frontline services up and running, and improving, as the coalition has pledged, at a time of great financial stringency. This means that the health service needs to be scrutinised and monitored even more carefully to identify inefficient or wasteful methods of working. It is important that if any quangos or other health-related organisations are to be abolished, as has been mooted, public health, or the effective functioning of the National Health Service as a whole, is not impaired. For instance, were NICE to be wound up, a valuable evidence-based resource would be lost. Can the noble Earl give the House any information on the Government's thinking here? There are those in the pharmaceutical and food industries who would like to see the end not only of NICE but also of the Food Standards Agency, which provides vital science-based public health guidance. I am sure that the noble Earl recognises the unique value of these two agencies, but can he reassure us that the Government will reject any pressure to close them or restrict their activities?

A good start in looking at where efficiency might be improved can be made by reading the final report of the House of Commons Health Select Committee of the previous Parliament entitled Commissioning. It will be the present Government's duty to respond to it, which I guess will happen in a month or two, but I would be interested in any preliminary thoughts the noble Earl might have about this hard-hitting but constructive report. Some members of that Select Committee were, like Members on these Benches, the Liberal Democrats, all the health professions and the universities, strongly opposed to the creation in 1990 of the internal market, particularly without a pilot study. However, it is now here and has become even more entrenched under the last Government, which carried on much as Kenneth Clarke might have wished. This is without any objective evidence that the internal market is beneficial except in the creation of bureaucracy and opening the door to the private sector. According to the Centre for Health Economics at York University, the percentage of NHS expenditure on administration has risen from less than 5 per cent in 1990 to 13.5 per cent. The Department of Health is rather shy about revealing this figure, although I gather that it commissioned the research. That percentage rise means that at today's costs we are spending £8.5 billion more than we would have had the administrative costs remained constant at 5 per cent.

The great majority of NHS expenditure is now channelled through primary care trusts. Acute hospital trusts receive the bulk of the funds disbursed, around 70 per cent or more. I would be grateful if the noble Earl could give me the latest data on the proportion. PCTs have little control over these powerful organisations which tend to lean on them to give them what they ask for. But of course they provide critical care for life-threatening conditions and are target-driven to reduce waiting lists. I do not say that in any derogatory way; it is a fact and it is necessary. It is therefore difficult for PCTs to decrease or stop funding hospital services, some of which may in fact have become redundant.

Paragraph 95 of the report it states that,

"there is a seeming perennial imbalance of power between providers and commissioners".

One solution to this would be for acute hospital trusts to have an entirely separate funding stream, as suggested in Volume II at Ev 135 of Commissioning by Professor Andrew Street, also of the York University health policy team. This would allow PCTs to concentrate on what is really their role, providing good quality community-based care.

"World Class Commissioning" is a rather grand title. But consider the finding of the Select Committee at paragraph 108 of its report:

"Weaknesses, due in large part to PCTs' lack of skills, notably poor analysis of data, lack of clinical knowledge and the poor quality of much PCT management".

There are other highly critical paragraphs. It is worrying that the great increase in administrative costs since the introduction of the purchaser/provider split 20 years ago is largely spent on funding a system which has such major deficiencies.

Two findings in the report which seem crucial concern the lack of clinical knowledge by administrators and the involvement of clinicians in the commissioning process, and the lack of skill in gathering or analysing complex data to guide rational decision-making. If the current system of PCT commissioning is to be retained, more medical and nursing input is needed, as my noble friend Lord Darzi said on many occasions, and as have the royal medical colleges and several noble Lords who have taken part in the debate today. A more meaningful use of practice-based commissioning, which so far has achieved very little, would see GPs, as well as consultants, in an advisory role at the highest level-and therefore with clout-as part of PCT commissioning teams.

Information on population needs and hospital activity should be made more meaningful and be processed more expertly. The outcomes of referrals and procedures need to be measured and assessed, again as my noble friend Lord Darzi said repeatedly, and not merely counted as episodes of activities-referrals, discharges and so on. Payment by results, apart from creating difficulties in predicting the costs of care, is a misnomer; it does not relate to the quality of care received but only to easily counted processes.

To cut swathes of administrative staff-30 per cent has been suggested-without first ensuring that the quality of the commissioning process is improved will lead to less effective care and might well increase rather than decrease costs. Constantly to bring in consultants to do the job is expensive and weakens the National Health Service, which should instead build up its own expertise.

Apart from the major burden of carrying the costs of acute or foundation hospital trusts and community health service care, PCTs have to fund a number of uneconomic, and sometimes redundant, independent sector treatment centres which they were obliged to engage, as well as meeting the heavy recurrent costs of paying for PFI or LIFT projects, which were brought in as part of the prevailing gung-ho culture of "buy now, pay later, even if it costs more" that underlies our parlous economic situation.

Finally, I would like the noble Earl to explain how the stated coalition policy of allowing access to any chosen GP regardless of place of residence is going to work. This could result in a two-tier service with local residents not being able to get an appointment to see a popular GP with whom they might be registered. This would undermine the basis of good primary care in which a practice looks after a defined population.

Photo of Lord Williamson of Horton Lord Williamson of Horton Crossbench 6:23 pm, 3rd June 2010

My Lords, I am still here and I intend to speak today on health and, in particular, on mental health. I welcome the noble Earl, Lord Howe, to the Government and recall that we had amiable and effective co-operation on mental health issues during the previous Parliament-we often agreed-so I am hopeful today.

Although there were no specific legislative proposals on mental health in the gracious Speech, the Government have indicated some forthcoming changes in the health field which may have repercussions for mental health. It is also evident that because the amount of financial resources for health expenditure is limited and is going to be under serious pressure, mental health is certainly not exempted from the pressures in the period ahead. Indeed, it may be under greater pressure than provision for physical health.

We do not have to legislate and re-legislate time and again to achieve the best results, but it is important that the Government should have a clear idea of their priorities, even if the implementation rests, as it does in many health areas, with the health authorities at local level. I am glad to see specific priority given in the coalition programme to research on dementia, and to see reference in paragraph 25 to "talking" therapies, both of which are important matters.

What, then, are the priorities for action on mental health in this period of strong pressure on the public finances? First, health authorities should try as far as possible to carry through the implementation of improvements to care decided on in the Mental Health Act in the previous Parliament. These include better provision of advocacy for those people, particularly young people, who are caught up in mental health problems which they do not always understand, and the provision of age-appropriate accommodation in mental health units for young persons and children. These changes resulted from amendments to the draft Bill in this House which I believe the noble Earl, Lord Howe, supported. I congratulate Lancashire Care on opening in April new facilities to provide age-appropriate accommodation for the young exactly as Parliament wished. I acknowledge at this point the efforts of the previous Labour Government, particularly the Ministers in this House, in carrying through the Mental Health Act. They perhaps needed a little prodding, but they did a good job none the less. Secondly, I share the view of Rethink, the largest voluntary provider of mental health services in the United Kingdom, which supports more than 48,000 people every year through its services and support groups. The areas which it considers crucial are: access and investment; criminal justice; and stigma and discrimination.

