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The Secretary of State for Social Security (Mr. Peter Lilley): I am grateful to the hon. Gentleman for giving way and for his remarks. I can go farther; we are ahead of the Select Committee. We have informed the Select Committee that we are consulting local authorities on the possibility of a national computer system to overcome the problems that he talks about and provide a coherent national service to all local authorities, and a national validation process to ensure that all local authorities use uniform minimum standards.
Mr. Field: The rhetoric is fine, but we should examine the Department's ability to get its computer system right, never mind the computer systems of the Child Support Agency and other agencies. When the Government say that they are going to establish a national computer system, I hope that we shall not hear hollow laughs in the rest of the country. Let us be modest and begin by producing a standard application form that can be used by existing computer systems throughout the country in our fight against fraud.
No one doubts that the Secretary of State is keen to counter fraud, but that requires co-ordination between Departments and not just at local authority level. If we read the paper on child benefit fraud that was submitted to the Select Committee and then read the Home Office's letter to the Committee, we can see that, never mind about introducing a national computer system, it would be good if the Secretary of State for Social Security occasionally spoke to the Home Office on this key matter. The paper on child benefit fraud says that either a passport or the standard acknowledgement letter for child benefit can be used to identify an individual for child benefit purposes. The Home Office told the Select Committee that on no account should the standard acknowledgement letter be used as an identification document.
The Home Office issued a statement saying that on no account should there be identity documents, whereas the Secretary of State for Social Security told the Select Committee that, when there is a doubt about the children of asylum seekers, child benefit will be paid on production of either a passport or the standard acknowledgement letter. Before we embark on the grand strategy of sweeping the country with a new computer system, will the Secretary of State occasionally talk to the Home Office about preventing benefit fraud?
Even if we had a wonderful computer system, it would be of little value if we continued to have a national insurance system--a number system--that was clearly overrun in the 1980s. I referred to the standard acknowledgement letter--the Secretary of State may mumble, but this is the crucial point--because during the 1980s hordes of people went to Croydon to pick up that letter, which was accepted by the Secretary of State's Department, to show that they were genuine asylum seekers. They were issued with national insurance numbers, which accounts for the discrepancy in the number of national insurance numbers. Until we clean up the national insurance system, all the fine talk about the fight against fraud will, sadly, be just that, and the measures taken will be less effective than they should be. I hope that the Opposition will massively strengthen the Bill to fight fraud.
I want to return to the most important theme of this debate, which was raised by the right hon. Member for Brent, North--the impact of the massive social security budget on not only the operation of government but the character of the nation. I hope that we have now gone through the long, dark tunnel. Many of us worry about whether there should be advertisements that promote smoking, because we believe that that affects people's behaviour, yet at the same time we believe that a Government can spend £95,000 million on social security and it will have no effect on people's behaviour. It certainly will.
When the Secretary of State replies to the debate, I hope that he will show--at least on these criteria, and perhaps on many others--whether the Government can present a proper face to the electorate. Spending on social security constitutes the largest part of the Government's budget, so the first thing we want to know from the Queen's Speech is whether we are spending that money in a way that supports people's natural, decent instincts. If there were no welfare state, how would people behave? How would they survive? We should mould our welfare state so as to encourage decent instincts, rather than, as at present, use so much of our money to destroy those instincts.
Secondly, we want to know whether, for the first time, the Secretary of State has got a grip of his budget. Every year that he has been in office, he has pleaded with his Cabinet colleagues, saying that he needs more money. His Cabinet colleagues regard him as a tough right winger, so he must find it easier to deal with them than some others. He has always obtained more money--usually about £3,000 million extra. He has presumably promised that he will be a good boy and will control his budget, but he is usually over budget by another £3 billion. He then goes back to them the following year, and so the process goes on.
The Secretary of State says that this year, for the first time, the rise in the social security budget will be below the increase in gross domestic product. He might manage that this year thanks to the Chancellor, who has his mind on when the election may be held. The growth rate in GDP this year is about 4 per cent., so if the Secretary of State does not keep social security expenditure growth below that level, matters are very serious indeed.
Sir Roger Sims (Chislehurst):
The House always enjoys listening to the hon. Member for Birkenhead (Mr. Field). He invariably presents us with thought-provoking arguments, which he expresses with clarity, and today was no exception. This is a broad debate, so I am sure that the hon. Gentleman and the House will understand if I do not deal with the topics that he covered.
I was particularly impressed by the penultimate passage of the Gracious Speech, which states:
The other difficulty is that organisations and individuals affected by that legislation may find it difficult to have an input into the contents of the Bill. Once the Bill is published, the only way in which they can have any influence is by finding an hon. Member who is on the Committee and who can be persuaded to take an interest in their concerns. That is a somewhat limiting factor, to put it no higher. Many of us have a range of interests outside the House and seek to represent those interests during the legislative process, but some organisations, companies and charities have no such voice. Now, thanks to Nolan, even if a commercial organisation or similar body comes to an arrangement with a Member to look after its interests and ensure that its voice is heard, if any money changes hands, the Member is debarred from
speaking in the House or in Committee. That, I think, is unfortunate, but I have made clear my views on Nolan before. It is a serious limitation on the ability of Parliament to reflect the views of those whom it is supposed to represent.