On access and investment, NICE produced as recently as 2009 updated guidelines on how schizophrenia should be treated, which individual NHS organisations should try to follow through. Currently, some of them are struggling, and it is clear from the very recent report of the All-Party Parliamentary Group that this continues. Contrary to some misunderstandings, a first onset of schizophrenia in many cases never recurs. In other cases, its impact can be much reduced by various treatments and rehabilitation achieved. We know that cognitive behavioural therapy-CBT is a rather easier way of describing it-has a significant effect on treating schizophrenia. This issue now arises because of the extremely long waiting times for access to this treatment. The average in the whole kingdom is between five and seven months-in some cases, of course, it is much longer because that is the average figure. Waiting times are a significant factor affecting engagement with therapy. They affect the effectiveness and the uptake even when therapy is later received. Despite the economic climate, an improvement in waiting times should be the objective.

I make my plea for mental health services because we know that the pressure on them is likely to be disproportionately strong. In his letter of 1 April to foundation trusts, Stephen Hay of Monitor, the independent regulator, pointed out that mental health providers face a different set of risks from those in the acute sector. Historically, during periods of financial pressure in the healthcare system, expenditure on mental health activity has fallen more rapidly than expenditure in other areas. Mr Hay was quite right to draw attention to revised, downward financial assumptions, but we in Parliament can rightly stress the importance of some elements of mental health treatment, as do I.

I wish to say a word about the large number of people with severe mental illness caught up in the criminal justice system without much needed treatment. In a powerful speech in the debate on the Address last week, the noble and learned Lord, Lord Woolf, pointed out the mess that we are in as a result of the overload on our prisons and the very high cost to the taxpayer. One of the most evident features of the problem is the very large number of prisoners who have some form of mental problem at any one time. At any one time, about 10 per cent of the prison population have serious mental problems and 30 per cent of female prisoners have had a psychiatric acute admission to hospital before they enter prison. I urge the Government to act on the recommendations in the excellent Bradley report, and make it a priority to reduce the large number of persons with mental illness in the prison system and divert more of them into healthcare.

Finally, we must keep up the effort to remove stigma and discrimination against those with mental illness. The Time to Change campaign, led by Mind, Rethink and Mental Health Media, is good, but mental health service users consistently identify stigma as an impediment to their overall health and well-being and access to other health services. I have spoken today to press on the Government why we must have priorities for improvements in mental health provision, and I look forward to a favourable reply.

Photo of Viscount Bridgeman Viscount Bridgeman Conservative 6:30 pm, 3rd June 2010

My Lords, I join every speaker in this debate in congratulating my noble friend Lord Howe on his appointment. It will be a great reassurance to this House to have the benefit of his experience, which he has built up with such distinction over the past 12 years when we sat on the opposite Bench. The noble Baroness, Lady Murphy, has referred to him seeing off successive Ministers of Health. I suggest that his approach has always been one of constructive engagement.

I shall speak briefly about the hospice movement, in which the United Kingdom has led the world and in which we can take great pride. I particularly honour the memory of Dame Cicely Saunders, the founder of the movement. I declare an interest as chairman until two years ago of the Hospital of St John and St Elizabeth in St John's Wood, London. Unusually, within it is St John's Hospice, which is part of the same charity on the same site. With those two institutions I maintain close links.

Hospices have suffered under successive Governments from what I might call an "it will be okay on the night" approach. In the case of hospices, that means that any shortfall in funding by government will be made good by the public conscience through charitable giving. Successive Governments have not been slow to realise that this virtually always works. Having said that, it would be churlish not to mention the contribution of the last Government in making available a substantial additional sum for hospices, of which St John's share was £600,000, applied towards the refurbishment of its in-patient unit. But the reality is that the maximum normal contribution by central government to running costs is 50 per cent of the total, so in every case the shortfall of a minimum of 50 per cent of total running costs has to be made good by fundraising, which is a drain on hospices' time with limited staffing resources, which could more productively be put to other uses. In the case of hospices, there is no national tariff and some hospices receive significantly less than 50 per cent. St John's is fortunate in receiving government funding at the upper end, and its case is not untypical, in that it must have separate negotiations with each of seven primary care trusts to which it has contracted. This, too, is a considerable drain on limited personnel resources. The remarks of the noble Lord, Lord Patel, who is not in his place, on the contraction of primary care trusts, will read very well with many hospices.

All this is in marked contrast to those hospitals that are acute care providers where there are national tariffs for a variety of procedures. St John's is leading the way in London on a north-central network comprising hospices and PCTs whose aim is to agree a local tariff. I hope that that will encourage the Government to roll this out on a national basis. A further encouragement to the Department of Health will, I hope, be the example of Wales, where a funding formula has been agreed across the Principality. I make a further plea to the Government to introduce rolling three-year contracts, which will enable hospices to plan strategically and deliver sustainable high-quality end-of-life care for all.

I turn to the last Government's plans, which I welcomed, for a national end-of-life strategy that lays much emphasis on the need for patients to identify with their doctor or nurse the preferred place where they want to die. That depends on adequate resources being available. St John's is fortunate in that three out of the seven PCTs to which it is contracted-namely, Westminster, Kensington and Chelsea, and Brent-make available such resources. Unfortunately, patients in many other PCTs do not have the same opportunities for excellence in care, and for some of those people the stark and only choice is between a nursing home and dying on a general nursing ward.

The importance of being given the choice to die at home, with friends and family around, cannot be overstated and the difference between those PCTs that are able to support home carers and those who are not is, indeed, marked. Patients need real choices in care, in their place of care and in the way that they receive care. The vast majority of patients wish to live independently until they die, and this can be achieved by good, patient-sensitive, hospice-at-home services, supported in many instances by excellent organisations such as, dare I say it, St John's and the Marie Curie nursing service. I emphasise the need for a level playing field and ask the Minister to eliminate what is, effectively, a postcode lottery as it applies to hospice at home.

I have received much help and advice from the noble Baroness, Lady Finlay of Llandaff, who cannot be here today as she has a medical engagement. She has asked me to raise with the Minister the matter of education in palliative care. Her concern, which I fully share, is that palliative care should be taught in all nursing schools at undergraduate level, as it now is in all medical schools in the United Kingdom. There are increasing pressures on the curricula in both medical and nursing schools, but if we do not teach the next generation how to care for those who are ill and nearing death, the standard of care will slip back as new graduates flounder. They risk picking up bad practice from those older practitioners who have never been taught proper pain control and other fundamentals of care. Do the Government plan to ensure that a comprehensive palliative care module should become a statutory part of all the proposed new nursing degree courses, since such education is the foundation of good care for patients?

I take this opportunity to welcome my noble friend Lord Hill, not only to his appointment to the Department for Education but for his masterly and, if I may say so, superbly delivered speech. May I also take this early opportunity to bend his ear? Hospices get no help from the universities for the considerable expense which they incur in training young doctors, in marked contrast to the general practitioners who get paid for having them. Therefore, this is indeed addressed to both my noble friends on the Front Bench: may this anomaly not continue to fall between two departmental stools?

Photo of Baroness Hollis of Heigham Baroness Hollis of Heigham Labour 6:38 pm, 3rd June 2010

My Lords, I, too, join in warmly welcoming the noble Earl, Lord Howe, and the noble Lord, Lord Hill, to their new posts. I remember the noble Earl when he was a Minister the first time around. People have mentioned that he has seen off a number of Ministers while he was in opposition; I firmly recall the battles that he had with the noble Countess, Lady Mar, and will merely mention sheep-dip to him. Such issues will no doubt reoccur.

I shall talk about pensions. Post-Turner and amid both the financial and longevity crises, as the number of pensioners will have doubled by 2050, we need a new, all-party pensions settlement-led, I hope, by the much respected Steve Webb. My assumptions, which I hope the House will share, are that we wish to continue reducing pensioner poverty, that we wish to reduce means-testing and to encourage people to save for their retirement, and that we can put together a settlement which is relatively simple, fair, easy to understand, affordable and-because it is based on consensus-has staying power. Yes, I believe it is possible. If your Lordships will allow me, I shall sketch the outlines of such a settlement.

The first essential is a new state pension similar to the NAPS foundation pension. I very much welcome the new Government's commitment to the earnings link of the basic state pension next year. That is much to be welcomed-well done. However, almost 50 per cent of pensioners may face means-testing to close the gap between that state pension of £97 a week and the pension credit figure of £132 a week. That means that any modest savings cost you 40p in the pound in lost pension credit, so unless you have a pot of some £50,000 floating you off pension credit altogether-the average pot is half that, at £26,000-it is simply not worth saving, so people do not. Sixty per cent of all pensioners have savings of less than £10,000.

What to do? People on low incomes or on credits simply cannot save their way off future means-testing. Pension credit has rescued hundreds of thousands of pensioners from retirement poverty, which is wonderful, but at the price of too high a hurdle for working people to save. But there is an alternative, and I hope your Lordships will forgive me if I urge a proposal outlined in my recent pamphlet, A New State Pension, to which the Minister, Steve Webb, was a contributor in his previous incarnation.

Put into one pot the state pension, the state second pension capped at 2020-this is key-and the £8 billion or so that we are now going to be spending on pension credit. Then, within the same broad cost envelope, you can pay all pensioners with a 30-year record of national insurance-some 90 per cent of them, in due course-a new state pension of £132 a week, at or fractionally above the means-tested pension credit level. That would mean a state pension that, as of right through the NI system, would lift most pensioners out of poverty and out of means-testing.

Few would need pension credit unless they had special needs. NEST, the new auto-enrolment scheme, would be safe from mis-selling because, unless you were on housing benefit, you would get every penny of value from it. Removing annuitisation at 75, which I greatly welcome, would also be safe because even if a few individuals did blow their pots on cruises or whatever, the new state pension would still lift them clear of means-tested benefits, so it would be up to them and not us. Incidentally, I would be happy to see their children inherit any residual pot, provided, of course, that it was ring-fenced for their own pension solely and was subject to IHT so it did not become a tax loophole. Above all, with a new state pension at or above pension credit level, we would make it pay to save. As they stand, private pensions are high-risk for small savers because of the benefits trap. A new state pension would remove that risk at a stroke.

The first step, therefore, is a new state pension, a foundation underpinning all else that we need to do. The second step is to make pension saving attractive. Over half the workforce are not contributing to any pension scheme. One way would be to ensure early access to at least the pension tax-free lump sum. At a stroke, that would turn the pension into a lifetime savings account, proposals long and rightly espoused by the government party. Why is it OK to use the lump sum at 55 to build a conservatory, but not at 45 to save your home from repossession? If modest savers knew that 75 per cent of their savings was ring-fenced for retirement but the other 25 per cent was available as an accessible savings slice, then women, the low-paid, young people and the self-employed might save for the first time.

Over and beyond a new state pension and early access to a pension slice, we also need to connect ISAs and pensions more intelligently, as a forthcoming pamphlet from Michael Johnson of the Centre for Policy Studies, familiar to Members opposite, argues most effectively; it will be called Simplification is the Key. Pensions, as your Lordships are well aware, attract tax relief on the way in, while ISAs attract it on the way out. However, five out of six higher-rate taxpayers become standard-rate taxpayers in retirement. You could reduce tax relief on pensions to the standard rate and save, even after the 2009 and 2010 Budget changes, some £3.5 billion. However, if pensions, like ISAs, were tax-exempt only on the way out-that is, on payment-you could probably save closer to £8.5 billion a year and build a simplified, attractive retirement package.

Please do not say that this would destroy pension savings. ISAs, which are tax-exempt only on the way out, already attract more money than pensions every year, even though there is no employer's contribution to them and, therefore, they represent less obvious value. Such integration would work. There would be a new state pension, early access to pension savings, greater integration of ISAs and pensions, and no compulsory annuitisation at 75. What is there not to like? It is fair, flexible, simple, supportive of women and the low-paid, and it could even save rather a lot of money.

Photo of Lord Alderdice Lord Alderdice Liberal Democrat 6:46 pm, 3rd June 2010

My Lords, several noble Lords have observed how the eloquence, elegance of presentation, experience and commitment of the noble Lords on the Front Bench add greatly to the positive prospects for governance in this new Parliament. The maiden speeches of the noble Lords and the right reverend Prelate also bode well for this as a thoughtful, engaged and reflective new Parliament.

It is a new Parliament and a new Government, but also a new type of Government and Parliament. It was interesting to listen to the noble Lord, Lord Elis-Thomas, and my noble friend Lord Kirkwood of Kirkhope speaking about those of us from the Celtic fringe, who have some experience of these questions. This is one of the marvellous things about our great United Kingdom: it is not all one country with one set of experiences. There are some of us who have experience of fairer forms of voting, which bring different ways of forming Governments. It is interesting now that many of those who said, "We can't have proportional representation because it will bring coalition government", now discover that first past the post may also-not only on this occasion, but perhaps in the future-bring coalition government.

One of the things that has interested me and several colleagues from Wales and Scotland is that it is clear that the institutions here at Westminster and in Whitehall, and many of those who are involved in them, have not yet quite understood what coalition government is. It is not merger government. It is not even a political marriage. It is coalition government in which parties bring their own sets of principles and ideas and decide that they will contract to work together for the better of the country. They do not, on that basis, give up either their principles or their policies. Anyone in this Parliament who thinks, for example, that Mr Martin McGuinness and Mr Peter Robinson no longer want to see, on the one hand, a united Ireland, or, on the other, a more united United Kingdom, clearly does not understand much about either the peace process or the politics of my part of the world. If they are sent to the Northern Ireland Office, they will find it a rather rude awakening.

Those of us on the Liberal Democrat Benches have Liberal Democrat principles and policies. We believe that-together, on this occasion, with our Conservative colleagues-we can see those brought into operation. It was gratifying to listen to noble Lords on the other side of the Chamber making clear that they had observed that this Government indeed have a different set of policies than would have been the case had they been wholly a Conservative Government or wholly a Liberal Democrat Government. That is all to the good. It is all part of the new approach to politics that we are seeing develop over time. We saw it in the approach of the previous Labour Government to a number of matters, and we see it going further.

Having heard my noble friends, Lady Walmsley, Lady Sharp, Lord Addington and Lord Kirkwood speak about education, children, sport and welfare, I want to concentrate on health, as it is very close to my heart and experience. I have just retired after working for 30 years in the health service, particularly in mental health. My wife is a pathologist; my brother is a dermatologist; my sister-in-law is a paediatrician; my brother-in-law is a general practitioner; and my sister and her husband are scientific officers in a medical laboratory, so I have some insight into the way the health service works.