It was a step in the right direction to introduce the concept of Special Standing Committees, under which--albeit to a limited extent--people with a particular interest in the Bill under consideration could appear before the Committee and express their views. I sat on one or two of those early Committees and thought that they were very successful for certain types of Bill.
The idea of a draft Bill that would go out to consultation seems a considerable improvement on those Committees. If, as the Prime Minister implied, draft Bills are to be published in each parliamentary Session for consideration in the subsequent Session, there will be ample opportunity for all those likely to be affected by the legislation to put their points of view, whether on policy or on technicalities.
We all know how, so often, we in Parliament pass a clause that becomes part of the law of the land, then a problem arises, the matter eventually goes to court and the judge says, "When Parliament decided so and so, it obviously meant such and such." The fact is that on the Tuesday morning when the Committee passed the clause, no one visualised the particular combination of circumstances that produced the case that went to court. The more people who can go through a draft Bill and put forward their views before it is presented to Parliament, the better the chance that the Bill will achieve what is intended and will be understood by those responsible for implementing it and by the courts. I therefore welcome the idea of draft Bills.
One of the draft Bills that we are to consider will be
In my view, insurance has a part to play, especially--as the hon. Member for Islington, South and Finsbury (Mr. Smith) implied--for those who are relatively comfortably off, are approaching retirement and can pay a lump sum to insure against the costs that they might incur in a nursing or residential home. The main purpose of that insurance, as I see it, would be to safeguard people's assets for their own benefit and that of their children. In any case, insurance will be of value only to the relatively small section of our community that has that sort of money available.
We must face up to the fact that not only are people living longer but, happily, more of them have assets in their old age which previous generations did not possess--assets on which they are expected to draw if the need arises. We have a twofold task. First, we have to educate people that the state cannot meet in full the cost of those whose age makes them frailer and in need of what is described as social care--indeed, it has never done
so. Secondly, we have to deal with the problem that many people feel that it is unjust that they are expected to pay for care in a nursing or residential home which would previously have been given in a hospital, under the national health service, at no cost to themselves.
People do not feel that that is fair, which is understandable. There are people whose state of health is such that they need some care, although it is not reasonable for them to occupy a hospital bed needed by others. I am attracted, therefore, by the proposition put forward by the Royal College of Nursing that nursing care should be free wherever it is given, be it in a hospital, nursing or residential home, whereas the cost of social care should be met from the pockets of those with the means or by the local authority for those whose income or assets are small.
I look forward to seeing the draft Bill and hope that it will lead to widespread consultation and debate, not simply on insurance, but on the wider issues. I hope that that will be another issue on which we can reach consensus.
I welcome the sentence in the Gracious Speech referring to the introduction of legislation to help and
We should recognise the desirability of medical services being easily available to all. People who may be considering whether they should consult their general practitioner might think twice about having to make an appointment and a special trip to see the doctor, particularly if he is not conveniently situated, and may well be inclined to put it off until the next day. If they can have such a consultation while they are out shopping, they will be more inclined to do so.
Yesterday, I visited the private, walk-in surgery set up in Victoria station a couple of months ago. Already, 25 people a day walk in for medical advice and treatment. They are able and willing to pay for that treatment, and the surgery is conveniently placed for them. If those people are willing to do that and to pay for it, might there be a greater demand for similarly situated NHS surgeries? It is, of course, important that patients should be registered with their own GP and that, if they do pop into Victoria station or anywhere else, there is proper liaison between that doctor and the patients' usual GPs.
Primary care depends on an adequate number of well-trained doctors now and in the future, so we have to ensure that we are training good doctors. I am sure that my right hon. Friend the Secretary of State and my hon.
Friend the Under-Secretary, who is in his place, will be aware of the present impasse in making pay awards to clinical academic staff, which has led to a serious shortage of lecturers and professors at medical schools. If we are to have continuous quality training of doctors, it is essential that we continue to have professors and lecturers of a high calibre. I urge my right hon. Friend to resolve the issue of academic pay for medical staff without further delay.
If primary care is to be developed, the role of district nurses, health visitors and practice nurses is bound to have to increase. Four years ago, Parliament approved a private Member's Bill, which I promoted and which had Government support, to allow appropriately trained nurses to prescribe a limited range of drugs and dressings. The measure was, needless to say, embraced enthusiastically by the Royal College of Nursing and nurses generally, although they recognised, as I do, the need for careful trials and evaluation before such a scheme could be introduced nationwide.
In a letter to me on 1 August, my hon. Friend the Minister for Health told me that the evaluation of the eight pilot sites would be published this autumn and that the evaluation of a district community trust pilot was to be reported in late 1997. I raised the point again last week with my right hon. Friend the Secretary of State when he made his statement on the White Paper, and I have to say that his response was rather vague and general. That does not suggest that the Government are pursuing the matter with the enthusiasm and vigour needed if nurses are to play their full part in developing primary care. I strongly urge my right hon. and hon. Friends to pursue the matter with far more energy than they have shown hitherto.