The previous Government were undoubtedly committed to achieving fairness in healthcare. They put substantial amounts of money into organising and reorganising healthcare to try to get a good outcome. However, I am afraid that there was a modest outcome and the morale of professionals working in the health service was remarkably low. I give an example. John Reid moved from the Northern Ireland Office-he moved through different ministries-and spent some time in healthcare. He had a notion, which he shared with the previous Conservative Administration, that half the consultants were out on the golf course most of the time. Therefore, he required all consultants to produce a diary showing what they did every half hour for a month, so that he and his colleagues could then clamp down on these lazy fellows and girls who obviously were not paying attention to what they were doing. The result was that consultants began to discover that they were doing far more work than they were contracted to do. They decided that if the Government were going to treat them with suspicion and say, "We will pay you only for this and this", they would drive a hard contract and reduce their commitment to working only the hours for which they were contracted. The result was a health service contract for consultants that cost the Government more and reduced output, and doctors, who were paid more, having lower morale. It was not that the Government were not committed to fairness-they were-it was a matter of how people were handled and a belief about the way that things work.

Mr Cameron and Mr Clegg have said that this Government will operate on the basis of freedom, fairness and responsibility. Nobody is going to stand up in your Lordships' House and say, "I am against fairness". We are here because we genuinely want to see a fairer country. However, fairness does not come from the top down through imposition; it comes through freeing and inspiring people. Of course, there is a need for an element of regulation. The noble Earl, Lord Howe, knows very well that I have been working on regulation in psychotherapy for some time. I am sure that he is awaiting the letter that he will get from me in the next week or two which asks if we can have a chat about how regulation in the psychological therapies should move forward. I am not against regulation at all. However, it has to be done in such a way that people feel that they are valued and are not being pushed away from their professional commitments. That is why one of the things that appeals to me about the approach that the coalition Government are taking is that they are saying, "We are not only going to try to work together in this way but we are going to try to give responsibility back to professionals".

One of the disastrous things that occurred in healthcare happened as a result of it becoming a question of managerial approach and a business ethos. Businesses never produced healthcare in the first instance; it came out of voluntarism, faith communities and professionalism. When you turn it into a business, you eat away at some of the key commitments that people have to this work. They do not do it for the money, but they are not going to do it if they are not paid. They want to make a commitment to people and to feel that it is valued, and they want to feel that those with whom and for whom they work are part of the world which they inhabit.

One way that the Government can get rid of a lot of the funding that is not going to front-line services is by reducing the degree of managerial input and returning a lot more decision-making to clinicians of all kinds-not just doctors-and to patients. We can start this new Parliament not by giving over many of the achievements of the previous Government but by building on the possibility that we can have real change for the better in our politics and in all the areas of work that we have been speaking about today, not least in healthcare.

Photo of Baroness Thornton Baroness Thornton Labour 6:55 pm, 3rd June 2010

My Lords, I apologise to the House and to the noble Lord, Lord Hill, for listening to his maiden speech from below the Bar. I begin by offering my congratulations to the new Government and Ministers. Like my noble friend, I wish that the noble Earl, Lord Howe, had got the top job in his department. I congratulate the noble Lord, Lord Hill, welcome him to his place on the Government Front Bench and congratulate him on his outstanding maiden speech. I also extend my congratulations to the noble Baroness, Lady Northover, who is now health whip-a job that I filled happily for a year or so.

It is a rum old world: many noble Lords from both parties opposite, and on this side, will share that sentiment. I was thinking about the rumness of it all and wondering how the conversations are progressing between the Minister and his new whip with regard to tobacco regulations. About a year ago, the noble Baroness and I made common cause against the noble Earl: so we shall see where that ends up.

We have had an excellent and wide ranging debate, with four maiden speeches of great quality. In all cases, I am happy to agree with noble Lords that we can look forward to all the maidens' future contributions of distinction to the work of this House. The noble Lord, Lord Hall of Birkenhead, is a long-standing friend whose speech made me think what a great champion he will be in discussions about the arts and heritage in this place. The right reverend Prelate the Bishop of Guildford, in his evocative descriptions of his diocese, made me realise that we need to organise a charabanc trip there. The presentation of the noble Lord, Lord Kakkar, showed that he will add greatly to the medical expertise of this House. I am also very pleased to learn that the noble Lord will join the Lord Speaker's outreach programme, of which I can modestly claim to be a veteran. It is an invigorating and humbling experience on every occasion when I go to speak to children and young people in their schools. I wish the noble Lord well and hope that he will enjoy it as much as I do.

My noble friend Lady Morgan spoke to the parts of the gracious Speech that addressed education and welfare. She was amply supplemented in her remarks by our noble friend Lord McKenzie of Luton. It remains for me to say only that I agree with every word that both of them said. I commend the contributions both of my noble friend Lady Hollis, who has given the noble Lord a brilliant pension scheme-we look forward to his comments on that-and of the noble Lord, Lord Kirkwood, who I sense will make a career of keeping his Government on their toes in these matters. It remains for me only to add a word of advice to the noble Lord, Lord Hill. The Government insist that they are about fairness, about closing the gap in achievement and about raising standards. All that they have to do to achieve this is to listen to the wise words of my noble friend Lady Morris of Yardley. Instead of relegating failing schools that need extra help and resources to the bottom of the list for attention and help, they should put them first, before outstanding schools that are doing well under present circumstances.

I turn to culture, media and sports. The gracious Address was largely silent about this important area of national activity, except for the commitment to high-speed broadband internet connections. That subject was well addressed by the noble Lord, Lord Elis-Thomas. My noble friend Lady Andrews added her voice to the championship in this House of heritage, tourism and the arts. The noble Lords, Lord Hall and Lord Macdonald, illustrated well the national benefits of the media, arts and heritage in creating wealth and jobs and in enriching the quality of life for millions of people. The arts and heritage play an important part in our economy, accounting for 10 per cent of our national economic activity. My right honourable friend Ben Bradshaw and his team-Margaret Hodge, Gerry Sutcliffe and Tessa Jowell-left this area in very good shape.

It is clear to me that this Government intend to turn the clock back in their approach to the arts. It is disappointing that-I am sorry to say this to the noble Lord, Lord Hall-the arts institutions have already had a budget cut of 3 per cent this year, despite promises from the Government during the election campaign. It is particularly disappointing that the Arts Council was singled out for a bigger cut of 4 per cent this year. As the BBC's respected arts editor, Will Gompertz, has pointed out, this creates a precedent that could see arts institutions across the land being asked to realise assets such as bank savings and buildings to fund their activity in lieu of government grants. Responsible saving and budgeting are being punished and to date the Secretary of State has refused to rule out taking the same approach to other arts institutions, so watch out Royal Opera House. I ask the Minister when we will know about this.

While we welcome the Government's commitment to increase philanthropy, they have gone quiet on moves to encourage philanthropy through the tax system. I am depending on the noble Lord, Lord Inglewood, to chase them on this matter. The Secretary of State has said that he intends to write to the 200 biggest philanthropic donors thanking them for their contributions. I am sure that they will be grateful and perhaps even flattered by this attention, but I suggest that the message might be seen as a little hollow when the Secretary of State's first contribution to the nation's great arts heritage has been to cut funding.

On the Olympic Games, the brilliant custodianship of my right honourable friend Tessa Jowell has ensured that this month's report on progress says that the 2012 London Olympics are on time and on budget. The Government have inherited much in arts and culture; they have inherited something that was working and working well. They need to provide reassurance that the budget cuts that they have proposed will not have an impact on the London Olympic Games in 2012.

I now turn to health. The House would expect me to look at the manifestos of the partners in the coalition Government, the coalition agreement and the gracious Speech, as well as, of course, the words of the partners in the past, to see how the Government will attempt to reconcile some interesting and occasionally diametrically opposed points of view. Let us start with the name of the Department of Health. The Conservatives said:

"We will turn the Department of Health into a Department for Public Health".

It is a small and relatively unimportant promise to break immediately, but what does it presage?

Here are some of the Conservative promises that do not appear to have survived the coalition negotiations. The Conservatives promised to scrap all central NHS targets relating to clinical processes, but now they do not seem so sure. They promised to end "pointless" reorganisations of the NHS, but now they are about to embark on a massive new NHS reorganisation. They promised to reduce the number of unaccountable quangos, but they are turning the NHS into a new quango. They promised a voluntary insurance scheme to pay for residential care, but they have dropped that. They promised to protect the disability living allowance and the attendance allowance, but they have suddenly gone very quiet on that. I know that government involves compromises-it is a lesson that the Conservatives and the Liberal Democrats are perhaps only just beginning to learn-but who would have thought that one of the benefits of coalition government was that you never needed to look at your manifesto again?

It is important to put on the public record at the start of this Parliament that Labour has left the NHS in its strongest ever position. In 1997, the discussion was about whether the NHS would survive at all; today in 2010, the NHS is substantially rebuilt and renewed. I do not apologise for repeating the figures: waiting times are at an all time low; infection rates are right down; patient satisfaction with the NHS is at an all time high; there are 44,000 more doctors and 89,000 more nurses; waiting lists are down by over half a million; and 3 million more operations are done per year. Also, we have seen the biggest hospital-building programme in the history of the NHS, with 118 new hospital schemes completed. As George Osborne might say, we did fix the roof while the sun was shining.

That did not happen by chance. In the teeth of opposition-from some, if not all, of the Benches opposite but particularly from the new Secretary of State-we took the decisions that have left the NHS in this position. I put the Minister on notice that we shall be watching closely the Government's decisions and the effect that they have on the NHS. I urge the Minister's Liberal Democrat colleagues to do the same, because they supported many of our changes and they, too, will be held to account for what happens next.

Of course, where we support the work of the Government, the noble Earl can expect my support. He and I have a history of co-operation and friendship, which, for my part, I intend to continue.

I read the new Government's coalition agreement with great interest. I am astonished that the document seems to have been signed off by the now Secretary of State, who, in opposition, promised over and over again to,

"scrap all centrally-imposed targets relating to clinical processes".

Perhaps one of the Secretary of State's new officials told him that his plan to remove targets which have helped to deliver so many improvements for so many patients was "very bold, Minister"-but perhaps not.

Therefore, we await the detail, and of course we have no doubt that any detail will be presented to Parliament before it is published elsewhere. Reports have already suggested that the four-hour accident and emergency target and the 18-week referral to treatment target will be scrapped. I think that the Minister needs to come clean with this House. Are his Government going to change those standards? Are they going to keep the 18-week target? Are they going to back down or keep the two-week target for cancer and the four-hour accident and emergency target? Not only does this House need a direct answer; so, too, do millions of patients.

However, not everyone will be unhappy about the ditching of targets. The Financial Times has already reported, on 18 May, that:

"Private hospitals are expecting a rise in business if, as expected, the Conservatives go ahead with their promise to scrap Labour's waiting-time targets".

That choice of going private is one that many patients will remember. Before targets were in place, patients had a choice: wait in the NHS or pay and go private. It is something that we changed, and I am proud of that. I ask the Minister what mechanism the Government are going to use to ensure that waiting lists do not rise. With hospitals encouraged to make savings, what will the mechanism be to ensure that savings are not made by making people wait, as the party opposite has done in the past?

Can the Minister also tell us what will happen to NICE? What will happen to the investment that we proposed for cancer diagnosis? Just before our Government left office, we announced £200 million a year in funding for new diagnostic equipment for cancer. Can the noble Earl tell me whether that target will be met, or has this money been diverted into the Secretary of State's cancer drugs fund? Can he tell me which is most likely to save more lives: investing in early diagnosis or investing in cancer drugs unapproved by NICE? Can he also explain what relationship the new cancer drugs fund will have with NICE?

The Government have promised that the health budget will rise but they have also promised to make savings. Can the Minister say by how much the budget will rise? In opposition, the new Secretary of State managed to do two things. He complained that deprived areas did too well out of the NHS budget at the expense of areas with less deprivation but more older people, and he called for a change in the funding formula. At the same time, he called for more of the health budget to go to deprived areas in the form of a health premium. It was impressive, to say the least, to complain that deprived areas were overfunded and underfunded at the same time, but I wonder how that feat might roll out in government. If we take the Secretary of State's words at face value, which PCTs will gain and which will lose?

Another promise that seems to have been forgotten is the one made repeatedly by the Prime Minister, when he was Leader of the Opposition, that he would have "no more pointless reorganisations" in the NHS. It now seems that the Government are planning one of the biggest reorganisations in the history of the NHS, with not only a new independent NHS board but, according to the Health Service Journal, the abolition of strategic health authorities. I am not sure that the Secretary of State is adopting the right way to deliver a reduction of costs by encouraging members of strategic health authorities to resign in protest. On that basis, it could take some time. The new Prime Minister once asked the question: are serious political issues too important to be left to unaccountable quangos? He has given his answer. The job of allocating the NHS budget is too important to be left with his Health Secretary. My noble friend Lord Morris hit the nail on the head with his analysis on this matter.

I turn to social care. Noble Lords will not be surprised to learn that I was disappointed to see that the Government have decided not to take forward free personal care at home for those with the highest needs. I am sure that I am not as disappointed as the elderly and disabled people and their families and carers who stood to benefit from the legislation. I should like to join with Carers UK in asking the noble Earl what has happened to the £420 million of funding and what is it now being used for. What about the £130 million that was earmarked for reablement and what has happened to the commitment, supported across the House, for the delivery of portability of care packages to those most seriously disabled?

I was less disappointed that the Conservative proposal to create a new private insurance system to cover the costs of residential care has been dropped. It seems to have bitten the dust. That was a policy whose sums never added up.

The Government's new proposal of a commission on long-term care is certainly better than the old Conservative policy, and we will be happy to support that commission's work. I hope the Minister took note of the job application of my noble friend Lord Warner to serve on the commission, as he is definitely very well qualified to do so. I recommend the White Paper which we launched just before the election as a blueprint that that commission might consider.