A measure that was not in the Gracious Speech, but which has rapidly popped back into the programme, is the register of paedophiles. I am glad to see that restored as it reflects one of the recommendations of the National Commission of Inquiry into the Prevention of Child Abuse, whose report was published this week. I sat on that commission, which was chaired by Lord Williams of Mostyn. We did two years' work on it, and that work, and the compilation of the report, was far more extensive than anything that I have done as a member of several Select Committees.
The thinking behind our inquiry was the pattern of events after instances of child abuse: so often an inquiry has been set up, a report issued, recommendations made, some implemented and some not and then little more seems to happen until the next incident of child abuse. We started with the question of what can we do to prevent child abuse as a community, as a Government and as local authorities. We can never prevent child abuse completely, but we must be able to take steps to prevent it. Our report is a substantial volume, and a similar volume will be printed containing some of the paperwork and submissions made to us. We made some 85 recommendations and I hope that at some point an opportunity will be found for the House to debate the report, when hon. Members have had time to digest it adequately.
However, I wish to make a few brief comments, if only to correct some of the misunderstandings and misinterpretations that have been put on the report, perhaps inevitably, given its size and attempts by certain people to reduce its details to a paragraph or two or even a headline. We have been criticised for our definition of
abuse and for the statistics that we produced. We devote a whole chapter in the report to seeking an appropriate definition of child abuse and another, even longer chapter to trying to assess its extent. We are not saying definitely that 1 million children are seriously abused every year, but we are saying that that number are harmed, whether by isolated incidents or by systematic and long-term maltreatment.
The truth is, of course, that we do not really know the extent of child abuse. Much of it is concealed. In a fascinating exercise as part of our work, one of our number, Deirdre Sanders, who will be known to some hon. Members as the so-called agony aunt of The Sun and who also speaks on television, put references in her column, as did several of her agony aunt colleagues, to the work of the commission. They invited readers to write in if they had had experience of child abuse. More than 11,000 adults wrote to tell us about their experience of child abuse, many of them writing for the first time about their experiences. We derived some valuable material from what they said about what had happened, the circumstances, why they did nothing about it and what they thought could be done to prevent abuse. Their responses make my point that abuse happens and we know nothing about it.
In trying to make an assessment of the extent of abuse, we drew on a range of official statistics and also on a number of surveys to try to provide an estimate. Indeed, one of our recommendations is that the collection of appropriate data should be carried out so that we know the extent of the problem.
Another of our recommendations is that the Secretary of State for Health should have his title expanded to Secretary of State for Health and Children, and we suggest also that the junior Minister who at present has responsibility for children should be upgraded to a Minister of State and given the specific title of Minister for Children. I was sorry to learn that my hon. Friend the Under-Secretary who at present has that responsibility seemed to dismiss the proposal out of hand. It is a little surprising that, having been offered such promotion, he should reject it in such a manner, but I wish to emphasise that that recommendation is not simply a gimmick or cosmetic, or an attempt to catch a headline.
The members of the commission believe that children's needs should be given a higher profile. Changing the titles of the Secretary of State and the Under-Secretary would spearhead a public awareness campaign on children's needs. An opportunity would be provided to enhance co-ordination between Government Departments and departments at local level. There are now eight Government Departments that have some involvement in children's welfare. It would be the specific responsibility of the Minister for Children to head up a committee that would not merely co-ordinate activities, but ensure that any activity of any Department that impinged upon children was carefully examined to ascertain its effect.
"My Government will also publish Bills in draft for consultation".
The concept of draft Bills was explained by the Prime Minister in his speech on Wednesday. It is not an entirely new idea--reference has already been made to the draft Bill on adoption--but it is not a familiar device. After 22 years in the House as part of the legislative machine, I am not satisfied that the process that we use is without imperfection. It is unfortunate that a Government of whatever colour introduce a Bill determined that it will go through the House and emerge in almost the same state as when it was introduced. It is a principle of the Whips that they discourage their hon. Members from altering a Bill. The assumption is that Ministers and their civil servants have produced a perfect Bill that is incapable of improvement, but I do not think that that is helpful.
"on measures to help people make better provision for their long term care needs in old age."
I am not sure, Madam Deputy Speaker, whether under Nolan I should declare an interest, as in a few months I shall be a retired pensioner in my late 60s. The long-term care of the elderly is clearly a matter of concern to us all. The House will be aware that the Select Committee on Health has been carrying out a detailed inquiry and published a first report about a year ago and a second report in July, which dealt with the issue of meeting the costs. We anxiously await the Government's response.
"develop primary health care services."
My right hon. Friend the Secretary of State for Health made a statement last week and issued a White Paper on the subject, the theme of which is to encourage
"local flexibility so that services can be delivered in a way which is better attuned to local needs and circumstances".
This morning, he explained his thinking on that. Increasingly, general practitioners are able to and want to offer a wider range of treatments in their surgeries, which obviously benefits the patient, who does not have to go to hospital. As we have heard, there has been speculation that that will lead to GPs setting up surgeries in supermarkets. My right hon. Friend commented that it would be by no means impossible for there to be a doctor's surgery in a pharmacy.
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