At the end of this Queen's Speech debate, I wish to make some general remarks. I want to mention the economy because it is important to put such general remarks on the record. Our Government made the Bank of England independent and that was opposed by the Conservatives. We took tough decisions to get our national debt lower than that of France, Germany, America or Japan before this global financial crisis began. Our Government led the worldwide effort to stop global financial collapse into recession and into depression, in the face of bitter and wrong-headed opposition from the party opposite. Although the Government may now pray in aid the loyal support of the Governor of the Bank of England and the German finance ministry in advocating immediate and deflationary spending cuts to reduce the deficit faster this year, he and his Chancellor are out of step with worldwide opinion and run grave risks with our recovery, our jobs and our vital public services.

We shall be holding this new coalition to account, make no mistake about it. We shall take our responsibilities as a loyal Opposition seriously to probe, to question and to challenge and we shall use the tools at our disposal to do so. I disagree with the noble Lord, Lord Hill, when he said that he felt nothing much had changed since the last time he was in his position. Government in 2010 is not the same as the Government which the Conservative Party left in 1997. There are different terms of engagement these days. I have no fears for the noble Earl, Lord Howe, as a model of transparency and accountability, but he may need to have a quiet word with some of his fellow Ministers.

We have had four days of wonderful, illuminating and considered debate. In closing, I congratulate all noble Lords on their contributions today and on the other days of this debate, particularly the maiden speeches that we have heard from new Members of your Lordships' House and the speeches by the maidens at both Dispatch Boxes. Your Lordships' wisdom and eloquence bodes well for our future debates.

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health 7:14 pm, 3rd June 2010

My Lords, this has been a wide-ranging and most fascinating debate, marking, as it does, the conclusion of our deliberations on the gracious Speech. Having been given the privilege of responding, I can begin by expressing my appreciation for the congratulations extended to me and to my noble friend Lord Hill from around the House. I also thank all noble Lords who have spoken so well and so eloquently. Chief among those have been our four maiden speakers, who have provided us with truly splendid contributions. The first of those came from my noble friend, who referred in brief to the Government's programme for health.

In health, as in education, our desire is simple. It is to see standards driven up in response to those who are closest to the delivery of the service: the professionals and, in the health service, the patients whom they look after. Those are the people whom we wish to empower. In fulfilling that wish, we shall move away from centrally imposed targets which focus simply on process in favour of quality standards linked to results. Those quality standards will be defined by reference to clinical evidence. We will commission for quality care. We will pay for performance. We will put the patient at the centre of care by giving him information and choice, and we will encourage health and social care providers to be more efficient and effective at delivering quality and good value. I say to the noble Baroness, Lady Wall, that that does not mean that providers will no longer be held to account. Good regulation matters very much, but it has to be meaningful regulation.

That is a far-reaching programme. One of the key steps in setting the NHS free from central diktat will be the creation of the autonomous NHS board. I was grateful to the noble Lord, Lord Patel, for his remarks in that connection. The board will allocate resources; it will provide commissioning guidance; and it will support GPs to commission services on behalf of their patients.

For the first time, the NHS will be led not by politicians but by clinicians, who will be fully accountable for what they do. Despite the huge investment in the NHS in recent years and the improvements that we have seen-which I am the first to acknowledge-the fact is that costs have risen, productivity has fallen, bureaucracy has increased and outcomes have simply not kept pace. In many of the common cancers, our survival rates are the worst in the OECD. We are on the wrong side of the average in western Europe for infant mortality and for premature mortality from lung cancer and heart and respiratory disease. People are more than twice as likely to die from a heart attack in the UK than in France.

We want our health outcomes to be among the best in Europe-indeed, among the best in the world. To achieve that, we have to set doctors, nurses and midwives free to do their job. It is a sobering statistic that the system now demands in the order of 250,000 separate data returns from trusts every year. We have to reduce that burden dramatically and trust the professionals on the ground to judge what is right for their patients.

If we are to match the best health outcomes in the world, we will have to improve our public health services alongside the NHS. That theme was pursued by the noble Baronesses, Lady Greengross and Lady Masham, my noble friend Lord Fowler, the noble Lords, Lord Kakkar and Lord Patel, and others. We will have to invest in prevention-to keep people healthy and prevent them getting ill in the first place. To do that, we shall give local communities greater control over public health budgets, with payments linked to the outcomes that they achieve. We will work more closely with local NHS organisations, local authorities and the voluntary and private sectors, and we will take more targeted action to reduce health inequalities.

That is where our health premium comes in. Like the pupil premium, it will directly tackle disadvantage and reduce inequalities, and it will make for a much fairer approach to public health. In the coming weeks, we will be publishing a White Paper which establishes our long-term strategy for reform of the NHS and we plan to introduce a health Bill in the autumn.

The right reverend Prelate the Bishop of Chichester spoke about the NHS workforce and asked who was included in that term. He was right to give me a prod on that. We will give all NHS doctors, nurses, allied health professions and other health professions back their professional autonomy. They need to be able to use their professional judgment about what is right for patients. He asked me specifically about chaplains. We very much value the work done by NHS chaplains, who play an important part in providing high-quality spiritual care services to patients and staff, and we are committed to ensuring that patients and staff in the NHS have access to the spiritual care that they want, whatever faith they may have.

The noble Baroness, Lady Greengross, asked about Monitor, which was also raised by the noble Baroness, Lady Murphy, who also asked me about the NHS board. In short, by creating an independent NHS board, we will make sure that funding decisions are made on the basis of need, that commissioning decisions are made according to evidence-based quality standards and that resources are allocated appropriately. We propose to develop the role of Monitor to establish an economic regulator with responsibility for ensuring that patients have access to essential services and that the money invested in the NHS achieves maximum value. The noble Lord, Lord Warner, was right in all that he said on that issue.

My noble friend Lord Colwyn, as he customarily does, spoke about his own subject: dentistry. We will introduce a new dentistry contract that will focus on achieving good health and increasing access to NHS dentistry. At this stage, we need to review the details of the system that we have inherited. Once we have done that and have talked to the profession and patient groups, we will announce the details of the reforms that we are proposing.

The noble Lord, Lord Mitchell, spoke about foetal alcohol syndrome, a subject about which he and I have spoken many times in the past. We want to improve labelling so that people are more aware of the amount of alcohol in drinks as well as of guideline limits. We want to see the necessary improvement in labelling information through a voluntary approach if we can, but we will consider all responses from the consultation that closed very recently-I think on 31 May-before we make any decisions on that matter.

The noble Lord, Lord Sutherland, chided the Government for setting up a royal commission on long-term care. He rightly pointed out that we have had many papers on this subject, not least the royal commission that he chaired in such a distinguished way. I simply say to him that this is an urgent matter. We are not pressing the reset button, as it were, on reform of long-term care. It is a hugely challenging issue, and the independent commission will consider the evidence and information gathered through the public debate over the past few years. We know that we must reform social care on a sustainable and long-term basis. A number of options have been put forward for funding a reformed system, so we just have to build on all this work and keep up the momentum of change. I welcomed what the noble Lord, Lord Warner, said on that subject.

The noble Baroness, Lady Masham, asked about the patient voice. We are going to give the public a strong and independent voice though Health Watch, which will be a statutory body with the power to investigate and support complaints. I hope that this will be music to the ears of my noble friend Lady Knight. Locally, we will strengthen the patient voice by having directly elected members of the public on the boards of PCTs. That will ensure that boards are balanced between locally accountable individuals and technical expertise. We will publish detailed data about the performance of healthcare providers online so that everybody will know who is providing a good service and who is falling behind. We will measure our success on the health results that really matter, such as improving cancer and stroke survival rates and reducing hospital infections.

The noble Lord, Lord Patel, asked me about preventive health measures, including those relating to alcohol, tobacco and nutrition. Lifestyle-linked health problems like those and the spread of infectious diseases are leading to soaring costs for the NHS. We will provide separate public health funding to local communities that will be accountable for and paid according to how successful they are in improving their residents' health.

The noble Baroness, Lady Thornton, asked me about targets. The service priorities for the NHS have to be based on evidence about their benefits for patients; that is, they should be focused on the outcomes that they achieve, rather than on chasing nationally mandated targets with incomplete clinical justification. We are going to remove the politically motivated process targets. I am looking at the list that we have inherited from the previous Government with a view to ensuring that any targets that work against better patient care are removed at an early opportunity.

The noble Baroness asked me about creating a department of public health. The coalition agreement is not the entire sum of our policy, and we will announce further information in due course. As I have indicated already, we are committed to taking action on public health and encouraging behaviour to change, to help people to live healthier lives.

The noble Baroness, Lady Murphy, asked about foundation trusts. I apologise for being so brief, but can say that we are considering a number of options for all NHS providers to become foundation trusts, taking into account many of the issues that she rightly raised. We want to resolve issues of efficiency, issues of clinical sustainability and an explicit assessment of quality, as those are affecting the flow of trusts becoming foundation trusts, as she well knows. This is not easy, but we are determined to make progress.

The noble Lord, Lord Rea, criticised the purchaser/provider split, particularly in relation to the costs of running a commissioning system. I should say to him simply that before we created the division between purchasers and providers, we did not have an accurate idea of how much anything cost in the NHS. That was a very basic lacuna in budgetary control and service planning, so the split has been a helpful feature of our health system at a time when value for money is more important than ever.

The noble Lord also asked about the workability of patients being able to choose their own GP. We believe that patients should be able to choose their own GP practice and not have an arbitrary set of rules that dictate where they can register. If people want to be able to register near their work or near their home, or with a practice that offers better service, they should be able to do so. We know, incidentally, that these problems persist mainly in our most deprived communities, where patients have historically had less choice, yet these are the areas with the greatest health needs.

My noble friend Lord Addington asked about getting the population involved in sport-a subject on which he is a renowned expert. As part of delivering a health legacy for the 2012 Olympics, the legacy action plan aims to make 2 million more adults in England active by 2012-13 and will be measured by the number of adults aged 16 and over who participate in sport or undertake some form of physical activity.

My noble friend Lord Bridgeman spoke about hospices, which play a very valuable role in end-of-life care, particularly for cancer patients. The coalition's programme for government included a commitment to introduce a new per-patient funding system for all hospices and providers of palliative care. I am sure he knows that the responsibility for setting standards in palliative care training for nurses sits with the professional regulators, but I shall ensure that his remarks are brought to the attention of the Nursing and Midwifery Council.

My noble friend Lord Fowler spoke about the prevention of HIV and hepatitis B and C. These are priorities for us. The Joint Committee on Vaccination and Immunisation considered the hep B vaccination last year and concluded that a universal programme would not be cost effective in the UK, but I note all that he said.

In view of the number of speakers in this debate, I hope that the House will allow me to take a little longer than I might otherwise take. We have had a curtailed debate on the gracious Speech, and I think that those who have spoken would like to hear what I have to say, although I will inevitably have to be brief.

The noble Baroness, Lady Morgan, made a powerful speech focusing in the main on education funding. She was especially worried about damage to front-line education because of spending cuts. There will have to be savings, but we plan that the savings will be made from reducing waste and cutting the cost of quangos. We have announced that schools, Sure Start and spending on 16 to 19 year-olds will be protected from any in-year spending cuts. Any efficiencies made within schools, Sure Start and 16 to 19 year-olds' education will be recycled within their respective budgets.

We are not back-tracking on one-to-one tuition. Front-line funding for one-to-one tuition is protected. The first quarter payment for one-to-one tuition for schools has been made this week in line with Standards Fund allocations. That funding will allow schools to provide up to 600,000 tuition places in primary and secondary schools. Although it was part of an overall budget identified for tuition by the previous Administration, it is not part of funding for the front line.

The noble Baroness also asked from where the money would come for new schools and academies. Decisions about the level of funding available to set up and run new schools will be dependent on the outcome of the spending review in the autumn. I cannot be of greater help on that at the moment. I do not agree with the noble Baroness that our policy will entrench unfairness or create a two-tier education policy, as she indicated. That concern was raised in various ways by the noble Lord, Lord Rix, and the noble Baroness, Lady Howe. We are committed to helping all children achieve their potential, which is why we will introduce a pupil premium and will ensure that extra money follows disadvantaged pupils. This will make sure that it is more attractive to establish new schools in areas of disadvantage and that schools with significant deprivations get more money even in less deprived parts of the country. Schools that recruit and retain disadvantaged children will know that they will receive additional funding to help them meet their needs. It will be for head teachers to decide how best to meet those needs, but they might, for example, use the money to attract the best teachers, to reduce class sizes or to provide extra tuition.

The noble Baroness, Lady Howe, asked about the calibre of teachers. The single most important determinant of a good education is for every child to have access to a good teacher. Our aim is to improve the quality of the teaching profession. As an example, I would cite the Teach First initiative. We also want to create Teach Now to build on the Graduate Teacher Programme and to look for other ways to improve the teaching profession, particularly in terms of attracting more science and maths graduates to be teachers.

The noble Baroness, Lady Morris of Yardley, in her thoughtful speech indicated that in her view there was no evidence that structural change led to successful reform or better results. We can see the evidence from academies which have shown a 5 percentage point increase in the proportion of pupils achieving at least five GCSEs at A* to C grades, which is double the average national increase of 2.5 percentage points. As regards non-academies, I have no hesitation in paying tribute to those that are outstanding, and I do not believe that any of my ministerial colleagues would either. The recent announcement allows all schools the opportunity to benefit from the additional freedoms and flexibilities of academy status, with those rated outstanding being fast-tracked through the process.

The noble Baroness made the very good point that teaching and leadership are the most important things. I agree with her on that. A key principle behind the partnership of the coalition Government is trusting professionals, which is why the Government will give them more power and control and will trust them to get on with the job. Many school leaders have already shown a keen interest in gaining academy freedoms.

The noble Baroness, Lady Sharp of Guildford, spoke about reducing bureaucracy in schools. We are committed to freeing all schools from unnecessary bureaucracy so that they can focus on their core purpose of raising standards for all children. We will shortly outline a package of proposals for how we intend to reduce bureaucratic restrictions placed on schools.

The right reverend Prelate the Bishop of Lincoln asked about free schools and how they would drive up standards for everyone. Free schools will be established to meet parental demand. They will be open to meet that demand wherever it exists. The introduction of free schools will make sure that parents get what they want in these schools and will act as a spur to improvement in other schools. I have already mentioned the pupil premium in this context.

My noble friend Lord Baker spoke compellingly about university technical colleges, a subject also referred to by the noble Baroness, Lady Sharp. Technical academies are likely to build on the university technical colleges model which we have been developing with my noble friend and the Baker Dearing Educational Trust. We are working on three pilot projects in Birmingham, Walsall and Greenwich. Those are progressing well, but they are unlikely to open before 2011.

The noble Lord, Lord Griffiths of Burry Port, spoke about school governance and particularly the role of school governors. I would say to him that, from family experience, I recognise all too well how hard school governors work. They give their time and energy to serving on governing bodies. It is true that their duties can be demanding, but a well-organised governing body can spread its workload, as I am sure he knows, by setting up sub-committees. He asked me to comment specifically on the future of Building Schools for the Future commitments, especially in relation to the Central Foundation Girls' School in Tower Hamlets. The Department of Education has not yet taken any decisions on Building Schools for the Future, and they will be announced in due course.

The right reverend Prelate the Bishop of Bath and Wells asked about the composition of boards of governors in academies. Our current model articles of association say that academies must have one local authority governor and at least one parent governor, but Ministers have not yet made a decision about the composition of future academy governing bodies. The noble Baroness, Lady Howarth, spoke about children's services, which she does so well. The Government recognise the challenges that local authorities face in delivering really effective children's services. When Ministers have evidence that a council is not discharging its accountabilities to an acceptable standard, the Government will want firm assurances that the local authority involved has the determination and the capacity to turn its performance around. We do not want to interfere unnecessarily in local authorities' improvement processes, but in the most severe cases where councils fail to improve, we will not hesitate to consider using our statutory intervention powers.

The noble Baroness, Lady O'Neill, said that there was too much assessment and testing. We are committed to external assessment and will review how the KS2 tests operate in the future. Schools, as she well knows, do not have to narrow the curriculum to achieve good test results, although I was very interested in all she had to say on that theme. The noble Baroness, Lady Massey of Darwen, asked about physical and personal education. These are important areas and the evidence available to us from Ofsted and the conclusion of the Macdonald review is that the quality of PSHE teaching is highly variable. The current policy is that all young people should receive a comprehensive programme of sex and relationship education to give them the knowledge and skills to make safe and responsible choices. High quality PSHE is a core theme of the Healthy Schools programme.

The noble Baroness, Lady Walmsley, talked about Sure Start and health visitors. The coalition agreement commits the Government to refocus funding from Sure Start peripatetic outreach services and from the Department of Health budget to pay for 4,200 extra Sure Start health visitors. We believe that our new approach to early years services and the profile of the Sure Start health visitor role will prove very attractive. The noble Baroness also spoke about child poverty, as did the right reverend Prelate the Bishop of Bath and Wells. We are very focused on this issue. The position we have inherited means that we are not on track to meet the 2020 target, and we will need to consider carefully what action is needed to make real progress in this area. The right reverend Prelate also asked about the commitment to end child detention, and I refer him to the Question on the subject answered by my noble friend Lady Neville-Jones this week.

The noble Lord, Lord Hall of Birkenhead, asked about funding for the arts, and he is right that more than half of this funding comes from public sources. The vast majority of government funding for the arts is of course via Arts Council England. The rest comes from private sources, including the earned income of people who attend events and venues. But as a general point, putting the economy back on its feet and restoring the nation's finances are in the interests of all our sectors, and that is the prime task of this Government.

The right reverend Prelate the Bishop of Guildford, in his excellent speech, addressed the issue of the churches needing repair. The Listed Places of Worship Grant Scheme, which makes grants equivalent to the VAT incurred, is expected to make grants of around £15 million in 2010-11. However, a decision on the scheme's future beyond the end of this year is pending. As he will know, though, other funding is available from various sources-the Repair Grants for Places of Worship Scheme, the Heritage Lottery Fund and the Churches Conservation Trust.

The noble Baroness, Lady Andrews, spoke very powerfully about heritage protection. I pay tribute to the work of English Heritage in protecting the historic environment and to her as its chair. We are currently considering options for legislating in this area. In doing so we are mindful that extensive consultation on reform of the heritage protection system has taken place over the past decade and that a programme of non-statutory reforms is now nearing completion.

My noble friend Lord Colwyn spoke about live music. There seems to be evidence that the Licensing Act 2003 has not created the growth in live music that was hoped for, and we cannot ignore public opinion out there, especially among musicians. We believe that there was much to commend in the Bill of the noble Lord, Lord Clement-Jones, but we want to consider the options carefully before deciding how best to support live music.

The noble Lord, Lord Elis-Thomas, asked about broadband. The UK has made a start on the deployment of superfast broadband but we want to go further. Steps are now in train to reduce the cost, and that could make a significant contribution to availability and open the market to new players. As regards S4C, there will be a reduction in its budget from DCMS for the current year of £2 million. S4C has said that it will endeavour to ensure that this reduction will not directly affect services to viewers.

The noble Lord, Lord Rea-I apologise, I am a little out of order-asked me about NICE and I forgot to address his question. I assure him that we believe that NICE has an important long-term role in assessing the clinical efficacy and cost-effectiveness of new treatments and safeguarding taxpayers' money.

Moving very briefly to work and pensions, the noble Lord, Lord McKenzie of Luton, asked whether the Government would continue his party's reforms to the operation of the work capability assessment. The Government take seriously the importance of correctly assessing fluctuating conditions and ensuring the accuracy of the WCA. We are currently considering the department-led review of the WCA and its recommendations. Do we plan to continue the timescale for reassessing those people on incapacity benefit set out by the previous Government? We will be testing and learning from the small-scale trial which will run from October 2010; full migration will not begin until April next year and is expected to take place over a three-year period.

The future jobs fund has not been abolished. We will continue to fund the bids already approved, which will mean that more than 100,000 people are likely to get jobs, but we will not accept any new bids for funding and we will tighten up the way in which contracts are managed.

My noble friend Lord Elton asked me whether I would talk to him about identity fraud. I shall be very happy to do that.

The noble Baroness, Lady Hollis, in an extremely powerful and compelling speech, spoke about pensions and savings. There are obvious attractions to introducing a single pension which wraps up the existing three elements of the state pension system, as she suggested. However, I think she will agree that significant issues would need to be addressed before such a system could be introduced, including costs and transitional issues such as what happens when a person has been contracted out of the state system. However, as the noble Baroness acknowledged, the Government have already brought forward the restoration of the earnings link to April next year. If I may write to her about the other points she made, that would probably be appropriate in the circumstances.

The noble Lord, Lord Rix, spoke powerfully about employment support for disabled people. I agreed with so much of what he said. The single work programme will offer targeted, personalised help for those who need it most. We want to give people who have been so-called "written off" the opportunity to work and contribute, and the reforms will aim to promote employment and tackle poverty.

It has been impossible in the available time to answer every question posed. I hope that noble Lords will forgive me for that, but I undertake to write to those noble Lords whose questions remain unanswered.

Our programme for health, as for education and welfare, has at its heart the concepts of trust, fairness and empowerment of the citizen. The role of government is to create the conditions which will make those concepts a reality. As we debate these important matters over the weeks and months ahead, my ministerial colleagues and I look forward to garnering the wisdom of this House in exactly the way that has proved so valuable to countless Governments who have preceded us.

Meanwhile, I am able with pleasure and a good deal of pride to commend the gracious Speech to your Lordships.

Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.

House adjourned at 7.46 pm.